ICD-10 · PDGM grouping
W13 Fall from, out of or through building or structure
All 21 codes in the W13 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in family
21
Can lead a claim
0
Cannot lead a claim
21
What CMS assigns to W13
None of the 21 codes is assigned a clinical group. None of the 21 is assigned a comorbidity subgroup. None can lead a claim.
Every code in W13
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| W13.0 Fall from, out of or through balcony | ||||
| W13.0XXA | Fall from, out of or through balcony, initial encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.0XXD | Fall from, out of or through balcony, subsequent encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.0XXS | Fall from, out of or through balcony, sequela | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.1 Fall from, out of or through bridge | ||||
| W13.1XXA | Fall from, out of or through bridge, initial encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.1XXD | Fall from, out of or through bridge, subsequent encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.1XXS | Fall from, out of or through bridge, sequela | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.2 Fall from, out of or through roof | ||||
| W13.2XXA | Fall from, out of or through roof, initial encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.2XXD | Fall from, out of or through roof, subsequent encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.2XXS | Fall from, out of or through roof, sequela | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.3 Fall through floor | ||||
| W13.3XXA | Fall through floor, initial encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.3XXD | Fall through floor, subsequent encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.3XXS | Fall through floor, sequela | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.4 Fall from, out of or through window | ||||
| W13.4XXA | Fall from, out of or through window, initial encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.4XXD | Fall from, out of or through window, subsequent encounter | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.4XXS | Fall from, out of or through window, sequela | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.8 Fall from, out of or through other building or structure | ||||
| W13.8XXA | Fall from, out of or through other building or structure, initial encounterCMS: Fall from, out of or through oth building or structure, init | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.8XXD | Fall from, out of or through other building or structure, subsequent encounterCMS: Fall from, out of or through oth building or structure, subs | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.8XXS | Fall from, out of or through other building or structure, sequelaCMS: Fall from, out of or through oth bldg, sequela | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.9 Fall from, out of or through building, not otherwise specified | ||||
| W13.9XXA | Fall from, out of or through building, not otherwise specified, initial encounterCMS: Fall from, out of or through bldg, not otherwise spcf, init | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.9XXD | Fall from, out of or through building, not otherwise specified, subsequent encounterCMS: Fall from, out of or through bldg, not otherwise spcf, subs | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
| W13.9XXS | Fall from, out of or through building, not otherwise specified, sequelaCMS: Fall from, out of or through bldg, not otherwise spcf, sqla | Cannot lead a claimExternal cause of injury code not reportable as principal diagnosis | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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