Surgery scheduling checklists are key to successful surgery schedule management. Take a chapter from Dr Gawande’s “checklists”.
The preoperative and postoperative surgery scheduling checklists help you manage each individual patient’s surgery scheduling process. Use a master checklist to manage surgical plans per surgical center, per surgery day, per provider.
Surgery scheduling checklist
Here’s a high level preoperative surgery scheduling checklist to use. I suggest you use a surgical scheduling software or a spreadsheet for this.
Postoperative
The postoperative surgical workflow includes the following:
- Surgery postoperative note by the surgeon.
- Postoperative orders by surgeon. This could include procedures, laboratory, diagnostics, medication, nutrition, postoperative followup appointments, transition of care referral order(s).
- Billing for the surgery procedure.
You can handle these manually, with a spreadsheet, or a surgical workflow management system.
Surgical scheduling plan
My advice is to organize surgery scheduling using checklists or a dedicated surgery scheduling software.
Organize your surgery scheduling process for multiple providers using a checklist like below.
Legend (you can use your own):
- All signatures obtained – Sig
- Payment guarantee obtained – Pay
- All clearances obtained – PAT
- Medications ordered – RX
- All histories, medications reconciled – Hist
- Preop, SX, Postop dates booked – Appt
- Surgery packet prepared – Order
Comprehensive surgical scheduling checklist
Here’s a format you can follow / change according to your needs.
Task id | Parent Task Id | Depends on task id | Task Title | Suggested due dates |
---|---|---|---|---|
1 | Surgery care plan for pt 1234 | |||
2 | 1 | 1 | Place Surgical procedure order | |
3 | 2 | 2 | Send fax for Surgical procedure order precertification | Date the order was created, due by 5 pm |
4 | 2 | 3 | Update surgical procedure order with precertification proof | Above date + 3 days , 5 pm |
5 | 2 | 4 | Notify patient about precertification approval status | Above date + 1 day , 5 pm |
6 | 2 | 5 | Send fax for Surgical procedure order prior authorization | Same as above |
7 | 2 | 6 | Update surgical procedure order with prior authorization proof | Above date + 7 days , 5 pm |
8 | 2 | 7 | Notify patient about prior authorization approval status | Above date + 1 day , 5 pm |
9 | 1 | Place Laboratory procedure order | ||
10 | 9 | Send fax for laboratory procedure order precertification | Date the order was created, due by 5 pm | |
11 | 9 | Update laboratory procedure order with precertification proof | Above date + 3 days , 5 pm | |
12 | 9 | Notify patient about precertification approval status | Above date + 1 day , 5 pm | |
13 | 9 | Send fax for laboratory procedure order prior authorization | Same as above | |
14 | 9 | Update laboratory procedure order with prior authorization proof | Above date + 7 days , 5 pm | |
15 | 9 | Notify patient about prior authorization approval status | Above date + 1 day , 5 pm | |
16 | 9 | Send fax for laboratory procedure request | Above date + 1 day , 5 pm | |
17 | 9 | Update laboratory procedure request order with appointment date | Above date + 1 day , 5 pm | |
18 | 9 | Notify patient about laboratory procedure appointment date | Above date + 1 day , 5 pm | |
19 | 9 | Send patient reminders about laboratory procedure appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | |
20 | 9 | Send patient laboratory procedure appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days , 8 am | |
21 | 9 | Send patient reminders about laboratory procedure appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | |
22 | 9 | Send fax for laboratory procedure results | This task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm | |
23 | 9 | Update laboratory procedure request order with laboratory results | This task can be created only if an appointment date is received. Above date plus 1 day, 5 pm | |
24 | Place imaging procedure order | |||
25 | Send fax for imaging procedure order precertification | Date the order was created, due by 5 pm | ||
26 | Update imaging procedure order with precertification proof | Above date + 3 days , 5 pm | ||
27 | Notify patient about precertification approval status | Above date + 1 day , 5 pm | ||
28 | Send fax for imaging procedure order prior authorization | Same as above | ||
29 | Update imaging procedure order with prior authorization proof | Above date + 7 days , 5 pm | ||
30 | Notify patient about prior authorization approval status | Above date + 1 day , 5 pm | ||
31 | Send fax for imaging procedure request | Above date + 1 day , 5 pm | ||
32 | Update imaging procedure request order with appointment date | Above date + 1 day , 5 pm | ||
33 | Notify patient about imaging procedure appointment date | Above date + 1 day , 5 pm | ||
34 | Send patient reminders about imaging procedure appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
35 | Send patient imaging procedure appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days , 8 am | ||
36 | Send patient reminders about imaging procedure appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
37 | Send fax for imaging procedure results | This task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm | ||
38 | Update imaging procedure request order with laboratory results | This task can be created only if an appointment date is received. Above date plus 1 day, 5 pm | ||
39 | Place Medical clearance referral order | |||
40 | Send fax for Medical clearance referral order | Date the order was created, due by 5 pm | ||
41 | Update medical clearance request order with appointment date | Above date + 3 days , 5 pm | ||
42 | Notify patient about medical clearance appointment date | Above date + 1 day , 5 pm | ||
43 | Send patient reminders about medical clearance appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
44 | Send patient medical clearance appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days , 8 am | ||
45 | Send patient reminders about medical clearance appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
46 | Send fax for medical clearance results | This task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm | ||
47 | Update medical clearance request order with laboratory results | This task can be created only if an appointment date is received. Above date plus 1 day, 5 pm | ||
48 | Place specialist clearance referral order | |||
49 | Send fax for specialist clearance order precertification | Date the order was created, due by 5 pm | ||
