TRACHEOSTOMY CARE KIT - CODING GUIDELINES


Codes A4625 (Tracheostomy care kit for new tracheostomy) and A4629 (Tracheostomy care kit for established tracheostomy) describe supplies that are used to maintain a tracheostomy tube including the tracheostomy site.  The items listed below are essential items that must be included in a tracheostomy care kit but may not be all-inclusive of items that meet the patient’s needs. Quantities of items in excess of those listed and/or additional items (e.g. other types of surgical dressings) are included in the kit codes and may not be billed separately.  Items included in these codes are not limited to pre-packaged “kits” bundled by manufacturers or distributors.

A tracheostomy care kit for a new tracheostomy (A4625) contains, at a minimum, the following:

Item

Number included

plastic tray

1

basin

 

1

sterile gloves

1 pair

tube brush

1

pipe cleaners

3

pre-cut tracheostomy dressing

1

gauze

1 roll

4x4 sponges

 

4

cotton tip applicators

2

twill tape

 

30 inches

A tracheostomy care kit for an established tracheostomy (A4629) contains, at a minimum the following:

Item

Number included

tube brush

1

pipe cleaners

2

cotton tip applicators

2

twill tape

30 inches

4x4 sponges

2

Published by Noridian as the PDAC, November 2009.  Republished by Palmetto GBA as the PDAC, February 2019.  Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.



Last Updated: 11/03/2009