How To Use CPT Code 15946

CPT code 15946 describes the excision of an ischial pressure ulcer, along with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 15946?

CPT 15946 can be used to describe the excision of an ischial pressure ulcer, along with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure. This code is used when the provider removes the pressure sore and its underlying bone in the hip area, when infection in the wound has spread to the bone. The wound is then prepared for closure with the use of a graft of skin or skin and muscle.

2. Official Description

The official description of CPT code 15946 is: ‘Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision around the ulcerated region of the ischium and removes the ulcerated tissue.
3. Part of the nearby bone is also removed (ostectomy).
4. The wound is then prepared for closure with the use of a graft of skin or skin and muscle.
5. If a myocutaneous flap is used, it is typically taken from the gluteus maximus muscle.

4. Qualifying circumstances

Patients eligible to receive CPT 15946 services are those with an ischial pressure ulcer that requires excision and ostectomy in preparation for muscle or myocutaneous flap or skin graft closure. The procedure is performed when infection in the wound has spread to the bone. The provider must ensure that the patient is appropriately prepped and anesthetized before performing the excision and ostectomy.

5. When to use CPT code 15946

CPT code 15946 should be used when the provider performs the excision of an ischial pressure ulcer, along with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure. This code should not be used for other types of pressure ulcers or for excision without the intent of subsequent closure with a graft.

6. Documentation requirements

To support a claim for CPT 15946, the provider must document the following information:

• Patient’s diagnosis of an ischial pressure ulcer
• Details of the excision procedure, including the incision, removal of ulcerated tissue, and ostectomy
• Description of the graft used for closure, whether it is a muscle or myocutaneous flap or a skin graft
• Any additional relevant details, such as the size of the ulcer or the extent of infection
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 15946, ensure that the excision and ostectomy are performed in preparation for muscle or myocutaneous flap or skin graft closure. Report separately the placement of the myocutaneous flap or skin graft using the appropriate codes (e.g., 15734 and/or 15738 for muscle or myocutaneous flap, 15100 and/or 15101 for split skin graft). Follow any additional guidelines provided by the payer or coding guidelines for accurate billing.

8. Historical information

CPT 15946 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with an ischial pressure ulcer undergoes excision and ostectomy in preparation for a muscle flap closure.
2. A provider performs the excision and ostectomy of an ischial pressure ulcer, preparing the wound for a myocutaneous flap closure.
3. An individual with an ischial pressure ulcer requires excision and ostectomy before a skin graft can be applied for wound closure.
4. A patient with an infected ischial pressure ulcer undergoes excision and ostectomy, followed by a muscle and skin flap closure.
5. A provider performs the excision and ostectomy of an ischial pressure ulcer, preparing the wound for a split-thickness skin graft.
6. A patient with a deep ischial pressure ulcer undergoes excision and ostectomy, followed by a muscle flap closure.
7. An individual with an extensive ischial pressure ulcer requires excision and ostectomy before a myocutaneous flap can be applied for wound closure.
8. A provider performs the excision and ostectomy of an ischial pressure ulcer, preparing the wound for a full-thickness skin graft.
9. A patient with a large ischial pressure ulcer undergoes excision and ostectomy, followed by a muscle and skin flap closure.
10. An individual with a chronic ischial pressure ulcer requires excision and ostectomy before a split-thickness skin graft can be applied for wound closure.