50 | Update specialist clearance order with precertification proof | Above date + 3 days , 5 pm | ||
51 | Notify patient about precertification approval status | Above date + 1 day , 5 pm | ||
52 | Send fax for specialist clearance order prior authorization | Date the order was created, due by 5 pm | ||
53 | Update specialist clearance order with prior authorization proof | Above date + 3 days , 5 pm | ||
54 | Notify patient about prior authorization approval status | Above date + 1 day , 5 pm | ||
55 | Send fax for specialist clearance referral order | Date the order was updated, due by 5 pm | ||
56 | Update specialist clearance request order with appointment date | Above date + 3 days , 5 pm | ||
57 | Notify patient about specialist clearance appointment date | Above date + 1 day , 5 pm | ||
58 | Send patient reminders about specialist clearance appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
59 | Send patient specialist clearance appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days , 8 am | ||
60 | Send patient reminders about specialist clearance appointment prerequisites | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
61 | Send fax for specialist clearance results | This task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm | ||
62 | Update specialist clearance request order with laboratory results | This task can be created only if an appointment date is received. Above date plus 1 day, 5 pm | ||
63 | Place pre operative Medication order | |||
64 | Send fax for preop medication order precertification | |||
65 | Update preop medication order with precertification proof | |||
66 | Notify patient about precertification approval status | |||
67 | Send fax for preop medication order prior authorization | |||
68 | Update preop medication order with prior authorization proof | |||
69 | Send fax for medication order | |||
70 | Notify patient about prior authorization approval status and RX order | |||
71 | Ask patient about RX fill status | |||
72 | Update medication order with RX fill status | |||
73 | Send patient reminders about pre op medications adherence | Each day the medication order is valid for | ||
74 | Place Device order | |||
75 | Send fax for surgery device order precertification | |||
76 | Update surgery device order with precertification proof | |||
77 | Notify patient about precertification approval status | |||
78 | Send fax for surgery device order prior authorization | |||
79 | Update surgery device order with prior authorization proof | |||
80 | Place Transportation order | |||
81 | Send fax for transportation order precertification | |||
82 | Update transportation order with precertification proof | |||
83 | Notify patient about transportation approval status | |||
84 | Send fax for transportation order prior authorization | |||
85 | Update transportation order with prior authorization proof | |||
86 | Notify patient about prior authorization approval status | |||
87 | Send fax for transportation order | |||
88 | Update transportation request order with appointment date | |||
89 | Notify patient about transportation appointment date | |||
90 | Send patient reminders about transportation appointment | |||
91 | Send transportation provider reminders about transportation appointment | |||
92 | Place surgery appointment request order | |||
93 | Send fax for surgery appointment request order | Date the order was created, due by 5 pm | ||
94 | Update surgery appointment request order with appointment date | Above date + 3 days , 5 pm | ||
95 | Notify patient about surgery appointment date | Above date + 1 day , 5 pm | ||
96 | Send patient reminders about surgery appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
97 | Send surgery partner reminders about surgery appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
98 | Send surgery provider reminders about surgery appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
99 | Send device product rep reminders about surgery appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
100 | Place surgery preoperative appointment request order | |||
101 | Update surgery preoperative appointment request order with appointment date | |||
102 | Notify patient about surgery preoperative appointment date | |||
103 | Send patient reminders about surgery preoperative appointment | |||
104 | Place preoperative NutritionOrder | |||
105 | Notify patient about preoperative nutrition instructions | Date the order was created, due by 5 pm | ||
106 | Remind patient about preoperative nutrition instructions adherence | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
107 | Place COVID clearance referral order | |||
108 | Send fax for COVID clearance appointment request order | Date the surgery date was finalized / updated, due by 5 pm | ||
109 | Update COVID clearance request order with appointment date | Above date + 3 days , 5 pm | ||
110 | Notify patient about COVID clearance appointment date | Above date + 1 day , 5 pm | ||
111 | Send patient reminders about COVID clearance appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
112 | Send fax for COVID clearance results | Date the clearance appointment order was updated, due by 5 pm | ||
113 | Update COVID clearance request order with COVID lab results | Above date + 3 days , 5 pm | ||
114 | Update surgery center with COVID clearance report | Above date + 1 day , 5 pm | ||
115 | Update post-operative results | |||
116 | Update actual surgery procedures performed | Surgery date + 1 day, due by 5 PM | ||
117 | Update post-operative diagnoses | Surgery date + 1 day, due by 5 PM | ||
118 | Update operative complications | Surgery date + 1 day, due by 5 PM | ||
119 | Update implants / devices administered | Surgery date + 1 day, due by 5 PM | ||
120 | Update specimens collected | Surgery date + 1 day, due by 5 PM | ||
121 | Update anesthesia medications administered | Surgery date + 1 day, due by 5 PM | ||
122 | Update tissues replaced | Surgery date + 1 day, due by 5 PM | ||
123 | Update estimated blood loss | Surgery date + 1 day, due by 5 PM | ||
124 | Update findings | Surgery date + 1 day, due by 5 PM | ||
125 | Place follow up post operative appointments orders | Surgery date + 1 day, due by 5 PM | ||
126 | Place surgery post-operative appointment request order | |||
127 | Update surgery post-operative appointment request order with appointment date | Surgery date + 3 day, due by 5 PM | ||
128 | Notify patient about surgery post-operative appointment date | Above date + 1 day, due by 5 PM | ||
