Billing, Coding, and Credentialing in the Thoracic Surgery Practice David T. Cooke, MD, FCCP a , Gary A.J. Gelfand, MD, MSc, FRCSC b , Joshua A. Broghammer, MD c, * For a trainee, embarking on a career in thoracic surgery represents a lifelong commitment to patient care, learning, and professional development. The current training paradigm, whether it be traditional surgical training followed by an independent tho- racic surgery residency or an integrated 6-year thoracic surgery residency program, provides the graduate with a broad palette of clinical and surgical skills necessary to address the needs of patients. After years of intense and focused study, caring for patients may be the easiest transition one has to make at the start of practice. North American thoracic residencies produce trainees well versed in the practice of thoracic medicine. However, despite expert teaching, access to new technology, cutting-edge research, and use of state-of-the-art techniques, many fall short in areas of practice management. The discussion of money and politics is often implicitly taboo in academic medicine, leaving recent graduates ill equipped to navigate the bureaucracy associated with the credentialing process and the barriers created by third-party payers when it comes to billing and coding ap- propriate patient services. In a sense, entering into practice may transform one from a qualified and competent medical practitioner to an often ill-prepared business associate. This situation has impacts on all practice models, whether academic or private, large or small. This article is a guide to educate recent graduates and new hires on the process of hospital credentialing; it provides an introduction to the myriad of terms for billing and coding services, and discusses a means to obtain privileges for new technology, drawing compari- sons with the health care systems of the United States and Canada. LICENSING AND CREDENTIALING The process of becoming fully licensed and creden- tialed can pose frustrations and challenges for both recent graduates and well-established thoracic surgeons who are transitioning to new practices. To the casual observer, the requirements often seem repetitive, overly complex, and nonintuitive. In addition, unanticipated delays in the processing of application documents can prevent one from starting practice with little control to remedy the situation. The primary reason for the time and complexity associated with licensure and credentialing is the requirement for primary, source-verified docu- ments (Box 1). Most graduates have a linear Financial statement: The authors have no personal financial interest to disclose. a Division of Cardiothoracic Surgery, University of California, Davis Medical Center, 2221 Stockton Boulevard, Room 2117, Sacramento, CA 95817-2214, USA b Division of Thoracic Surgery, Foothills Medical Centre, University of Calgary, Room G33, 1403–29th Street NW, Calgary, Alberta, Canada T2N 2T9 c Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3016, Kansas City, KS 66160, USA * Corresponding author. E-mail address: jbroghammer@kumc.edu KEYWORDS  Thoracic  Coding  Billing  Licensing  Credentialing Thorac Surg Clin 21 (2011) 349–358 doi:10.1016/j.thorsurg.2011.04.003 1547-4127/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved. thoracic.theclinics.com