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The procedure described by CPT® Code 15940 involves the excision of an ischial pressure ulcer, which is a type of wound that occurs due to prolonged pressure on the skin, often seen in patients who are immobile. The ischial region refers to the area around the ischium, one of the three main bones that make up the pelvis, located at the lower part of the hip. In this surgical procedure, the physician typically positions the patient face down to access the ulcer effectively. An elliptical incision is made over the ischial tuberosity, which is the bony prominence of the ischium, allowing the surgeon to remove not only the ulcer itself but also any surrounding infected tissue. After excising the affected area, the wound is thoroughly irrigated to cleanse it of any debris or bacteria. The final step involves closing the wound with primary sutures, ensuring that the area is properly sealed to promote healing. It is important to note that if any bone beneath the ulcer is removed during the procedure, CPT® Code 15941 should be used instead, indicating a more extensive surgical intervention.
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The excision of an ischial pressure ulcer is indicated for patients who present with a pressure ulcer in the ischial region that has not responded to conservative treatment methods. This procedure is typically performed when the ulcer is infected, has significant necrotic tissue, or poses a risk of further complications if left untreated. The primary goal of the excision is to remove the damaged tissue, promote healing, and prevent the progression of the ulcer.
The procedure begins with the patient being positioned face down to allow optimal access to the ischial region. The physician then marks the area around the pressure ulcer to outline the elliptical incision that will be made. This incision is carefully created over the ischial tuberosity, ensuring that it encompasses the ulcer and any surrounding infected tissue. Once the incision is made, the physician excises the ulcer along with the affected skin, taking care to remove all necrotic and infected tissue to promote healing and reduce the risk of recurrence. After the excision, the wound is thoroughly irrigated with a sterile solution to cleanse it of any debris, bacteria, or remaining infected tissue. This step is crucial for preventing postoperative infections. Finally, the physician closes the wound using primary sutures, which are placed to securely bring the edges of the skin together, facilitating proper healing. It is important to document the procedure accurately, and if any bone beneath the ulcer is removed, CPT® Code 15941 should be utilized instead.
After the excision of the ischial pressure ulcer, the patient will require careful monitoring to ensure proper healing. Post-procedure care includes keeping the surgical site clean and dry, as well as following any specific wound care instructions provided by the physician. Patients may be advised to avoid pressure on the affected area to promote healing and prevent the formation of new ulcers. Follow-up appointments will be necessary to assess the healing process and to remove sutures if non-absorbable sutures were used. Additionally, the healthcare team may provide guidance on repositioning techniques and pressure-relief strategies to prevent future pressure ulcers.
| Short Descr | EXC ISCHIAL PR ULC PRIM SUTR | Medium Descr | EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE | Long Descr | Excision, ischial pressure ulcer, with primary suture; | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 170 - Excision of skin lesion |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2025-01-01 | Changed | Short Description changed. |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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