129 | Send patient reminders about surgery post-operative appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
130 | Place post-operative NutritionOrder | |||
131 | Notify patient about post-operative nutrition instructions | Surgery date + 1 day, due by 5 PM | ||
132 | Remind patient about post-operative nutrition instructions adherence | Surgery date + each day the nutrition order is valid for | ||
133 | Place post-operative Medication order | |||
134 | Send fax for post-operative medication order precertification | Surgery date + 1 day, due by 5 PM | ||
135 | Update post-operative medication order with precertification proof | Surgery date + 3 day, due by 5 PM | ||
136 | Notify patient about precertification approval status | Above date + 1 day, due by 5 PM | ||
137 | Send fax for post-operative medication order prior authorization | Above date + 1 day, due by 5 PM | ||
138 | Update post-operative medication order with prior authorization proof | Above date + 3 day, due by 5 PM | ||
139 | Send fax for medication order | Above date + 1 day, due by 5 PM | ||
140 | Notify patient about prior authorization approval status and RX order | Above date + 1 day, due by 5 PM | ||
141 | Ask patient about RX fill status | Above date + 1 day, due by 5 PM | ||
142 | Update medication order with RX fill status | Above date + 1 day, due by 5 PM | ||
143 | Send patient reminders about post-operative medications adherence | Each day medication order is active | ||
144 | Place transition of care referral request order | |||
145 | Update transition of care appointment request order with appointment date | Surgery date + 1 day, due by 5 PM | ||
146 | Notify patient about transition of care referral appointment date | Surgery date + 1 day, due by 5 PM | ||
147 | Send patient reminders about transition of care referral appointment | This task can be created only if an appointment date is received. Appt date minus 7 days, appt date minus 3 days, appt date 8 am | ||
148 | Send fax for transition of care consult note | Appointment date + 1 day, due by 5 PM | ||
149 | Update transition of care request order with visit note results | Appointment date + 3 day, due by 5 PM | ||
150 | Place specimen analysis request order |
Best practices
Following is based on my experience of managing a high volume of surgeries.
- Use surgery scheduling checklists – a surgery scheduling software works best. Try to eliminate spreadsheets or paper based scheduling.
- A large part of the surgical scheduling process can be automated using software. Automate surgery scheduling as much as possible and reduce paper forms wherever possible.
- Handle medication reconciliation with utmost care – this would also take care of patient allergies. This would help you organize and optimize your surgery block times.
- Collaborate between various teams – Surgical scheduling success depends on collaboration between the patient, the schedulers of the surgery center, your facility, the primary care office, the specialist office, the imaging center, the laboratory facility, the transportation vendor etc.
- Communicate proactively with stakeholders – Keep the appropriate surgical care team in the loop at all times. Do not cause alert fatigue by communicating information to team members that do not need to participate in a particular step of the surgical scheduling process. A surgery scheduling software with web, email, SMS, phone, fax communications helps you with that.
- Use surgery scheduling templates (order sets) as much as possible. This reduces errors and omissions in the preoperative process.
- Eliminate paper based surgeon preference cards. Use a surgery scheduling software to manage your surgeons’ preference cards in real time.
- Patient experience and engagement are key to reducing surgical no-shows, cancellations and delays. Keep the patient in the loop at all times (communicate with them regularly), remind patients about their referral / tests / clearance / surgery related appointments diligently. This kind of personalized patient experience is quite easy to do with surgical scheduling software.
- Ensure financial guarantees are completed well before the surgery data. If the patient is paying, have them put the deposit down. This is a great way to reduce chances of the patient being a no-show. Some surgical software allow you to accept payments via credit cards or ACH. Utilize those.
- Automate prior authorizations wherever possible. Some insurance carriers have web based prior authorization portals. Even if they do not, automating personalized faxes and electronic faxing is very easy to do. Use a surgical software that allows you to do this.
- Keep all appointments under your control. Missing appointments is where surgical scheduling delays occur. Triage with the patient and the referred facility to get appointments. These can include laboratories, imaging centers, primary/specialty care clinics, transportation vendors etc. I recommend that you use a surgery scheduling software that allows you to make phone calls, send faxes right from the software itself.
- Both you and the patient have a lot of tasks to complete before the surgery due dates. It’s easy for both of you to let things fall through the cracks. Automated reminders for tasks due help you stay on top of the scheduling process. Use a surgical scheduling software system to help you achieve this seamlessly.
- Keep the postoperative surgical workflow as a part of your surgical scheduling. Your billers cannot bill for services rendered nor can they maximize surgical services billing unless the post op note is received, surgery global period is handled for each surgery. Use software that helps you, the surgeon and the billers/coders achieve this seamlessly.
- Centralize surgical cases and associated appointments, communications, tasks, steps, forms, records all in one place. This is where the patient care continuum breaks down and surgical delays occur.
- Follow up on no-shows and cancellations diligently, while keeping patient safety and patient experience as top priorities. Use a surgical scheduling system to do this automatically for you.
How to organize surgery scheduling
If you manage multiple surgeons, I recommend using a surgical scheduling software and a medical call center. I organize surgery schedules by day, by provider, by surgery center following these guidelines.
Surgical privileges
I would look at the surgical center credentialing / surgical privileges per surgeon. On top of this, I would consider the block times my surgeon has available at each one of those surgery centers.
