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Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each

HCPCS code

Name of the Procedure:

Ostomy Pouch Application (A4417)

  • Common name: Closed Ostomy Pouch with Barrier
  • Technical terms: Closed Ostomy Pouch with Built-in Convexity and Filter (1 piece)


An ostomy pouch is a medical device used to collect waste from a surgically created stoma. This type of pouch is a one-piece system that includes a barrier with convexity and a filter to manage gas, making it convenient and comfortable for the patient.


This device addresses the needs of patients with ostomies due to conditions such as colorectal cancer, Crohn's disease, or diverticulitis. The goal is to provide a secure, comfortable, and hygienic way to manage stoma output.


  • Colorectal cancer
  • Crohn's disease
  • Ulcerative colitis
  • Diverticulitis
  • Patients who have undergone ostomy surgery and require an efficient waste management system


  • Ensure the skin around the stoma is clean and dry.
  • Trim the pouch aperture to fit the size of the stoma if not pre-sized.
  • Assess for any skin sensitivities or need for additional protective barriers.

Procedure Description

  1. Clean the stoma and surrounding skin with warm water and mild soap, and then pat dry.
  2. Remove the adhesive backing from the pouch.
  3. Center the pouch opening over the stoma.
  4. Press down firmly to attach the adhesive barrier to the skin, ensuring a secure fit.
  5. Smooth out any wrinkles for a snug, leak-proof seal.
  6. Make sure the filter is positioned correctly to manage gas without odor.


The application of an ostomy pouch typically takes about 5-10 minutes.


The procedure can be done at home or in an outpatient clinic setting.


  • Primarily performed by the patient or a caregiver.
  • Nurses or ostomy care specialists may assist or provide initial training.

Risks and Complications

  • Skin irritation or breakdown around the stoma.
  • Leakage or odors if the pouch is not fitted correctly.
  • Infections if the area is not kept clean.


  • Improved quality of life through reliable waste management.
  • Increased comfort due to secure fit and built-in filter.
  • Enhanced convenience with a one-piece system.


  • Immediate use after application.
  • Regular monitoring and changing of the pouch as needed.
  • Follow-up with healthcare providers for ongoing stoma care and management.


  • Two-piece ostomy systems with separate pouches and barriers.
  • Reusable ostomy pouches.
  • Non-convex pouches for stomas that do not require additional support.

Patient Experience

Patients may feel apprehensive initially but typically find the procedure straightforward with practice. Pain is generally not an issue, but skin irritation can occur, which can be managed with proper skincare products and techniques.

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