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Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each

HCPCS code

Name of the Procedure:

Ostomy Pouch, Closed; for Use on Barrier with Locking Flange, with Filter (2 Piece)

  • Common Name: Ostomy Pouch Change
  • Medical Term: Ostomy Appliance Replacement (Code: A4423)


An ostomy pouch change involves replacing an existing ostomy pouch with a new, closed-end ostomy pouch that attaches to a skin barrier with a locking flange and includes a filter. The process helps manage waste from a stoma, which is an opening in the abdomen created surgically for waste to be expelled from the body.


An ostomy pouch change addresses the need for safe and hygienic management of waste in patients with a colostomy, ileostomy, or urostomy. The goals are to prevent leaks, reduce odor, and ensure comfort and skin protection around the stoma.


  • Presence of a stoma from surgery (e.g., colostomy, ileostomy, urostomy)
  • Need for waste collection and odor control
  • A leaking or full current pouch
  • Skin irritation around stoma due to the existing pouch


  • Ensure all materials (new pouch, barrier with locking flange, cleaning supplies) are prepared
  • Wash hands thoroughly
  • Optionally, ensure the room is well-lit and comfortable
  • No specific fasting or medication adjustments

Procedure Description

  1. Clean the area around the stoma with warm water and a mild soap.
  2. Remove the existing pouch gently to avoid skin irritation.
  3. Clean the stoma and surrounding skin thoroughly, ensuring no residue is left.
  4. Dry the skin completely before attaching the new barrier.
  5. Attach the new barrier (with locking flange) securely around the stoma.
  6. Click the new closed-end pouch onto the locking flange until it is firmly in place.
  7. Ensure the filter is functional and properly aligned.


The procedure typically takes about 15-30 minutes.


  • Home (self-care)
  • Outpatient clinic
  • Hospital


  • Patient or trained caregiver
  • Nurses (if in a clinical setting)

Risks and Complications

  • Skin irritation or damage around the stoma
  • Leakage or improper sealing of the pouch
  • Infection from improper hygiene
  • Rare: Allergic reaction to the materials


  • Improved hygiene and waste management
  • Enhanced comfort and mobility
  • Reduced odor and leakage, improving quality of life
  • Immediate benefit with a properly attached new pouch


  • No specific recovery time
  • Regular monitoring of the stoma and surrounding skin
  • Follow-up appointments as needed if there are issues


  • One-Piece Ostomy Systems: Simpler but less adjustable
  • Different Ostomy Pouch Brands or Types: Various features to suit individual needs
  • Surgical Revision of Stoma: If severe issues persist

Patient Experience

  • Minimal discomfort or pain during the procedure, primarily around the stoma area
  • Feeling of cleanliness and confidence after a successful change
  • Adjustments may be needed for comfort
  • Access to pain relief creams if skin irritation occurs

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