Example surgical privileges matrix
Surgery Type
First, I look at major vs minor surgeries. Major surgeries are almost always inpatient surgeries. Minor procedures tend to be day surgeries / outpatient surgeries. I group and process these two types of surgeries separately.
Medical priorities
The general idea is to group surgeries according to their priority.
First, I would look at surgery priorities as indicated by the surgeons in their surgery booking orders. These procedure priorities are typically – ROUTINE or URGENT or ASAP or STAT. The priority order would be thus:
- STAT – highest priority, Life threatening situation.
- ASAP – next highest priority, evident fast progression of disease.
- URGENT – next highest priority, Potential fast progression of disease.
- ROUTINE –
For STAT surgeries, you might have to coordinate with your surgery center schedulers to get the patient and the surgeon scheduling outside of their designated block times. Unless a surgery is requested as STAT, surgery scheduling typically takes 2-4 weeks. This is due to the various steps involved in a surgical scheduling workflow.
Maximum Time Before Treatment
I focus on the STAT surgeries first. My goal is to get the patient and surgeon scheduled for the surgery at the earliest (same day or next).
In these scenarios, oftentimes ASCs will have physicians available to handle the medical + specialist clearances, can perform urgent diagnostic testing (limited), and might be able to do some laboratory tests. In addition to this, insurance carriers will typically allow submitting prior authorizations within 72 hours of the procedure (STAT).
Next, I can focus on ASAP surgeries.
I have a bit more time for these and can submit urgent orders for prior authorization, laboratory tests, imaging tests, medications, medical clearance, specialist clearance (if needed), COVID clearance etc. However, getting all these done in a week is a herculean effort. This is where a tight referral / partner network helps. I do not give priority to patient preferences for these referrals and choose facilities / providers from my referral network instead. This helps me ensure all surgical prerequisites are finished on time.
Then, I can focus on URGENT and finally, ROUTINE surgeries.
Patient allergies
I would typically request patients with known drug or latex allergies to be scheduled first. This is to minimize the patient’s potential exposure to any allergens.
Surgery Durations
The general idea is that within each group created, I order surgeries according to their duration by the longest processing times rule. Here, I assign the highest priority to surgeries with the longest processing time.
NOTE: The OR / surgery center can and might change my suggested times based on their own surgery scheduling logic as well. An OR might choose to have surgeries ordered first by Shortest Processing Time or First-Come, First Serve or Least Setup Time.
Add similar surgeries
At this point, there may be some time left in the block time allotted to my surgeon. E.g. my surgeon might have a 2 hour block time on the day I am scheduling for. Meanwhile, based on my prioritizations as mentioned, I might be left with a 30 minute time slot. In these cases, I try to fit in similar surgeries regardless of their medical / surgical priorities. This helps the OR reduce their idle time and reduce repeating the surgery setup.
Backward surgery planning
Surgery scheduling success is all about good project management. I prefer to do backward project planning and have achieved success even with high surgical volumes. Once the surgical cases are set up by the grouping mentioned before, they are ready for bin packing. The surgery dates are fixed. So, I start from the end goal and plan backwards for finishing the pre-requisites. I immediately place orders for prior authorization, laboratory tests, imaging tests, medications, medical clearance, specialist clearance (if needed), COVID clearance etc and assign due dates + responsible person to each such task.
Surgical care team management
Studies have repeatedly shown that surgical care team management are key to success. Based on my experience running high surgical volumes, I suggest aligning your thoughts into 3 surgery teams.
- Preoperative care team – This team that gets the patient to the operating room successfully, fully prepared.
- Peri-operative care team – this team ensures surgery procedure success and patient safety
- Postoperative care team – this team ensures postoperative patient success
I suggest that you use a surgical scheduling software for it. You can avoid using software if you are very diligent.
Surgical care team communications
Surgical scheduling workflow involves many team members and many moving parts. It’s best to have everyone on the same page at all times (preoperative, peri-operative, postoperative). Use a spreadsheet or surgery software to ensure effective communication and coordination.
Whether you use email, phone, fax, text messages or HIPAA secure messaging platforms – surgery care team communication is crucial.
If you are using a surgery scheduling software that allows communications, your job becomes a lot easier.
Preoperative surgical care team
The following is a list of care team members involved in a surgical scheduling process. These folks ensure that the patient has completed all the preoperative requisites, is eligible for surgery, and finally, is prepared for surgery.
If you are using a surgery scheduling software, you can add all these members into a team. Below is a list of surgery scheduling tasks and the associate surgical care team members.
Care team for surgery orders
If you are co-managing surgeries and patient care with another physician, the surgery order might come from the requesting physician office (e.g. optometrists co-managing surgeries with ophthalmologists).
In these cases, the following surgical scheduling care team members need to stay in the loop.
Requesting physician office
- Appointment scheduler
- Medical assistant
- Scribe
- Physician
Of course, your own providers can also identify surgery candidates, place surgery orders. In this case, the following surgery team needs to coordinate with each other.
Performing Physician / Surgeon office
- Appointment scheduler
- Medical assistant Scribe
- Physician
- Physician office surgery scheduler
- Prior authorization staff
- Denials staff
- Coder / biller
Care team for laboratory orders
This would include prior authorizations, patient preparation, laboratory results.
In almost all cases, your surgeon will place various preoperative laboratory test orders. A surgical scheduler’s job is to send the referral to the laboratory. They do not have much visibility into the referral order until after the test results are obtained from the laboratory or the patient themselves.
