Summary & Overview

CPT 15952: Trochanter Pressure Ulcer Excision with Skin Flap Closure

CPT code 15952 defines surgical excision of a pressure ulcer at the trochanter with closure using a skin flap, a reconstructive procedure used to treat advanced pressure injuries over the hip. This code captures a resource-intensive operative intervention that addresses tissue loss, infection risk, and the need for durable wound coverage, and it aligns with broader national efforts to manage pressure injuries in complex patients. Key payers in national coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides concise benchmarks and clinical context for CPT code 15952, including typical site-of-service expectations and the surgical nature of the intervention. Readers will find comparative insights on how the procedure is classified and billed, common clinical indications informing use, and relevant coding considerations. Where payer policy summaries apply, national commercial insurers and Medicare practices are summarized. Data not available in the input is noted where applicable. The content is intended to inform coding staff, revenue cycle professionals, and clinical leaders about the code’s purpose, typical utilization context, and areas to consider when reviewing surgical wound reconstruction claims.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare15952CPTpressure ulcertrochanterskin flapwound reconstructionsurgical procedurewound careoperative coding

Billing Code Overview

CPT code 15952 describes surgical removal of a pressure ulcer of the trochanter (hip area) with wound closure using a skin flap. The procedure involves debridement of ulcerated tissue at the trochanter region and reconstruction of the defect with a local or regional skin flap to achieve wound closure and durable coverage.

Service type: Surgical wound reconstruction; flap closure for pressure ulcer

Typical site of service: Operating room or procedure suite in an inpatient or outpatient surgical setting, commonly performed where surgical debridement and flap reconstruction can be performed under appropriate anesthesia.

Clinical & Coding Specifications

Clinical Context

A typical patient is an elderly, immobile individual with a chronic trochanteric pressure ulcer that has progressed to full-thickness tissue loss with non-viable tissue or exposed subcutaneous tissue despite conservative wound care. The patient is evaluated in an inpatient or outpatient surgical setting (commonly an operating room or ambulatory surgery center) by a plastic surgeon, general surgeon, or wound reconstruction specialist. Preoperative steps include wound assessment, optimization of nutrition and comorbidities (for example diabetes or peripheral vascular disease), debridement of necrotic tissue, and wound culture as indicated. The procedure involves excision of the pressure ulcer and closure using a local or rotational skin flap from the trochanteric region to provide durable soft tissue coverage. Postoperative workflow includes dressing application, pain control, instructions for pressure off-loading, possible negative-pressure wound therapy adjunct, and scheduled follow-up for flap monitoring, suture removal, and assessment for complications such as flap necrosis or infection. Typical sites of service are the hospital operating room, ambulatory surgery center, or inpatient ward for patients requiring extended monitoring.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and complexity substantially exceed typical for `15952` (document specifics).

Taxonomy Code	Specialty	Notes
207P00000X	Plastic Surgery	Common specialty performing flap reconstruction for trochanteric pressure ulcers.
207R00000X	General Surgery	General surgeons often perform debridement and flap closure in hospital settings.
2080P0202X	Wound Care/Hyperbaric Medicine	Specialists involved in preoperative optimization and postoperative wound management.
208D00000X	Geriatric Medicine	Providers coordinating perioperative optimization for elderly, high-risk patients.
364S00000X	Surgical Critical Care	Consultants for medically complex patients requiring intensive perioperative support.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L89.152`	Pressure ulcer of left trochanter, stage 3	Directly describes a stage 3 pressure ulcer of the left trochanter which commonly requires excision and flap closure.
`L89.153`	Pressure ulcer of left trochanter, stage 4	Identifies full-thickness tissue loss with exposure of muscle, bone, or supporting structures often needing flap reconstruction.
`L89.052`	Pressure ulcer of right trochanter, stage 3	Right-sided trochanteric stage 3 ulcer indicating similar surgical indication for `15952` when on the right.
`L89.053`	Pressure ulcer of right trochanter, stage 4	Right trochanter stage 4 ulcer requiring extensive debridement and flap coverage.
`E11.9`	Type 2 diabetes mellitus without complications	Common comorbidity that impairs wound healing and is relevant to perioperative risk and management.
`I70.229`	Atherosclerosis of native arteries of the extremities, unspecified extremity	Peripheral vascular disease can compromise perfusion to flaps and affect surgical planning.
`Z98.890`	Other specified postprocedural states	May be used to document prior surgical history relevant to current reconstruction planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, muscle and/or fascia (first 20 sq cm or less)	Often performed prior to flap closure to remove necrotic tissue when deeper debridement is required.
`11043`	Debridement, muscle and/or fascia with bone (first 20 sq cm or less)	Applicable if underlying bone is involved and debridement includes bony involvement before reconstruction.
`15271`	Application of split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or first 10% BSA	May be used when skin grafting is chosen instead of a flap or as adjunct to cover donor sites.
`15830`	Revision of existing skin flap or graft	Used for postoperative revisions or when partial flap failure requires corrective surgery.
`97607`	Negative pressure wound therapy (intermittent)	Often used pre- or postoperatively as adjunctive therapy to manage exudate and promote healing.
`10160`	Puncture aspiration of abscess	Performed if abscess drainage is needed prior to definitive excision and flap closure.