Thoracoscopy converted to an open operation

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare respiratory or cardiovascular professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Operative plan

A fictional adult has a planned therapeutic thoracoscopic operation on the left side of the chest. The indication and therapeutic plan are established before the operation. This is not a diagnostic-only examination to decide whether treatment is needed.

Procedure course

The surgeon starts the therapeutic thoracoscopic work, encounters a limitation that prevents completing it through that approach and converts to an open operation. The same intended treatment is completed through the open approach during the same encounter.

Anatomical relationship

All of the described work concerns the same left thoracic operative field. No separate right-sided procedure is performed. The report preserves the attempted approach, the reason for conversion and the completed operation.

Claim review

The proposed claim lists the open operation and the attempted thoracoscopic procedure. An alternate worksheet substitutes diagnostic thoracoscopy for the attempted surgical service. The learner must apply the explicit thoracoscopy conversion rule, without importing a different organ’s example.

Your coding worksheet

Identify the completed approach.
Distinguish a therapeutic conversion from a diagnostic decision.
Evaluate both proposed thoracoscopy lines.
Locate the completed open procedure in the authorized book.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The open approach completes the operation.
The record describes attempted therapeutic work, not a separate diagnostic decision-making examination.
Under NCCI C.15, neither the attempted surgical thoracoscopy nor a relabeled diagnostic thoracoscopy is added to that conversion.
Use the full operative details for the completed open entry and preserve the conversion in the documentation.

Reference sections: C.15

Practice the linked chart questions