I recommend handling the pre-requisites of the laboratory order appointment yourself. This way, you have full control of your surgical timelines.
Following are the patient care team members that need to get involved for expedient preoperative laboratory order results.
Laboratory
- Appointment scheduler
- Lab technician Physician
- Prior authorization staff
- Denials staff
- Coder / biller
Care team for imaging / diagnostic orders
This includes prior authorizations, patient preparation, laboratory results tasks.
Your surgeon will place various preoperative diagnostic/imaging procedure / test orders. The referral needs to be sent to the diagnostic facility.
Here as well, I recommend handling the pre-requisites of the order appointment yourself.
Following are the patient care team members that need to get involved for expedient preoperative imaging order results.
Imaging / diagnostics center
- Appointment scheduler
- Technician
- Physician
- Prior authorization staff
- Denials staff
- Coder / biller
Care team for medication orders
You have tasks related to prior authorizations, patient preparation, medication adherence.
The surgeon will certainly be placing several preoperative, peri-operative and postoperative medication orders. While surgical scheduling staff doesn’t always have to handle the postoperative medication orders – they do have to ensure preoperative and peri-operative medication orders are placed, dispensed and administered as ordered.
Following are the patient care team members that need to get involved for expedient preoperative medication orders.
Pharmacy
- Pharmacy Technician
- Pharmacist
- Prior authorization staff
- Denials staff
- Coder / biller
Care team for medical clearance
Each surgery is going to have medical clearance referral requirements. This requires you to send a referral to the primary care physician’s office for a complete history and physical.
Try to get the complete medication list from the PCP as well. This helps with the medication history list that needs to be sent along with the surgery packet (to the surgery facility).
For the history and physical to be done expediently, the following staff from the PCP office need to work together and communicate well with your office.
Primary care physician office
- Appointment scheduler
- Medical assistant
- Physician
- Prior authorization staff
- Denials staff
- Coder / biller
Care team for specialty clearance
Based on the patient’s medication conditions (existing) and possibly, the co-morbidities, your surgery scheduling might need to include specialist medical clearance(s). This requires you to send a referral to the specialist physician’s office for a clearance (e.g cardiology, pulmonary, hematology etc.).
Try to get the complete specialty medication list from the specialist office as well. This helps with the medication history list that needs to be sent along with the surgery packet (to the surgery facility).
The following staff from the specialist office need to work together and communicate well with your office.
Specialist office
- Appointment scheduler
- Medical assistant
- Physician
- Prior authorization staff
- Denials staff
- Coder / biller
Care team for operating room supplies, block times
Surgeon preference cards typically cover most of the operating room supplies requested by each surgeon. Whether your surgeon is part of the surgery facility / hospital itself, or if they have hospital privileges, you need to keep the surgeon preference cards up to date.
Typically a surgeon preference card would note the following:
- Supplies and custom packs (if any)
- Instruments and Trays
- Equipment
- Gloves
- Sutures
- Medications
- Implantable items
Your surgeon will often ask the implant vendor sales representative to be present in the operating room.
You will also need to work with the OR surgery scheduling team to ensure you get the correct block times, optimize your surgeon’s schedule and move the each surgery scheduling plan along.
This is where a lot of the communication gaps occur (preoperative/surgery scheduling). Typically, the following surgical care team members have to coordinate and communicate well.
Surgery center
- Surgery scheduler
- Logistics/ supplies manager
- Anesthesiologist Nurse
- Prior authorization staff
- Denials staff
- Coder / biller
Implants vendor
- Logistics / order manager
- Implant / device representative
Care team for escorting patient to / from surgery center
Many times, your patient will be escorted to the surgery facility by a related person. Or, the patient might come in themselves. However, patients are not allowed to leave the surgery facility without an escort. If the patient is leaving with a related person, the patient escort also becomes part of the care team.
Patient escort (related persons)
If the patient needs transportation arrangements to arrive at the surgical facility, then you would need to arrange and manage transportation for the patient. In this case, the transportation vendor staff also becomes part of the patient care team.
Transportation vendor
- Appointment scheduler
- Driver
As the patient leaves the surgery facility, they cannot be released to a general transportation vendor that will not accompany the patient for a few hours postoperatively. In these cases, you would need to help the patient arrange for an escort from services like those offered by Visiting nurse services.
In this case, you need to coordinate with the vendor’s patient escort team.
If you are using our surgery scheduling software, we handle these tasks as shown below
Patient escort vendor
- Appointment scheduler
- Attendant
Care team for Prior authorizations
You need prior authorizations for almost all your procedure, medications, transportation, devices orders.
While the payer’s staff never really becomes part of the care team per se, you do need to coordinate with them for almost everything (if the patient is not a self pay patient). Unless you have expedient responses from the insurance / payer office w.r.t various prior authorization requests, your surgery scheduling will surely lead to delays.
Insurance / payer office
- Customer service representative
- Adjudicator
If you are using our surgery scheduling software, we handle these tasks as shown below
Surgical care team
The surgical care team that’s actually performing the procedure includes the following team members:
- Surgeon
- Anesthesiologist
- Certified registered nurse anesthetist (CRNA)
- Operating room nurse
- Surgical technician(s)
- Residents or medical students (depends on whether it is a teaching hospital or not)
- Physician assistant
- Medical device company representative (as mentioned above, often, surgeons would request the device representatives to be present during the procedure).
