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A trochanteric pressure ulcer, commonly known as a pressure sore, bedsore, or decubitus ulcer, is a localized injury to the skin and underlying tissue that typically occurs over bony prominences, such as the greater trochanter of the femur. This procedure involves the excision of the ulcer in preparation for subsequent closure using a muscle or myocutaneous flap or a skin graft. The greater trochanter is a prominent bony structure located on the outer aspect of the femur, serving as an attachment point for various muscles of the thigh and buttock. During the excision, the physician makes an incision around the ulcer, carefully removing all necrotic tissue, which includes the skin, subcutaneous tissue, and potentially muscle. In some cases, the bursa and any affected bone may also be excised to ensure complete removal of the ulcer and to prepare the wound bed adequately. The procedure emphasizes the importance of protecting surrounding nerves and blood vessels during the excision process. After the necrotic tissue is removed, any rough bony surfaces are smoothed to facilitate proper healing. The wound edges are then trimmed, and the site is prepared for the placement of a muscle or myocutaneous flap or skin graft, which will be performed as a separate procedure. It is important to note that if the procedure is conducted without the removal of bone, the appropriate code to use is 15956, whereas if ostectomy is performed, the code 15958 should be utilized.
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The procedure is indicated for the treatment of trochanteric pressure ulcers, which may arise due to prolonged pressure on the skin over the greater trochanter, often seen in patients with limited mobility. These ulcers can lead to significant complications if not addressed, including infection and further tissue damage. The excision is performed to remove necrotic tissue and prepare the site for closure using a muscle or myocutaneous flap or skin graft.
The procedure begins with the physician making an incision around the trochanteric pressure ulcer. This incision is critical as it allows for the complete excision of the ulcer and any surrounding necrotic tissue. The physician carefully removes the skin, subcutaneous tissue, and muscle as necessary, ensuring that all compromised tissue is excised. In some cases, the bursa and any involved bone or bony protuberances may also be excised to ensure that the wound is free of infection and necrotic material. Throughout this process, the physician must take care to protect surrounding nerves and blood vessels to prevent complications. After the necrotic tissue is removed, any rough bony surfaces are smoothed using a file, which is essential for creating a clean wound bed. The edges of the wound are then trimmed to facilitate proper healing and to prepare the site for the muscle or myocutaneous flap or skin graft. The flap or graft is developed and prepared for placement in the wound, which will be performed as a separate reportable procedure.
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing of the excised area. Patients may require pain management and should be educated on wound care to promote optimal recovery. Follow-up appointments are essential to assess the healing process and to determine the appropriate timing for the placement of the muscle or myocutaneous flap or skin graft, which is a separate procedure. The healthcare team will provide specific instructions regarding activity restrictions and any necessary rehabilitation to support recovery.
| Short Descr | EXC TRCHNTR PR ULC PREP FLAP | Medium Descr | EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN | Long Descr | Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | 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) | P5A - Ambulatory procedures - skin | MUE | 2 | CCS Clinical Classification | 170 - Excision of skin lesion |
| 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). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | 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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