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2025 ICD-10-CM code W16

Fall, jump or diving into water.

The code W16 should be used as a secondary code to another code from Chapters I to XVIII indicating the nature of the condition. The most commonly used chapter is Chapter 19, Injury, poisoning and certain other consequences of external causes (S00-T88). If a code from Chapter 20 is applicable, it should be used to provide additional information about the cause of the condition.

This code can be further specified with the use of the 7th character to indicate the encounter type (initial encounter, subsequent encounter, or sequela).

Medical necessity is established by the need for treatment of the injuries or conditions resulting from the fall, jump, or dive. The documentation should support the need for the specific services provided.

The clinical responsibility for this code lies in accurately documenting the circumstances of the fall, jump, or dive into the water. This includes the type of water (e.g., swimming pool, natural body of water), the height of the fall (if applicable), and the impact point (e.g., water surface, bottom). Any resulting injuries or conditions should also be documented with appropriate ICD-10-CM codes.

In simple words: This code describes an incident where someone falls, jumps, or dives into water, resulting in an injury or other adverse effect.It does not include drowning or submersion unless it is a direct result of the fall. It also excludes incidents involving watercraft, diving-related air pressure effects, or hitting a diving board.

Fall, jump or diving into water. Excludes1: accidental non-watercraft drowning and submersion not involving fall (W65-W74), effects of air pressure from diving (W94.-), fall into water from watercraft (V90-V94), hitting an object or against bottom when falling from watercraft (V94.0). Excludes2: striking or hitting diving board (W21.4)

Example 1: A patient falls into a swimming pool and hits their head on the edge, resulting in a concussion., A patient jumps into a lake from a high cliff and fractures their leg upon impact with the water., A patient dives into a shallow pool and sustains a spinal cord injury.

The documentation should clearly specify the event as a fall, jump, or dive into water. The type of water body (e.g., swimming pool, lake, ocean) should be noted, as should the height from which the individual fell or jumped, if applicable. Any objects struck during the incident (e.g., diving board, bottom of the pool) should also be documented. Details of the resulting injuries or conditions should be thoroughly recorded, including diagnostic findings, treatments administered, and prognosis.

** It is crucial to differentiate W16 from codes related to drowning and submersion (W65-W74) or other water-related incidents involving watercraft (V90-V94).Accurate coding depends on clear documentation of the event and the resulting injuries.

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