Summary & Overview
CPT 15945: Excision of Pressure Sore with Hip Bone Removal and Flap Closure
CPT code 15945 denotes excision of a pressure ulcer with removal of underlying hip bone and closure using a skin flap. This procedure is used when wound infection has progressed to involve bone, requiring both debridement and reconstructive closure to achieve wound control and prevent recurrence. Nationally, the code captures a high-acuity surgical intervention relevant to hospitals, wound care centers, and reconstructive surgery services.
Key payers commonly involved in coverage and payment for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses payer coverage patterns, comparative benchmarks, and relevant clinical context for coding and documentation.
Readers will find an overview of the clinical indication and procedure components, expected sites of service, common billing modifiers and documentation points (where provided), and guidance on how the code fits into related surgical and wound-care service lines. The publication also highlights typical areas of coding scrutiny and documentation essentials to support medical necessity and accurate claim adjudication. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 15945 describes surgical removal of a pressure ulcer and the underlying bone in the hip area when infection has extended to bone, followed by closure of the wound using a skin flap to promote definitive healing and reduce recurrence.
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Service type: Surgical debridement with bone resection and reconstructive soft-tissue closure using a flap.
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Typical site of service: Hospital operating room or inpatient surgical setting, including specialized wound care or reconstructive surgery environments.
Clinical & Coding Specifications
Clinical Context
A 72-year-old male nursing home resident with chronic immobility presents with a Stage IV pressure ulcer over the right greater trochanter with exposed necrotic bone and signs of osteomyelitis (draining sinus, purulent material, elevated inflammatory markers). After a multidisciplinary evaluation including infectious disease, wound care, and plastic surgery, conservative measures and debridement failed to resolve the deep infection. The surgical team schedules operative management under general anesthesia. Intraoperatively, the provider performs extensive debridement, removes the infected subcutaneous tissue and the involved portion of the underlying ilium/bone, and reconstructs the defect using a local or regional myocutaneous or fasciocutaneous flap with layered closure to achieve durable coverage and reduce recurrence risk. The procedure includes preoperative imaging review, perioperative antibiotic administration guided by cultures, intraoperative tissue sampling for culture and pathology, flap planning and inset, and postoperative wound monitoring with serial dressing changes and rehabilitation coordination. Typical site of service is an inpatient operating room with postoperative recovery on a surgical ward or step-down unit; outpatient or ambulatory settings are uncommon for this level of debridement and flap reconstruction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work or complexity than usual (extensive debridement, prolonged operative time, significant additional reconstruction). |
24 | Unrelated evaluation and management service during a global period | Data not available in the input. |
52 | Reduced services | Use when the procedure was partially reduced or not completed as originally planned (limited flap or incomplete bone resection). |
53 | Discontinued procedure | Use when the procedure was aborted for patient safety reasons prior to completion. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons (orthopedic or general surgeon plus plastic/reconstructive surgeon) and both perform critical portions. |
66 | Surgical team | Use when a surgical team approach is required for highly complex reconstruction. |
78 | Unplanned return to the operating room following initial procedure | Use when the patient returns to OR for complications related to the index procedure (e.g., flap compromise, hematoma evacuation). |
79 | Data not available in the input. | Data not available in the input. |
80 | Assistant surgeon | Use when an assistant surgeon provides assistance and an assistant surgeon fee is reported. |
81 | Minimum assistant surgeon | Use when a surgeon provides minimal assistance during the procedure. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an advanced practice clinician serves as surgical assistant in accordance with payer rules. |
QX | CRNA service with medical direction by physician | Use for anesthesiology billing when a certified registered nurse anesthetist provides services with medical direction. |
TC | Technical component | Not typically applicable to surgical procedures; report when only the technical component of a service is billed. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208000000X | General Surgery | Frequently performs debridement and coordinate reconstructive care. |
207P00000X | Orthopedic Surgery | Involved when underlying bone (pelvis/ilium) resection is required. |
208C00000X | Plastic Surgery | Performs flap reconstruction for soft-tissue coverage and closure. |
364S00000X | Infectious Disease | Consults for osteomyelitis management and perioperative antibiotics. |
363L00000X | Physical Medicine & Rehabilitation | Manages post-op mobility, pressure redistribution, and prevention strategies. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L89.154 | Pressure ulcer of right hip, stage 4 | Stage IV trochanteric pressure ulcers often involve full-thickness tissue loss with exposed bone, indicating need for debridement and flap coverage. |
M86.171 | Acute osteomyelitis, right femur | Osteomyelitis of the proximal femur/ilium adjacent to the pressure ulcer necessitates bone resection and targeted antibiotic therapy. |
L89.253 | Pressure ulcer of left hip, stage 4 | Left-sided trochanteric ulcers with deep tissue involvement require similar surgical management when present. |
L89.1540 | Data not available in the input. | Data not available in the input. |
T81.4XXA | Infection following a procedure, initial encounter | Used if postoperative infection develops requiring reoperation or additional management. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11042 | Debridement, subcutaneous tissue (eg, fat, fascia) — first 20 sq cm or less | May be billed for initial soft tissue debridement when performed separately or prior to definitive bone resection and flap. |
11043 | Debridement, muscle and/or fascia — first 20 sq cm or less | Billed when deeper debridement of muscle/fascia is performed in addition to bone resection. |
11045 | Debridement, bone — first 20 sq cm or less | Used when separate reporting of bone debridement is appropriate in staged or concurrent procedures. |
15271 | Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less | May be used when skin grafting is required in conjunction with flap or as a secondary coverage technique. |
15738 | Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis | Applicable when free flap reconstruction is performed instead of a local/regional flap. |
99223 | Initial hospital care, typically 70 minutes or more | Represents high-complexity inpatient E/M services commonly reported on the same day as major surgical procedures when not included in global surgical package. |