Either Debridement or Excision Is Possible for Decubitus Ulcers: Here’s How to Choose

Make sure documentation is complete to capture total facility payment

When reporting treatment for a decubitus ulcer (also called a pressure ulcer or bedsore), you should know the method of closure (if any), as well as the wound’s location and depth. With this information, choosing the correct code is easy.

Consider Closure First

If the physician closes the wound, you can be certain that she performed an excision (15920-15958), says Tray Dunaway, MD, FACS, CSP, CHCO, CHCC, a surgeon, speaker, physician and coding educator, and healthcare consultant in Camden, S.C. In this case, the surgeon will clear the wound of all infection before closing.
And underlying bony structures (such as a portion of the sacrum) may become infected as a result of the pressure ulcer, and the surgeon may remove these structures at the same time as the pressure ulcer excision in a procedure called an ostectomy. The surgeon might also perform ostectomy when the ulcer won’t heal and excision of the underlying bone will keep the wound from rubbing. CPT provides dedicated codes to report pressure ulcer excision with ostectomy.
Finally, CPT distinguishes between the type of closure, which can include primary suture, skin flap closure, and muscle/myocutaneous flap or skin graft closure.
Consequently, you will choose an appropriate excision code according to the ulcer’s location, whether the procedure includes ostectomy, and the type of closure, as illustrated in the chart on page 35.
For hospital outpatient facilities, the CPT code you select will, in turn, determine the appropriate APC payment group (for example, excision of coccygeal pressure ulcer with primary suture, 15920, is a component of APC 0019, while the same excision with flap closure, 15922, is a component of APC 0027).


You Can Report Muscle/Skin Grafts Separately

When the surgeon closes a sacral, ischial or trochanteric ulcer excision using muscle flaps or skin grafts, you should report a separate code to describe the closure, according to CPT guidelines.
Specifically, you can report muscle/skin graft codes in addition to excision codes 15936-15937, 15946, 15956 and 15958.
For example, the surgeon excises an ischial pressure ulcer with ostectomy. She then closes the operative wound using muscle flap. To report the excision, you should use 15946 (Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure). Per CPT instructions, you may report the muscle flap closure separately using 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk). Both of these procedures are components of APC 0027.


Select Debridement Codes by Depth

If the surgeon leaves the [...]

- Published on 2007-08-24