Surgery scheduling templates
Surgery scheduling templates reduce manual data entry work required, therefore reducing possibilities of errors. Using a predefined surgery scheduling template / standard order set allows you to reduce physician variability in addition to adhering to evidence based guidelines for a specific disease area.
If you are using our surgery scheduling workflow software, you can apply surgery templates to each surgery plan. Use surgery scheduling templates in the following cases:
- Your surgeons plan/order the same surgery procedure / CPT for a given set of diagnoses and co-morbidities..
- Surgeons order the same pre-admission laboratory tests (PAT) for a given set of diagnoses, patient demographics and co-morbidities.
- You notice that the same pre-admission diagnostic / imaging tests (PAT) are being ordered for a given set of diagnoses, patient demographics and co-morbidities.
- Your surgeons have a preference of a surgery facility or have specific hospital privileges.
- Surgery block times and days of week are already specified for your surgeons.
- Your surgeons order the same medications before and/or after the surgery procedure.
- History and physical / medical clearance, COVID clearance tests are always accompanied with the surgery orders (as they should be).
- The surgeon orders the same specialist clearances for a given set of diagnoses, patient demographics and co-morbidities.
- Your surgeons order the same diet(s) / place the same nutritional orders before and/or after the surgery procedure.
- You need to have the patients answer the same questionnaire(s) before the surgery procedure (e.g. ADL, allergy, medication history, etc.)
If your surgeon(s) elect for enhanced recovery after surgery protocols, you can create templates / order sets for postoperative protocols as well.
Surgery scheduling template including diagnoses
In most cases, your surgeons would order surgeries for specific diagnosis codes. These don’t vary tremendously. Whether you use our surgery scheduling software or use spreadsheets, create surgery scheduling templates for each diagnosis / disease form.
You can set surgeon specific preferences here. When you see a paper surgery order for a set of ICDs, you can easily choose the matching template to ensure that all the preoperative and postoperative protocols are adhering to evidence based medicine guidelines.
Surgery scheduling template – care team
Care teams would typically not vary greatly. Success in preoperative surgery scheduling depends a lot on the care team. The more you keep the care team involved, the better chances of a successful surgery.
Whether you use our surgery scheduling software or use spreadsheets, create surgery scheduling templates for each diagnosis / disease form that also include a care team.
Surgery scheduling template – care plan
Care plans would typically not vary greatly either. Having a care plan in place allows you to tie things together both preoperatively and postoperatively.
Whether you use our surgery scheduling software or use spreadsheets, create surgery scheduling templates that also include a care plan.
Surgery scheduling template / order sets
Pre-defining surgery scheduling templates / order sets is what reduces errors and manual data entry tremendously.
Whether you use our surgery scheduling software or use spreadsheets, create surgery scheduling templates that include an entire order set.
A surgery order set would typically include:
- Surgery procedure order(s)
- Laboratory procedure order(s)
- Imaging / Diagnostics procedure order(s)
- Medication order(s)
- Referral order(s) to primary care and specialists for clearances
- Appointments that may include preoperative and postoperative ones
- Devices and implants orders that might contain
- Supplies and Custom Packs
- Instruments and Trays
- Equipment
- Gloves
- Sutures
- Implantable Items
- Diet/Nutrition order(s)
- Transportation order(s)
Surgery scheduling template – tasks
Successful surgery scheduling and successful postoperative surgical workflow are just a matter of tasks / project management.
The biggest benefit of using a surgery scheduling software is (or should be) automated task management and reminders.
Whether you use our surgery scheduling software or use spreadsheets, managing tasks is key to success.
Surgery scheduling workflow / Preoperative workflow
You can handle the surgery scheduling workflow with spreadsheets, or a surgical workflow management system (recommended).
This surgical scheduling workflow contains everything up to the point when the patient is admitted to the hospital / surgery center.
High Level steps
- Surgeon places order for surgery case
- Surgery scheduler and patient discuss prerequisites (financial, medical)
- Tentative surgery date is booked
- Patient finishes prerequisites (financial, medical)
- Surgical scheduler finishes prerequisites (financial, medical results)
- Surgery date is confirmed
- Patient arrives at surgery center / hospital and is admitted
Detailed steps
- In case of an elective surgery, the patient might call in to start the preoperative workflow
- A surgical case might also be referred in by a provider / doctor that’s not part of the surgeon’s healthcare organization
- First the patient has a preoperative consult appointment with the surgeon that will be performing the procedure
- At the preoperative consult appointment, the surgeon discusses the procedure, what to expect, alternatives, the urgency of the procedure and answers questions that a patient might have
- Next, the surgeon places a surgery order. This will accompany the surgery reasons / diagnoses (ICDs), the procedure(s) requested (CPTs), the anesthesia recommended, the body site where the surgery is to be performed, preoperative laboratory and imaging tests needed, preoperative (and sometimes postoperative as well) medications required, fasting and/or nutrition orders (if any), specialist clearance referrals (if any), surgery center / location preferences (if any)
- The surgical scheduling staff are notified of this surgery case. Either the patient will then get in touch with the scheduling staff or the surgery scheduler will contact the patient to start the surgery scheduling process.
- The schedulers advise the patient about the costs of the surgery, what’s covered by the patient’s insurance (if any), financial responsibilities etc.
- If the patient decides to proceed with scheduling the surgery, the surgery scheduling staff then has the patient sign the necessary consent + release forms.
