ICD-10 W16.531
Non-Billable HeaderJumping or diving into swimming pool striking wall causing drowning and submersion
About ICD-10-CM W16.531
ICD-10-CM code W16.531 represents Jumping or diving into swimming pool striking wall causing drowning and submersion. This is a non-billable header code in the External Causes of Morbidity chapter (block W16). The 2026 edition of ICD-10-CM W16.531 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with W16.531. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- drowning and submersion while in swimming pool without jumping or diving (W67)
Medicare LCD Coverage for W16.531
Local Coverage Determinations (LCDs) from CMS MACs that list W16.531 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing W16.531.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but W16.531 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with W16.531
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To W16.531
Other codes in section W00-W19 (Slipping, tripping, stumbling and falls).
ICD-10 W16.531, Billing FAQ
Is ICD-10 code W16.531 billable? +
No, W16.531 is a non-billable header code. Use a more specific child code from block W16 when submitting claims.
What codes are Type 1 Excludes for W16.531? +
Type 1 Excludes (never code together with W16.531): drowning and submersion while in swimming pool without jumping or diving (W67)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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