CPT® Code 15946

An ischial pressure ulcer, commonly known as a pressure sore, bedsore, or decubitus ulcer, is a localized injury to the skin and underlying tissue, typically over a bony prominence, resulting from prolonged pressure. The procedure described by CPT® Code 15946 involves the excision of this ulcer, which may include the removal of surrounding necrotic tissue and, if necessary, the excision of bone (ostectomy). This surgical intervention is performed to prepare the affected area for closure using a muscle or myocutaneous flap or a skin graft, which are techniques used to cover the wound and promote healing. The ischium, located in the lower posterior part of the bony pelvis, is the specific anatomical site addressed in this procedure. During the surgery, the patient is positioned face down, allowing the physician to create an incision around the ulcer. The excision process involves the careful removal of all necrotic tissue, including skin, subcutaneous tissue, and muscle, to ensure a clean wound bed. If any bone or bony protuberances are involved, these are also excised, and any rough bony surfaces are smoothed to facilitate proper healing. The edges of the wound are then trimmed, and the site is prepared for the subsequent placement of a muscle or myocutaneous flap or skin graft, which will be reported separately. Common types of flaps utilized in this procedure include the gluteal thigh rotation flap, gluteus maximus muscle flap, or inferior gluteus maximus myocutaneous flap, each chosen based on the specific needs of the patient and the characteristics of the wound.