W16.531S ICD-10-CM Code: Jumping or diving into swimming pool striking wall causing drowning and submersion, sequela

W16.531S is the ICD-10-CM diagnosis code for jumping or diving into swimming pool striking wall causing drowning and submersion, sequela. W16.531S sits in the ICD-10-CM chapter for external causes of morbidity (v00-y99), within the section covering slipping, tripping, stumbling and falls (w00-w19).

W16.531S is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

W16.531S is a billable ICD-10-CM code that can be reported on claims but does not currently contribute to a Medicare Advantage member's RAF score under any CMS risk adjustment model (V28, V24, ESRD, or RxHCC). Coders reviewing W16.531S should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.