Summary & Overview
CPT 15935: Excision of Sacral Pressure Ulcer with Flap Closure
CPT code 15935 covers surgical removal of a sacral pressure ulcer and underlying bone with closure using skin flap reconstruction. This procedure is performed to eradicate infected or nonviable tissue, lower the risk of recurrence, and promote durable wound healing in patients with advanced sacral decubitus ulcers. Nationally, procedures for pressure ulcer management are high-cost, complex surgical services frequently provided to medically complex patients and are relevant to hospital utilization, surgical quality metrics, and payer coverage policies.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of service, and an overview of the documentation and clinical indications that drive coding and reimbursement. The publication also presents benchmarks and procedural considerations useful for billing teams and policy analysts, and summarizes common modifiers and coding practice themes where data are available. Data not available in the input are noted explicitly where applicable.
This summary is intended for a national audience of clinicians, coding professionals, and payer policy analysts seeking a concise reference to the clinical intent and administrative implications of CPT code 15935.
Billing Code Overview
CPT code 15935 describes the surgical excision of a sacral pressure ulcer (decubitus ulcer) including removal of underlying bone, with reconstruction by one or more skin flaps to achieve wound closure and reduce recurrence.
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Service type: Surgical wound debridement and flap reconstruction
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Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgical center depending on patient complexity and comorbidities
Clinical & Coding Specifications
Clinical Context
A typical patient is an elderly, immobile individual with a chronic stage 4 sacral pressure ulcer that has failed conservative care (off-loading, wound care, antibiotics as indicated). The patient presents for operative management due to persistent full‑thickness tissue loss with exposed bone and recurrent infection. Preoperative workup includes wound culture, optimization of nutrition and comorbidities (eg, glycemic control), and imaging to assess underlying osteomyelitis. In the operating room under general or regional anesthesia, the surgical team performs wide debridement including excision of necrotic soft tissue and underlying sacral bone as needed, followed by reconstruction using a local or regional fasciocutaneous or myocutaneous flap to achieve durable soft tissue coverage and tension‑free closure. Postoperative workflow includes admission for flap monitoring, pain control, pressure off‑loading, physical therapy as tolerated, and scheduled wound checks with suture removal and longer‑term surveillance to detect recurrence or flap compromise.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity is substantially greater than typical for 15935 (document intraoperative factors). |
23 | Unusual anesthesia | Use when general anesthesia is required for medically indicated reasons that normally would allow local/regional anesthesia. |
26 | Professional component | Use when reporting only the professional component of a diagnostic service; rarely applicable to 15935 unless separated services are billed. |
50 | Bilateral procedure | Use when identical procedures are performed on both sides of the body; not typical for sacral ulcers but included when applicable. |
51 | Multiple procedures | Use when 15935 is one of multiple distinct procedures performed in the same operative session. |
52 | Reduced services | Use when 15935 is partially reduced or not completed as described (document reason). |
53 | Discontinued procedure | Use when 15935 is started but discontinued for extenuating circumstances. |
62 | Two surgeons | Use when two surgeons work together substantially to perform 15935 (eg, plastic and general surgeon). |
76 | Repeat procedure by same physician | Use if the same surgeon performs the same procedure again within the global period (if applicable). |
77 | Repeat procedure by another physician | Use if a different physician repeats the procedure during the global period. |
78 | Unplanned return to OR | Use when a related return to the operating room for a complication occurs during the global period. |
80 | Assistant surgeon | Use when a surgical assistant participates in 15935 and assistant surgeon fees are allowed. |
81 | Minimum assistant surgeon | Use when a minimum assistant surgeon provides assistance and that modifier is required by payer. |
82 | Assistant surgeon (when qualified resident not available) | Use when a qualified resident is not available and an assistant surgeon is required. |
TC | Technical component | Use when billing only the technical component of an associated service; rarely used for 15935 alone. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208100000X | General Surgery | Commonly performs debridement and flap reconstruction for sacral pressure ulcers. |
| 208200000X | Colon and Rectal Surgery | May be involved when ulcers are near the perineal region or bowel involvement is a concern. |
| 208400000X | Plastic Surgery | Frequently performs flap design and complex soft tissue reconstruction for durable coverage. |
| 208800000X | Orthopedic Surgery | Involvement when sacral bone resection or complex skeletal reconstruction is required. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L89.154 | Pressure ulcer of sacral region, stage 4 | Represents full‑thickness tissue loss with exposed bone, the typical indication for 15935. |
M86.171 | Osteomyelitis, acute, sacral region | Indicates bone infection that may necessitate bone excision during the procedure. |
L89.153 | Pressure ulcer of sacral region, stage 3 | Full‑thickness skin loss that may progress and require surgical closure with flap coverage. |
E11.621 | Type 2 diabetes mellitus with diabetic foot ulcer | Diabetes is a common comorbidity that impairs wound healing and increases infection risk. |
R64 | Cachexia | Poor nutritional status impairs healing and is relevant to perioperative management. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11043 | Debridement, muscle and/or fascia, including removal of necrotic tissue | Often performed preoperatively or intraoperatively to remove devitalized tissue prior to flap coverage for a pressure ulcer. |
11044 | Debridement, muscle and/or fascia with bone and/or cartilage | Performed when debridement includes bone; may be an adjunct or preliminary step before definitive flap closure. |
15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk | May be used for reporting flap reconstruction of the sacral region depending on flap type and size when more specific codes apply. |
14040 | Adjacent tissue transfer or rearrangement, trunk; single stage, rotation flap | Used when local tissue rearrangement or rotation flap is performed for sacral defect closure. |
99223 | Initial hospital care, typically 70 minutes or more | Used for complex preoperative or postoperative inpatient evaluation and management related to 15935. |