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Ostomy irrigation supply; cone/catheter, with or without brush

HCPCS code

Name of the Procedure:

Ostomy Irrigation Supply

  • Common Names: Ostomy irrigation, stoma irrigation
  • Technical/Medical Term: Ostomy irrigation supply using cone/catheter, with or without brush (HCPCS Code: A4399)


Ostomy irrigation is a procedure used by some individuals with a colostomy to flush out the colon through the stoma. Using a cone or catheter, the process helps regulate bowel movements and manage waste output, often reducing or eliminating the need for an ostomy pouch.


Ostomy irrigation helps maintain a regular bowel movement schedule for individuals with a colostomy, making life more predictable and comfortable. It can help control and reduce complications like constipation and blockage, providing better overall stoma management.


  • Patients with a colostomy who have a formed stool.
  • Individuals seeking more control over stoma output.
  • Patients without contraindicating conditions such as inflammatory bowel disease or compromised bowel integrity.


  • The patient should follow specific dietary recommendations (e.g., increasing fluid intake) before irrigation.
  • Not necessary to fast, but a consistent time each day for irrigation is recommended.
  • Some patients might need a prior consultation or training from a stoma care nurse.

Procedure Description

  1. Gather supplies: cone/catheter, irrigation bag, water, and optionally, a brush.
  2. Fill the irrigation bag with lukewarm water (typically around 500-1000 mL).
  3. Attach the cone or catheter to the irrigation bag.
  4. Gently insert the cone or catheter into the stoma.
  5. Allow water to flow into the colon through the stoma.
  6. Remove the cone/catheter carefully.
  7. The water and waste material will then evacuate into the toilet or an ostomy bag.


The entire procedure takes approximately 30-45 minutes from preparation to completion.


This procedure is performed at home by the patient, often with initial instruction and supervision from a healthcare provider, such as a stoma nurse.


  • Stoma Nurse (for initial training and guidance)
  • Patient (self-administered procedure)

Risks and Complications

  • Minor risks include irritation or minor trauma to the stoma.
  • Rare risks might include infection or bowel perforation.
  • Complications can be managed with prompt medical attention and proper post-procedure care.


  • Provides predictable bowel movements, often eliminating the need for an ostomy pouch.
  • Enhances the patient's quality of life and comfort.
  • Benefits can often be noticed within a few irrigation sessions as the body adjusts.


  • No significant recovery time needed as it's a routine maintenance procedure.
  • Patients should follow a stable routine and maintain regular irrigation schedules.
  • Report any abnormalities or discomfort to healthcare providers.


  • Using an ostomy pouch without irrigation.
  • Dietary management to regulate stoma output.
  • Medications to manage bowel movements.

Pros of Alternatives:

  • Less time-consuming.
  • Minimal direct intervention with the stoma.

Cons of Alternatives:

  • Less control over bowel movements.
  • Potential for more frequent changing of ostomy pouches.

Patient Experience

  • Patients might feel an initial sensation of pressure or fullness during water instillation.
  • Ensuring the water is at an appropriate temperature helps in comfort.
  • Mild discomfort is possible, but with practice, the procedure typically becomes painless and routine.
  • Proper relaxation and gentle technique are key to a comfortable experience.

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