- Next, the surgery scheduler advises the patient about the tentative surgery date, expected next steps and touch points from the scheduling team, tasks the patient needs to complete before the surgery date (medical, specialist clearances, laboratory & imaging tests, medication adherence) and also the tasks the surgery scheduling team needs to finish by the surgery date (prior authorizations, medication reconciliation, medical history reconciliation, specialty history reconciliation, gathering all laboratory + imaging test results, medical / specialist / COVID clearance test results, confirming surgery date/time)
- The surgery scheduler then proceeds to confirm the patient’s insurance information (if any), the patient’s primary care doctor contact information (for medical clearance), specialist(s) contact information (for specialist clearance, if any), accurate patient demographics / contact information (for prior authorizations and scheduling COVID tests near patient’s preferred location), patient transportation options before and after the surgery, patient’s postoperative escort contact information, patient’s preferred pharmacy contact information for preoperative (and maybe postoperative as well) medication prescriptions
- Depending on the healthcare facility’s policies, the scheduler would collect a deposit from the patient for booking the surgery. The scheduler might also book the final preoperative appointment for the patient
- The scheduler will also have the patient fill out a few questionnaires (unless this information is already up to date as of today in the patient’s medical record). These would typically include questionnaires for allergies (drug, food, latex), activities of daily living (ADL), medical history, surgical history, imaging history, laboratory history, social history
- Next, the surgery scheduler might print out various forms, counseling guides for the patient. These can also be sent electronically to the patient
- The scheduler will now place referral orders for prior authorizations, laboratory tests, imaging tests, medical clearance, specialist clearance, COVID clearance, medication prescriptions. The scheduler might also place orders for nutrition, transportation (if any), These may be done with the patient in the room or after the patient has left the facility
- Based on the healthcare facility’s preferences, the scheduler might also triage between the referred facility and the patient to obtain confirmed appointment date/times for various tests. Alternatively, the surgery scheduler might leave such appointment requests entirely up to the patient (not recommended) and merely suggest due dates for such tests / clearances to the patient
- Once the patient has left, and on the due dates for appointments, prior authorizations, clearances or tests, the scheduling team will be following up with the referred facility for test results.
- The surgery scheduler would also then be collaborating with the surgeon for the appropriate materials request (devices, instruments, implants etc) needed on the surgery date
- Based on the healthcare facility’s and / or the surgery center operating policies, the surgery scheduler will notify the surgery center of the number of surgical cases expected to be booked for a specific day, for a specific allotted block time, per surgeon. They will also communicate the consolidated materials request to the surgery center
- The surgery scheduler might also be reminding the patient regularly about the various due dates or might be advising the patient of surgery planning status. This is based entirely on the healthcare facility’s operating policies
- Again, based on the healthcare facility’s and / or the surgery center operating policies, the surgery scheduler will notify the surgery center of all confirmed surgical cases at a predetermined date before the surgery date. This confirmation would be possible to do for each planned case once the case prerequisites are satisfied
- On the day of surgery, the patient will arrive at the surgery center / hospital and be admitted. Thereafter, the peri operative workflow needs to be followed
- The postoperative workflow begins after the patient is discharged from the surgery setting. Postoperative surgical workflow is as important and complicated as preoperative surgery scheduling itself.
Postoperative surgical workflow
The postoperative workflow begins after the patient is discharged from the surgery setting. Postoperative surgical workflow is as important and complicated as preoperative surgery scheduling itself:
- Surgeon creates the surgery postoperative note.
- Your surgeon places postoperative orders (if any). This could include procedures, laboratory, diagnostics, medication, nutrition, postoperative followup appointments, transition of care referral order(s).
- Your biller completes billing for the surgery procedure after the global period.
You can handle these manually, with a spreadsheet, or a surgical workflow management system.
Surgical operative note
Writing an opnote is part art, part science.
As part of your postoperative surgical workflow your surgeon needs to update the following to ensure appropriate billing/reimbursement and for patient continuity of care. Higher levels of documentation specificity leads to lower billing headaches.
First and foremost you are going to need the planned vs performed procedure narrative. In other words, what procedure was planned based on preoperative diagnoses / findings and what was actually performed.
Keep in mind that your prior authorization was for a specific procedure and if the actual procedure differs from the authorized procedure, you are going to need this documentation during your postoperative surgical workflow for claims support.
The note has at least a few sentences about “Indications for Surgery” that your coders can use.
You need to be able to document why the patient was brought to the OR. If there are any past surgeries related to this procedure, the operative note needs to document that.
This alone will dictate whether your coders will use modifier 58 (Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period) or modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period).
Make sure that your surgeon’s operative note has “Complexity” section that buttresses your claim for any extra payment. This section is very important for coders to be able to use Modifier 22 (Increased Procedural Services).
In our postoperative surgical workflow software, you can use the notes section for this.
Automate postoperative workflow with software
As a surgeon you would be required to do the following in order for your billers to collect the maximum reimbursements for your work. We recommend you use a surgery scheduling software that allows you to automate as much as possible.
Update post-operative results
- Update actual surgery procedures performed
- Update anesthesia medications administered
- Update implants / devices administered
- Update tissues replaced
- Update estimated blood loss
- Update specimens collected
- Update findings
- Update post-operative diagnoses
- Update operative complications
Document the surgery team
Make sure you document the surgeon, co-surgeon (if any), assistant surgeon, assistant at surgery.
Keep in mind the following:
- An assistant surgeon and surgery assistant bills their work but are not responsible for pre / post operative care, nor do they document an operative note.
