Ask Dr. Z

For the following case, would we report codes 33241 and 33207? "Patient had downgrade of an ICD generator at ERI to a pacemaker due to normalization of ejection fraction and new RV lead due to lead fracture. An incision was made along the old pocket, which was opened under sterile condition. The old generator was removed. The leads were partially dissected, then the RV lead was cut and capped. 10 mL of contrast was injected in the left brachial vein to visualize the left axillary vein… Introducer wire was removed, and the sheath was used to place a pacing lead in the low septal area using active fixation. Pacing and sensing thresholds were obtained, after which the sheath was removed and the leads were sutured to the pectoral fascia around the sleeve. The new RV lead and the old atrial lead were connected to new generator. Generator and leads were positioned in an antibiotic pocket and then placed in the subcutaneous pocket, which was irrigated with Ancef solution and closed in four layers."