I need a little bit more information to help you. What was removed? Was it the pacemaker generator and leads or just the generator? What was implanted? Generator only or a whole new unit; generator with the leads. If leads were implanted how many, single or dual? In your scenerio you can bill for both the removal and implant of the device, just need to know exactly what was done.
You are kinda on the right track, coding for fluoroscopy guidance but the code is wrong. Only one fluoroscopy code is used for both the pacemaker and ICD implants; 71090-26.
Pacemakers and ICD removals and implants have a 90 day global period, therefore you cannot bill an observation code the day of the surgery or hospital visits following the implant.
Hope this makes sense,
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