Falling Back: A Timely Guide to Coding Falls

This past weekend we “fell back” and gained that extra hour. This makes it a good time to look at how we assign codes for falls. 

First, from the Alphabetic Index, we have a listing for Falling, falls, with a non-essential modifier of “repeated.” This listing takes us to R29.6, Repeated falls. Our inclusion terms noted in the Tabular List are falling and tendency to fall.

We also see we have an Excludes 2 note, which lists at risk for falling and history of falling. Both reference code Z91.81. Remember, on our Excludes 2 instructional notes, these conditions may be assigned together.

For our purposes today, that means we could assign both R29.6 for a patient with repeated falls and Z91.81 for a tendency or history of falling. In fact, our Guidelines explicitly note this at Section I.C.18.d. Repeated falls instructs “Code R29.6, Repeated falls, is for use for encounters when a patient has recently fallen and the reason for the fall is being investigated.

Code Z91.81, History of falling, is for use when a patient has fallen in the past and is at risk for future falls. When appropriate, both codes R29.6 and Z91.81 may be assigned together.” This is important to note, since many coders think one code is sufficient. 

The World Health Organization (WHO) has published some key facts about falls. They note that as of 2021, approximately 684,000 people die globally from falls.

Eighty percent of these deaths occur in low- and middle-income countries. Worldwide, falls are the second-leading cause of unintentional injury deaths, with adults over the age of 60 suffering the greatest number of fatal falls. Not all falls are fatal, obviously; however, the World Health Organization (WHO) notes that 37.3 million falls each year are severe enough to require medical attention. 

Injuries occurring from falls may be fractures, sprains, contusions, or concussions, just to name a few. In addition to assigning a code for the specific injury, we would assign an external cause code to identify the etiology of the injury. Our Official Guidelines for Chapter 20, External Causes of Morbidity, reminds us that the external cause codes should never be sequenced as the first-listed or principal diagnosis.

The guidelines also instruct that these “external cause codes are intended to provide data for injury research and evaluation of injury prevention strategies.” Another important note in the guidelines is the reference that “there is no national requirement for mandatory ICD-10-CM external cause code reporting.

Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required. In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.”

From the External Causes Index, we see Fall, falling as an entry, with a non-essential modifier of accidental. We would assign W19 with placeholder X and a seventh character for the episode of care. This is our unspecified fall option. We know that with ICD-10-CM, we can be very specific on the circumstances of the fall. We can identify environmental factors such as ice and snow. We can assign specifically for falls from a stumble or slip or trip. Falls from specific furniture or vehicles can also be assigned. 

When you do a frequent review of external cause guidelines, coding falls won’t trip you up.