What is the ICD‑10‑CM code for a work‑related fall?

ICD-10-CM Coding for Work-Related Falls

For a work-related fall, use a combination of two codes: (1) a nature-of-injury code from Chapter 19 (S00-T88) describing the specific injury sustained, and (2) an external cause code from Chapter 20 (V00-Y99) that includes the activity code Y99.0 to designate the injury as work-related. 1

Coding Structure for Occupational Falls

The ICD-10-CM system requires dual coding to capture both the injury and its work-related context:

Primary Diagnosis Code (Nature of Injury)

• Select from Chapter 19 (S00-T88) based on the specific injury sustained (e.g., fracture, contusion, laceration, traumatic brain injury) 2
• This code describes what happened to the patient anatomically 2

External Cause Code (Mechanism and Place)

• Use fall codes from W00-W19 to specify the fall mechanism 1, 3
  • W00: Fall on same level involving ice and snow
  • W01: Fall on same level from slipping, tripping, stumbling
  • W10: Fall on and from stairs and steps 1
  • W11: Fall on and from ladder
  • W12: Fall on and from scaffolding
  • W13-W19: Other fall codes based on specific circumstances 4

Activity Code (Work-Related Designation)

• Add Y99.0 as a supplementary code to explicitly identify the injury as occurring during work activity 3
• This is the critical code that distinguishes a work-related fall from other falls 3
• ICD-10-CM introduced these optional activity codes specifically to enable identification of work-related injuries for the first time 5

Practical Coding Example

For a worker who falls from a ladder at a construction site and sustains a wrist fracture:

• S62.001A (Fracture of unspecified carpal bone, right wrist, initial encounter)
• W11.XXXA (Fall on and from ladder, initial encounter)
• Y99.0 (Activity code for civilian activity done for income or pay)
• Y92.69 (Place of occurrence: other specified place, if applicable) 4

Enhanced Surveillance Capability

ICD-10-CM codes identify 36% more work-related injury ED visits compared to using workers' compensation expected payer data alone, demonstrating the superior sensitivity of this coding approach 3. The 246 work-related ICD-10-CM codes available provide substantially more granular capture of occupational injuries than the traditional workers' compensation billing method 3.

Critical Coding Pitfalls

• Never rely solely on expected payer (workers' compensation) to identify work-related falls – this misses a substantial proportion of cases 3
• Always include the Y99.0 activity code – without it, the fall cannot be distinguished as work-related in surveillance systems 3, 5
• Ensure the external cause code is placed in any diagnosis field – ICD-10-CM allows external cause codes in any position, not just as secondary diagnoses 2
• Use seventh character extensions appropriately (A for initial encounter, D for subsequent encounter, S for sequela) to capture the episode of care 4