2025 ICD-10-CM code W13.0
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A External causes of morbidity - Falls Chapter 20: External causes of morbidity and mortality Feed
Fall from, out of, or through a balcony or railing.
Modifiers may be applicable depending on the circumstances of the fall and the services rendered.Consult official coding guidelines for appropriate modifier usage.
Medical necessity is established by the presence of injuries requiring medical attention. Documentation of the fall and the resulting injuries is required to support medical necessity for treatment and billing.
The clinical responsibility involves assessing the patient's injuries resulting from the fall, providing appropriate medical care, and documenting the incident and injuries for billing and reporting purposes.
- Chapter 20: External causes of morbidity and mortality
- W00-W19 (Slipping, tripping, stumbling, and falls)
In simple words: This code is used when someone gets hurt after falling from a balcony or railing.The doctor will also use a code to describe the specific injury (like a broken bone or bruise).
This ICD-10-CM code classifies injuries resulting from a fall from, out of, or through a balcony or railing.It is used to indicate the external cause of injury and should be secondary to a code from another chapter specifying the nature of the injury (e.g., fractures, contusions).
Example 1: A patient falls from a second-story balcony during a party, sustaining a fractured tibia and multiple contusions.W13.0 is used as a secondary code along with codes for the fracture and contusions., An elderly patient falls from a railing while attempting to enter their home, resulting in a head injury and a concussion.W13.0 is used secondarily to codes describing the head injury and concussion., A child falls from a balcony at a high rise apartment, sustaining severe injuries including multiple fractures and internal bleeding.W13.0 is a secondary code here too, with other codes used to describe the detailed nature of the injuries sustained.
Thorough documentation is crucial.This includes details of the fall (height, surface landed on), a description of the mechanism of injury, and a detailed account of all injuries sustained.Radiological reports, operative notes, and progress notes are essential.
** The seventh character (A, D, or S) should be appended to indicate the encounter status (initial, subsequent, or sequela).
- Payment Status: Active
- Specialties:Emergency Medicine, Orthopedics, Neurosurgery
- Place of Service:Emergency Room - Hospital, Inpatient Hospital, Office