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 |
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