Card Cath

Hi, I am new to Cardiology coding. Can anyone tell me how to code the following?
Arterial access
Left Heart Catheterization
Coronary Angiography
Aortic Root Angiography
Right Heart Catheterization

DX: Severe Calcification bilaterally
Tortuous abdominal aorta


I thought it might be 93460-26, 93567
Thank you so much!

Here is the op note:

PROCEDURES PERFORMED:
1. Arterial access.
2. Left heart catheterization.
3. Coronary angiography.
4. Aortic root angiography.
5. Left ventriculography was not performed.
6. Right heart catheterization.

PREOPERATIVE DIAGNOSIS: See below.

POSTOPERATIVE DIAGNOSIS:

ACCESS SITE: Right common femoral arterial access.

CATHETERS USED: JL4, JR4, angled pigtail. All exchanges over the wire.

Prior to procedure, risk and benefits discussed, risk of bleeding, perforation, renal failure, cerebrovascular accident, myocardial infarction, emergent need of surgery, thrombosis discussed. Before the procedure, I introduced myself to the patient and the family discussed the procedure, risks and benefits, went over lab data information provided to me and also discussed the case with the referring cardiologist.

INDICATIONS: Chest Pain

PROCEDURE: After informed consent was taken, the patient was brought to the Cardiac Catheterization Laboratory n.p.o. state where the right groin was prepared in the usual aseptic fashion. The patient was premedicated with 25 mg intravenous Demerol, 1 mg intravenous Versed, and 2% Xylocaine solution was used for local anesthesia. A French arterial sheath was introduced into the right femoral artery utilizing the modified Seldinger technique its lumen was appropriately flushed. Selective right and left coronary arteriography was then carried out using a JR4 and a JL4 coronary catheters and multiple views were taken. At the end of the procedure, these catheters including the right femoral sheath were removed and hemostasis was achieved by local compression. The patient tolerated the procedure well. There were no immediate complications noted.
FINDINGS:

CARDIOLOGY:
1. ANGIO-SEAL:
2. LEFT MAIN:
3. LEFT ANTERIOR DESCENDING: Tapered, 40% stenosis.
4. LEFT CIRCUMFLEX: Mid 80% stenosis.
5. RIGHT CORONARY ARTERY: Totally occluded.
6. LEFT VENTRICLE:
Right heart cath shows RA of 5, RV of 52/2, PA of 60/13, mean of 26. Pulmonary capillary wedge pressure of 20. Cardiac output is 2.8. Cardiac index is 1.9. Pulmonary and venous oxygen saturations were drawn.

Coronary artery shows that left main is severely calcified. I was unable to cross the valve. 2000 units of heparin was given. There was no complication.

I did a left subclavian angiography and LIMA was visualized. First branch order (left subclavian) catheter placement was performed. Manual compression was used to obtain hemostasis. Findings were discussed with the patient and family. The patient will be referred for a three-vessel coronary artery bypass graft surgery and aortic valve replacement to Dr. Afifi. The patient, because of mild renal insufficiency, will be given Mucomyst. He was given Mucomyst prior and also IV hydration. Repeat BMP after 48 hours to document the renal functions and to avoid any direct nephrotoxic action of contrast material will be reassessed. Prescription for BMP written. Total amount of contrast utilized, 90 cc.

Of remarkable notice, there is severe calcification noted bilaterally. This can be seen under fluoroscopy. Tortuous abdominal aorta was noted.

PLAN: At this time, I would like to you for allowing me to take care of this patient.


CPT® Code(s):

ICD-9 Code(s):

re: Card Cath

Hi, I coded this as
CPT: 93460-26,93567
ICD-9: 786.50,429.2, 424.1
Does anyone know if this is correct or not?
Thank you for all your help!