carotid 2nd order w/lhc

Not too familiar with IR coding. Very new to the carotid area. Could use some direction on this please.

Indications: Patient was referred for cardiac catherization to asses the coronary anatomy. Indications for the procedure include: chest pain and positive stress test.

Procedure details:

The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. patient was further sedated with fentanyl and versed. patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6-french sheath was placed in the right femoral artery. A left heart catherization was done right and left coronary angiograms were also done.

Interventions: no intervention.

After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with Angio-Seal.

Findings:

Hemodynamics LVEDP=16

Left Main: Patent with no angiographic ally significant disease

LAD: 60-70% proximal stenosis. competitive flow from the LIMA graft distally.

RCA: Is occluded proximally. Strong left to right collaterals are noted, mostly from the circumflex distribution.

CIRC: Patent with Mild to moderate disease and 40% stenosis in the proximal and midportion.

SVG: To RCA is occluded.

LIMA to LAD is widely patent.

Selective right common carotid artery angiography was done there was evidence of 90% ostial stenosis to the right internal carotid artery.

LV: LV angio was done and revealed Akinesis involving the proximal and mid inferior wall with moderate left ventricular dysfunction and an estimated ejection fraction in the neighborhood of 40%-45% mitral regurgitation is noted.

I'm wondering how to code the carotid angio.

carotid 2nd order w/lhc