2025 CPT code 15999
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Integumentary System - Pressure Ulcers (Decubitus Ulcers) Procedures Surgery Feed
Unlisted procedure, excision of pressure ulcer.
Modifiers may apply depending on the complexity of the procedure and any additional services provided. For example, modifier 22 (increased procedural services) may be appropriate if the work involved significantly exceeds what is normally expected for a similar excision, while modifier 59 (distinct procedural service) might be used if other procedures were performed on the same day.Consult the CPT manual and payer guidelines for appropriate modifier use.
Medical necessity for excision of a pressure ulcer is established when conservative measures have failed to resolve the ulcer and there is evidence of ongoing tissue damage, infection, or significant impairment of function. The documentation should include details about the unsuccessful conservative treatment and clear justification for surgical intervention.
The physician's responsibility includes complete excision of the pressure ulcer, meticulous hemostasis, appropriate wound closure technique, and ensuring the patient's safety and well-being.Detailed documentation of all steps taken is crucial.
- Surgery
- Surgery > Surgical Procedures on the Integumentary System > Pressure Ulcers (Decubitus Ulcers) Procedures
In simple words: This code is used when a doctor removes a pressure sore (bed sore) and there isn't a more specific code to describe exactly what they did.The doctor must write down everything they did very carefully so the insurance company knows it was necessary and can pay for it.
CPT code 15999 is utilized for the excision of pressure ulcers when no other specific CPT code accurately reflects the procedure performed.This is an unlisted procedure code used when the performed procedure is unique or uncommon and doesn't fit into existing CPT codes. Comprehensive documentation detailing the procedure is mandatory for accurate billing and reimbursement.
Example 1: Excision of a 5cm stage III pressure ulcer on the sacrum, requiring extensive debridement of necrotic tissue and layered closure with interrupted sutures., Excision of a 2cm stage II pressure ulcer on the heel, with undermining and requiring flap closure., Excision of a 3cm complex pressure ulcer on the trochanter, involving significant bone exposure, requiring extensive debridement and complex closure techniques.
Detailed operative report including:
** Always attempt to use a more specific CPT code before resorting to 15999.Thorough documentation supporting the medical necessity of the procedure is paramount for reimbursement. The use of this code must be justified clearly and comprehensively in the accompanying documentation.
- Revenue Code: P1G (Major Procedure - Other)
- RVU: Reimbursement varies widely and depends on factors such as location, size, depth of the ulcer, complexity of the procedure, and additional services rendered.Documentation is key to justifying reimbursement.Relative Value Units (RVUs) are not directly assigned to this unlisted code.
- Global Days: The global surgical period for this unlisted code is not specifically defined and would depend on the complexity of the procedure and any associated services.
- Payment Status: Active, but reimbursement requires detailed documentation.
- Modifier TC rule: A technical component (TC) modifier would not typically apply to this code as it represents the entire service of excision.
- Fee Schedule: Reimbursement for CPT 15999 is not standardized; it is dependent on detailed documentation and payer-specific policies.Historical fee schedules are not readily available for unlisted codes.
- Specialties:Podiatry, General Surgery, Plastic Surgery
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center, Skilled Nursing Facility