- A co-surgeon bills their work but is responsible for pre / post operative care, documenting an operative note for their part of the surgery. So, in this case, you will have more than 1 post operative note.
In our surgical scheduling software, you would document it like below. The software handles following tasks for you.
- Update transition of care appointment request order with appointment date
- Notify patient about transition of care referral appointment date
- Send patient reminders about transition of care referral appointment
- Send fax for transition of care consult note
- Update transition of care request order with visit note results
Postoperative surgical workflow – Procedure Narrative
As a surgeon, you are required to record procedure narrative as part of your surgery postoperative note. As most surgery billers/coders will tell you, the more descriptive you are in the notes, the more helpful it is for billing purposes.
Your procedure narrative could/should include descriptions of the procedure. It is very helpful for billers when it includes extensive details of procedure site preparation, measurements and markings details, procedure times, instrumentation, and vital signs and other monitoring data.
Postoperative & preoperative diagnosis
Make sure you document both preoperative and postoperative diagnosis. Payors like to see whether the diagnoses were the same before and after the surgery. This also helps you with your follow up orders.
Keep in mind that the preoperative diagnosis is a surgeon’s opinion. The diagnosis is confirmed during surgery.
In our surgical scheduling software, you would document it like below.
Procedure anesthesia narrative
Document which anesthesia was used (it might be different from what was originally ordered). You can also choose to record the agents / medications that were actually used.
Surgery complications
Document any additional medical problems that developed following the surgical procedure. When you order follow up surgery procedures, documenting complications will help you support your reimbursement request.
In our surgical scheduling software, you would document it like below.
Procedure estimated blood loss
All surgery postoperative notes will contain this section. As part of your postoperative surgical workflow , your surgeon should document the estimated blood loss is the approximate amount of blood that the patient lost during the procedure or surgery.
You can record this in a quantitative amount, e.g., 500 milliliters, or simply use free text like “Minimal”, “None” etc.
In our surgical scheduling software, you would document it like below.
Procedure findings
Did you have any clinically significant observations that you confirmed during the procedure? Did you/the surgeon discover any new clinically significant findings during the procedure? If so, those are to be recorded in the surgery postoperative note.
In our surgical scheduling software, you would document it like below (separate from the preoperative + postoperative diagnosis)
Postoperative surgical workflow – specimens
If any specimens were collected during the procedure, those should be duly noted in the surgery postoperative note. These can include tissues, objects, or samples taken from the patient etc.
This allows your staff to place follow up pathological analysis orders. As part of the postoperative surgical workflow, they need to remember to place this order). This also assists your billers/coders for future billing.
In our surgical scheduling software, you would document it like below.
Procedure implants and drains
Any materials placed during a procedure are required to be documented in the surgery postoperative implants narrative section. These can/shall include stents, tubes, and drains.
In our surgical scheduling software, you would document it like below.
Surgical operation note fluids narrative
This is an optional section where you record the amount of fluids administered during the surgical procedure. We allow for entering this information as it can be made a part of the surgery postoperative note.
Plan of care note
The discharge plan of care note contains ongoing care information for the patient. This is important because of the general disconnect between surgeons and clinical/non-clinical staff in their practice.
This section could/should include postoperative orders, interventions, encounters, services, and procedures for the patient.
Using this section helps office staff prepare follow up procedure/imaging/laboratory orders and also helps with clinical reminders.
Postoperative surgical workflow – followup appointments
In our surgical scheduling software, you would document it like below. The software handles following tasks for you.
- Place surgery post-operative appointment request order
- Update surgery post-operative appointment request order with appointment date
- Notify patient about surgery post-operative appointment date
- Send patient reminders about surgery post-operative appointment
Postoperative surgical workflow – Nutrition
Often you / your surgeon will place postoperative nutrition / diet orders. These can be oral diets, supplements or even enteral formulae, as deemed needed by the surgeon.
Using our surgery scheduling software you can manage these postoperative nutrition / diet orders with ease (see below).
The related tasks that you have to handle for these diet orders are as follows – the software handles reminders on your behalf as well.
- Notify patient about post-operative nutrition instructions
- Remind patient about post-operative nutrition instructions adherence
Postoperative surgical workflow – Medication orders
In your postoperative / discharge plan of care, you would be prescribing various medications. If you enter all such details in your narrative, your staff can thereafter follow up with the requisite medication orders.
In our software, you can also choose to prescribe medications as you did/do for the preoperative stage. Alternatively, your surgical coordinator can place those orders for you as well.
Our surgical scheduling software will handle the following tasks for your staff.
- Send fax for post-operative medication order pre-certification
- Update post-operative medication order with pre-certification proof
- Notify patient about pre-certification approval status
- Send fax for post-operative medication order prior authorization
- Update post-operative medication order with prior authorization proof
- Send fax for medication order
- Notify patient about prior authorization approval status and RX order
- Ask patient about RX fill status
- Update medication order with RX fill status
- Send patient reminders about post-operative medications adherence
Postoperative surgical workflow – Transition of care
Whether you are transitioning the care of your patient to another provider, or if you need a consult with another specialist / provider, you would need to place such referral orders with your staff.
In our surgical scheduling software, you would document it like below. The software handles following tasks for you.
- Update transition of care appointment request order with appointment date
- Notify patient about transition of care referral appointment date
- Send patient reminders about transition of care referral appointment
- Send fax for transition of care consult note
- Update transition of care request order with visit note results