CPT 15933: Excision of Pressure Sore and Underlying Sacral Bone with Closure - OpenPayer

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Summary & Overview

CPT 15933: Excision of Pressure Sore and Underlying Sacral Bone with Closure

CPT code 15933 designates surgical excision of a pressure sore and the underlying bone at the base of the spine, followed by primary closure. This code captures a definitive operative intervention for advanced sacral or coccygeal decubitus ulcers that involve exposed or infected bone. Nationally, the procedure is clinically significant because it addresses deep tissue loss, reduces infection risk, and can be a pivotal step in complex wound management and rehabilitation pathways.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national perspective on clinical context for CPT code 15933, typical settings where the procedure is performed, and the kinds of documentation and coding scenarios that commonly accompany this service. The publication also summarizes benchmarks and policy considerations relevant to coverage and coding practices, highlights common modifiers associated with surgical procedures, and outlines the clinical indications and procedural elements that justify use of this code.

This summary is intended for coding professionals, surgical providers, compliance officers, and payer policy analysts seeking a clear, operational description of CPT code 15933 and its role in management of severe pressure ulcers.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 15933pressure ulcer surgerysacral wound excisionsurgical debridementwound closureoperative codeambulatory surgeryhospital surgerywound management

Billing Code Overview

CPT code 15933 describes the removal of a pressure sore (decubitus ulcer) and excision of the underlying bone at the base of the spine with primary closure. The procedure involves surgical excision of necrotic soft tissue and bone at a sacral or coccygeal site and suturing the wound to achieve closure and promote healing.

Service type: Surgical debridement and excision with primary wound closure

Typical site of service: Hospital operating room or ambulatory surgery center, performed by a surgical specialist (such as a general surgeon, plastic surgeon, or colorectal surgeon) experienced in wound and pressure ulcer management.

Clinical & Coding Specifications

Clinical Context

A typical patient is an older, immobile adult with a chronic stage IV sacral decubitus ulcer that has exposed necrotic tissue and underlying coccygeal bone with recurrent infection and failed conservative wound care. The patient is evaluated in an outpatient surgical clinic or an inpatient setting by a general surgeon or a plastic surgeon. Preoperative workup includes wound assessment, imaging (if osteomyelitis is suspected), optimization of nutrition and comorbidities (for example, diabetes control), and informed consent discussing risks including bleeding and infection. Operative workflow: the patient is brought to the operating room, placed in a prone position, and the sacral wound and surrounding tissue are debrided. The provider removes devitalized soft tissue and resects necrotic bone at the base of the spine (coccygectomy or partial sacrectomy as indicated). Hemostasis is achieved, the wound bed is irrigated, and the defect is closed with layered suturing or left for flap coverage per surgical plan. Postoperative care includes wound care, pressure offloading, antibiotics if osteomyelitis was present, pain control, and coordination with nursing and wound care teams for follow-up and possible reconstructive procedures.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when the work, time, or complexity substantially exceeds typical for `15933` (document extra work).

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Most common specialty performing sacral pressure sore excision and coccygeal bone removal.
208C00000X	Plastic Surgery	Performs wound debridement with soft-tissue reconstruction or flap coverage after bone removal.
2080P0006X	Colon & Rectal Surgery	Sometimes involved when sacral wounds are near the anus or require coordination for perineal management.
207L00000X	Surgical Oncology	Involvement when complex oncologic wounds or prior radiation complicate closure.
310400000X	Wound Care Specialist (Nursing)	Provides perioperative and postoperative wound management; used for coordination though not a surgical taxonomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L89.154`	Pressure ulcer of sacral region, stage 4	Stage IV sacral pressure ulcers commonly require excision of necrotic tissue and underlying bone as described by `15933`.
`L89.153`	Pressure ulcer of sacral region, stage 3	Deep ulcers with exposed subcutaneous tissue or bone may progress and require surgical intervention including bone removal.
`M86.171`	Osteomyelitis, acute hematogenous, right femur (example)	Osteomyelitis of adjacent bone (coccyx/sacrum) is a common indication for bone removal during pressure sore surgery; site-specific code for sacrum would be used clinically.
`M86.169`	Osteomyelitis, unspecified, site unspecified	Osteomyelitis coding supports surgical bone debridement and antibiotic planning when bone infection is present.
`Z98.890`	Other specified postprocedural states	May be used for documentation of prior surgical history relevant to wound management and planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (first 20 sq cm)	Often performed prior to or as part of initial wound bed preparation when extensive soft-tissue debridement is needed before `15933`.
`11043`	Debridement, muscle and fascia (first 20 sq cm)	Used when deeper soft-tissue layers overlying sacrum require debridement in addition to bone removal.
`11044`	Debridement, bone (first 20 sq cm)	May be reported when significant necrotic bone beyond the coccyx is debrided in addition to `15933` (check payer bundling rules).
`15271`	Large complex wound closure, trunk (simple)	Used when primary closure or complex layered closure of the sacral defect is performed after bony debridement.
`15734`	Muscle, myocutaneous or fasciocutaneous flap; trunk	Reported when flap coverage is required following excision of a pressure sore and removal of underlying bone.
`97602`	Removal of devitalized tissue from wound(s) (e.g., enzymatic, sharp debridement), without anesthesia	Can be used for serial bedside debridements before definitive surgical excision coded with `15933`.