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

Synthetic hospital operative record, September 9, 2026. An adult with biopsy-confirmed adenocarcinoma of the left upper lung lobe is scheduled for therapeutic thoracoscopic left upper lobectomy. The decision to remove the lobe is established before the operation.

Signed operative course

The surgeon places thoracoscopic ports and begins mobilizing the left upper lobe. Dense adhesions prevent safe exposure through that approach. The surgeon converts to a left thoracotomy and completes the left upper lobectomy during the same operation.

Completion record

The report identifies the removed lobe, documents hemostasis and closure, and preserves the reason for conversion. No right-sided operation or independent diagnostic thoracoscopy is performed. The initial inspection belongs to the planned therapeutic procedure.

Claim review

A draft lists completed open lobectomy plus attempted surgical thoracoscopy. An alternative adds diagnostic thoracoscopy in place of the therapeutic attempt. Apply the Medicare NCCI thoracoscopy conversion rule before selecting the full current entry for the completed open operation.

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