2025 HCPCS code A4423
(Active) Effective Date: N/A Revision Date: N/A Medical Supplies - Ostomy Pouches and Supplies Medical and Surgical Supplies Feed
Closed ostomy pouch with filter, used with a barrier and locking flange (two-piece system).
Modifiers may apply depending on the circumstances of service. Consult local payer guidelines for specifics.
The medical necessity for A4423 is established by the presence of an ostomy requiring a closed collection system.Documentation supporting the need for this specific type of pouch, considering factors like output, skin condition, and patient preference, is vital for reimbursement.
The clinical responsibility lies with the healthcare provider who determines the appropriate ostomy supply based on patient needs and manages the ostomy care, including education on pouch usage and skin care.
In simple words: This code is for a special bag used after surgery to collect waste from a stoma (an opening in the body). The bag has a filter to reduce odor and a locking system to make it easier to empty.
HCPCS code A4423 represents a closed ostomy pouch designed to collect waste material from a surgically created opening (stoma).This two-piece system includes a pouch with a filter (typically containing activated charcoal to neutralize odor) and a barrier with a locking flange. The locking flange mechanism prevents backflow of waste, allows for emptying the pouch while leaving the barrier in place, and improves hygiene.The adhesive on the barrier secures the system to the patient's skin.
Example 1: A patient with a colostomy receives a new supply of closed ostomy pouches (A4423) following their routine visit with their enterostomal therapist., A patient with an ileostomy experiences leakage from their current ostomy pouch system. Their physician orders a new supply of closed ostomy pouches (A4423) with a higher absorbency capacity for better management of output volume., During a home health visit, the nurse observes that the patient's ostomy pouch system needs to be replaced due to skin irritation around the stoma. The home health agency bills for the replacement with code A4423.
Medical record should include documentation of the type of ostomy (e.g., ileostomy, colostomy), location of the stoma, size and type of pouch, and any related skin conditions.Prescriptions or orders for ostomy supplies are also required.
** The quantity of ostomy supplies billed will be determined by factors such as ostomy type, location, construction, and skin condition.Appropriate documentation is crucial for justifying the quantity billed.
- Payment Status: Active
- Specialties:Ostomy care nurses, surgeons, gastroenterologists, and enterostomal therapy nurses.
- Place of Service:Office, Home Healthcare, Hospital Inpatient, Hospital Outpatient