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Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each

HCPCS code

Name of the Procedure:

Ostomy Skin Barrier Application (A4409)

  • Common Names: Ostomy Skin Barrier, Adhesive Skin Barrier
  • Technical Terms: Ostomy Skin Barrier with Flange, Extended Wear, Non-Convex, 4 x 4 inches or smaller


An ostomy skin barrier, typically made from a flexible, adhesive material, is used to protect the skin and secure an ostomy pouch for patients with stomas. This particular type of barrier is designed for extended wear and does not include built-in convexity.


Medical Conditions Addressed:

  • Protects the skin around the stoma.
  • Provides a secure attachment for the ostomy pouch, ensuring leakage control and hygiene.


  • Minimize skin irritation and prevent leakage.
  • Ensure patient comfort and confidence in managing their stoma.


  • Presence of a stoma due to surgical procedures such as colostomy, ileostomy, or urostomy.
  • Patients requiring an extended wear barrier without built-in convexity.
  • Patients needing a barrier size 4 x 4 inches or smaller.


Pre-Procedure Instructions:

  • Clean the stoma and surrounding skin according to healthcare provider guidelines.
  • Ensure the skin is dry and free from oils and lotions to guarantee proper adhesion.


  • Regularly inspect the stoma and peristomal skin for any signs of irritation or infection.

Procedure Description

  1. Skin Cleaning: The area around the stoma is cleaned and dried.
  2. Barrier Preparation: The skin barrier is measured and cut to fit the stoma size.
  3. Application: The backing is removed, and the barrier is aligned and adhered around the stoma.
  4. Pouch Attachment: The ostomy pouch is attached to the flange of the skin barrier.

Tools and Equipment:

  • Ostomy skin barrier.
  • Cleaning supplies (e.g., water, soap, and wipes).
  • Scissors to cut the barrier to size.


  • The application process typically takes about 10-15 minutes.


  • This can be performed at home, in an outpatient clinic, or within a healthcare facility.


  • Patients or caregivers at home.
  • Nurses or specialized ostomy care professionals in clinical settings.

Risks and Complications

Common Risks:

  • Skin irritation or allergic reactions to the adhesive.
  • Potential for leaks leading to skin damage.

Rare Complications:

  • Infection at the stoma site.
  • Significant skin breakdown requiring medical intervention.


  • Securely attaches the ostomy pouch, preventing leaks.
  • Protects the skin, promoting comfort and confidence.
  • Extended wear reduces the need for frequent changes, thereby lowering the risk of skin damage.


Post-Procedure Care:

  • Monitor skin and stoma for signs of irritation or infection.
  • Change the barrier as recommended by healthcare providers, usually every few days.

Expected Recovery Time:

  • Immediate improvement in comfort and leak prevention.


  • Regular follow-up with an ostomy care nurse or healthcare provider, especially if any issues arise.


Other Options:

  • Convex skin barriers for irregular stoma shapes.
  • Customized ostomy appliances.
  • Non-adhesive barriers with separate holding belts.

Pros and Cons:

  • Convex Barriers: Better fit for some stomas but may be uncomfortable for some patients.
  • Non-Adhesive Barriers: Less skin irritation but may not offer as secure attachment.

Patient Experience

During Procedure:

  • Generally painless, mild discomfort may occur while handling the stoma.

After Procedure:

  • Patients might feel more secure and confident in their day-to-day activities.
  • Skin should feel protected without irritation if the barrier is applied correctly.
  • Any discomfort from the adhesive is typically minimal and short-lived.

Pain Management:

  • Over-the-counter ointments for minor skin irritation.
  • Consultation with a healthcare provider for any persistent discomfort or issues.

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