cardiology coding

Can someone help me code this op note?

PROCEDURES PERFORMED: 1. Arterial access. 2. LH catheterization. 3. Coronary angiography. 4. Aortic root angiography. 5. Left ventriculography was not performed. 6. RH catheterization.
PREOPERATIVE DIAGNOSIS: See below.

ACCESS SITE: Right common femoral arterial access.

INDICATIONS: Chest Pain

PROCEDURE: After informed consent, the patient was brought to the Cardiac Catheterization Laboratory n.p.o. where the right groin was prepared in aseptic fashion. 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. 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.

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.

A left subclavian angiography was performed and LIMA was visualized. First branch order (left subclavian) catheter placement was performed. Manual compression was used to obtain hemostasis. 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. Total amount of contrast utilized, 90 cc.

There is severe calcification noted bilaterally. This can be seen under fluoroscopy. Tortuous abdominal aorta was noted.


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