RETIRED - Tracheostomy Care Kit - Coding Guidelines

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Original Effective Date: 11/05/2009
Revision Effective Date: 11/01/2013

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 the following:

Item Number Included
tube brush 1
pipe cleaners 2
cotton tip applicators 2
twill tape 30 inches
4x4 sponges 2

 

            Last Updated Thu, 10 Jan 2019 13:23:44 +0000