CPT 15922: Sacrococcygeal Pressure Ulcer Debridement with Flap Closure - OpenPayer

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Summary & Overview

CPT 15922: Sacrococcygeal Pressure Ulcer Debridement with Flap Closure

CPT code 15922 covers surgical management of a sacrococcygeal pressure ulcer with removal of necrotic or infected bone and closure using a skin flap. This operative procedure addresses deep, chronic pressure wounds that involve soft tissue and underlying bone, aiming to remove infection and reconstruct the defect to facilitate healing and reduce recurrence. Nationally, procedures for complex pressure ulcers are clinically significant due to their association with morbidity, prolonged hospitalization, and resource-intensive surgical and post‑operative care.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected sites of service, and typical service type. The publication also provides benchmarking and reimbursement context where available, highlights policy considerations relevant to coverage of complex wound reconstruction, and summarizes clinical implications for care coordination and post‑operative management. Where specific data elements were not provided in the input, the text notes that those details are not available. The goal is to give payers, providers, and administrators a clear, actionable overview of CPT code 15922 for national planning and billing reference.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 15922pressure ulcer surgeryflap reconstructionwound debridementsurgical wound managementsacrococcygeal ulceroperative procedurehospital surgeryambulatory surgical center

Billing Code Overview

CPT code 15922 describes surgical removal of a pressure ulcer (decubitus ulcer) located at the tailbone (sacrococcygeal) area with partial removal of underlying infected bone (sequestrectomy or debridement) and closure of the defect using a skin flap to promote complete healing and reduce recurrence.

Service Type: Surgical debridement and flap reconstruction for a sacrococcygeal pressure ulcer
Typical Site of Service: Hospital operating room or ambulatory surgical center for operative wound management and flap closure

Clinical & Coding Specifications

Clinical Context

A 68-year-old male nursing home resident with long-standing immobility presents with a chronic, non-healing pressure ulcer over the sacrococcygeal region. The ulcer has developed full-thickness tissue loss with exposed and infected coccygeal bone (osteomyelitis) after multiple failed local wound care attempts. The patient has recurrent serous drainage, surrounding cellulitis, and intermittent fevers despite targeted antibiotics. After multidisciplinary evaluation (wound care nurse, infectious disease, and plastic/reconstructive surgery), the decision is made to perform surgical debridement with partial ostectomy of infected bone and closure using a local rotational or advancement tissue flap to achieve durable coverage and reduce recurrence.

The clinical workflow includes preoperative optimization (wound cultures, imaging such as MRI to define osteomyelitis extent, nutrition assessment, and medical stabilization), intraoperative radical debridement of devitalized soft tissue, resection of the infected coccygeal bone, and immediate closure with an appropriate flap (gluteal or fasciocutaneous flap) with layered closure and drains as indicated. Postoperative care includes wound and flap monitoring, continued targeted antibiotics guided by cultures, pressure offloading, physical therapy for repositioning, and close outpatient wound follow-up to monitor for flap viability and infection resolution.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
207L00000X	General Surgery	Commonly performs debridement and wound procedures; may coordinate care.
208600000X	Plastic Surgery	Frequently performs flap reconstruction and complex soft tissue closure.
207P00000X	Colorectal Surgery	Involved when sacral-coccygeal wounds are near anorectal structures or require multidisciplinary care.
207Q00000X	Orthopedic Surgery	Consulted when significant bone involvement or ostectomy/orthopedic reconstruction is required.
208000000X	Surgical Oncology	Occasionally involved in complex wound resections when malignancy is a concern.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L89.152`	Pressure ulcer of sacral region, stage 4	Stage 4 pressure ulcers involve full-thickness tissue loss with exposed bone, commonly necessitating debridement and flap closure such as in `15922`.
`M86.171`	Osteomyelitis, right femur (example)	Osteomyelitis of adjacent bone (here an example) illustrates the need for partial ostectomy when bone is infected; sacral/coccygeal osteomyelitis codes would be used when specific.
`L03.116`	Cellulitis of right thigh (example)	Surrounding soft tissue infection/cellulitis commonly coexists and impacts surgical planning and antibiotic therapy.
`Z48.813`	Encounter for surgical aftercare following surgery on the musculoskeletal system	Used for postoperative follow-up visits for wound and flap care.
`Z98.89`	Other specified postprocedural states	May be used to denote altered anatomy or prior procedures affecting current management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`15922`	Excision of pressure ulcer(s), sacral area; with partial ostectomy and closure using myocutaneous or fasciocutaneous flap	Primary procedure: removal of ulcer and infected bone with flap coverage to achieve definitive closure.
`11043`	Debridement, includes removal of devitalized tissue and subcutaneous tissue, first 20 sq cm or less	Often performed prior to or during operative debridement to remove necrotic soft tissue before definitive flap closure.
`11045`	Debridement, includes removal of devitalized tissue and muscle and/or bone, and includes more extensive tissue removal	May be reported when deep debridement involving bone is performed contemporaneously when coding rules allow.
`27030`	Excision of sacrococcygeal pilonidal cyst or sinus; simple	Used when a limited excision of pilonidal disease is part of the differential or performed in the same operative session.
`15271`	Split-thickness skin graft, trunk, arms, legs; 100 sq cm or less	Used when skin grafting (instead of a flap) is required for wound coverage either in the same admission or staged procedure.
`11010`	Debridement of extensive eczematous or infected skin; single skin lesion (value varies)	Sometimes used for minor debridement procedures adjunctive to the primary surgery.