Ask Dr. Z

I need help coding this case. "Patient is having pacemaker system removed due to infection. A temporary pacemaker was placed via the right femoral vein, and an active-fixation (screw-in) lead was attached to an externalized pacemaker via the right IJ vein. ICE was performed during the procedure, visualizing the right ventricular lead during the extraction. Leads were clearly adherent to the subclavian/innominate veins. After removing the right ventricular lead, contrast was injected in the innominate vein, demonstrating a tear in the distal third of the vein. Atrial lead was then removed. I elected to place a covered Wallstent covering the entire innominate vein. Pocket was irrigated with antibiotic solution, and wound VAC was applied." I was thinking about reporting codes 33233 pacemaker removal, 33235 lead removal dual system, 33216-59 fixation (screw-in) lead, and 97605 for wound VAC. I don’t think ICE can be reported due to no primary procedure code associated with it being billed. Also, I'm thinking that the stent placement would be inclusive with procedure due to perforation created by physician, but I'm not sure. Thoughts?