Summary & Overview
CPT 15946: Excision of Hip Pressure Sore with Bone Resection and Graft Preparation
CPT code 15946 identifies a surgical procedure to excise a pressure sore and the underlying bone in the hip area when infection has spread to bone, with preparation of the wound for closure using a skin or skin-and-muscle graft. This code is important nationally because it captures complex wound management that often involves multidisciplinary care, extended operative time, and substantial resource utilization. Proper coding supports clinical documentation, reimbursement accuracy, and population-level tracking of advanced pressure ulcer care.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, and the types of outcomes and resource considerations tied to this level of surgical wound care. The publication also summarizes expected benchmarks and billing considerations relevant to hospitals and surgical practices, and highlights policy or coverage issues that commonly affect payment and prior authorization for complex wound excisions and grafting.
This summary is written for a national audience and is intended to help coding managers, clinical leaders, and policy analysts understand the clinical intent of CPT code 15946, what services it represents, and the practical implications for billing and coverage.
Billing Code Overview
CPT code 15946 describes surgical removal of a pressure sore (decubitus ulcer) and the underlying bone in the hip region when the wound infection has extended to bone. The procedure includes preparing the defect for definitive closure using a skin graft or a combined skin-and-muscle graft.
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Service type: Surgical debridement with excision and reconstruction preparation (wound debridement and graft preparation)
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Typical site of service: Operating room or surgical suite, commonly performed in an inpatient or ambulatory surgical setting depending on patient complexity and comorbidities.
Clinical & Coding Specifications
Clinical Context
A 68-year-old immobile patient with advanced dementia and multiple comorbidities presents with a chronic, nonhealing Stage IV pressure ulcer over the greater trochanter with purulent drainage and imaging-confirmed osteomyelitis of the underlying iliac crest/greater trochanteric bone. After failed conservative care including wound debridement, antibiotics guided by culture, and negative-pressure wound therapy, the surgical team elects to perform radical debridement with removal of necrotic bone and soft tissue followed by preparation of the bed for flap coverage. The procedure described by 15946 involves excision of the pressure sore and the involved bone in the hip region (trochanteric/ischial area) and preparation for closure using a skin graft or musculocutaneous flap.
Preoperative workflow includes wound culture and sensitivity, plain radiographs or MRI to assess bone involvement, optimization of medical comorbidities (glycemic control, nutrition), informed consent discussing risks of persistent infection and flap failure, and coordination with plastic/reconstructive surgery for flap planning. Intraoperative workflow includes wide excision of soft tissue and sequestrated bone, irrigation, possible intraoperative cultures, and immediate reconstruction with a rotational muscle flap or free tissue transfer and skin grafting as indicated. Postoperative care focuses on flap monitoring, antibiotic therapy per culture results, pressure offloading, wound care, and rehabilitation planning. Typical site of service is an inpatient operating room, often within a tertiary care hospital or specialized wound center with capabilities for complex reconstructive surgery.
Coding Specifications
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