Retired - 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 |
| Date | Update |
|---|---|
| 11/03/2009 | Published on PDAC website |
| 01/10/2019 | Retired – content incorporated into the applicable Local Coverage Determination or related Policy Article |