Organize your surgery scheduling process into two checklists – pre operative checklist and post operative checklist. As a surgery scheduler, do not send / accept the surgery packet (combined order of all surgeries to be performed by one surgeon in a block of time) unless the pre-operative checklist is marked completed. As surgery coordinator and surgery billers, do not send/accept a post operative packet unless the post operative checklist is marked completed.
Surgery scheduling pre-operative checklist
The pre operative checklist will contain patient details, allergies, diagnoses, care team, care plan, care plan order set (including surgery + imaging/diagnostics + laboratory procedure order + referrals for medical / specialist clearances + appointments pre/post surgery + transportation requests + nutrition order + counseling order + medications order + devices/implants order) , insurance details + prior authorizations, signed documents related to the surgery.
- Chief complaint
- Pre operative
- Care Team
- Co surgeon
- Medical Assistants
- Device representatives
- Care plan
- Care plan orders
- Surgery order(s)
- Surgery method
- Surgery body position
- Anesthesia type
- EBL (estimated blood loss)
- Blood bank
- Vital signs
- Pain management
- Diet / Nutrition Order
- Imaging / Diagnostics order(s)
- Laboratory order(s)
- Counseling order(s)
- Referrals order(s)
- Appointments order(s)
- Devices / implants order(s)
- Medications order(s)
- Transportation order(s)
- Surgery order(s)
- Pre certification
- Prior Authorization
- Surgery Packet
- Each patient’s surgery order
- Consolidated supply requisition
- Patient reminders for
- Medication order(s)
- Nutrition order(s)
- Transportation before and after surgery
Surgery scheduling post-operative checklist
The post operative checklist will contain Pre-Operative diagnosis, Post-Operative diagnosis, Procedure, Surgeon, Assistants, Anesthesia, Estimated blood loss, Complications, Disposition, post operative order set (including nutrition order, activity order, vitals, Investigations ins/outs, Medication orders for Pain, puking, prophylactic, pus, precedent medications, discharge transportation).
- Implants / Drains
- Specimens collected
- Follow up order
- Discharge details
- Admission date/time
- Discharge date/time
- Transition of care date/time
- Intubation days
- ICU days
- Hospital stay period
- ISS score
Suggested steps for organizing surgery scheduling
If you follow these steps, most of your surgery scheduling workflow should go smoothly.
As mentioned above, maintain surgery scheduling checklists.
- Get the diagnoses in your surgery scheduling form
You will either have the surgery scheduling order in paper form, or you will have the surgery order placed in the EMR itself (depends on how your healthcare setting operates).
Make sure that your provider and/or scribe have provided the diagnoses for this surgery order.
Make sure you get the diagnosis role correct – whether it is a chief complaint, pre-operative diagnosis or a co-morbidity diagnosis.
If any of these are missing, then ask the surgeon or the scribe for these details right then.
- Note the allergies for the surgery scheduling plan
The patient allergies will typically be recorded in your EMR. However, keep in mind that the EMR does not always record the most accurate data relevant for surgeries.
As you’re scheduling a surgery, make sure you ask the patient about their allergies. Make sure that you ask them about their drug related allergies, paying special attention to penicillin related allergies.
Many times patients are not actually sure that they might have penicillin allergy because they’ve never been tested before nor have been in a situation where such a test was warranted.
Dig deeper when a patient responds negatively to “are you allergic to penicillin “.
- Use surgery scheduling order sets or templates
Using a surgery scheduling order set allows you to have predetermined / prepackaged groups of orders (surgery, diagnostic, laboratory, teams etc) set up for your healthcare setting.
This will greatly reduce surgery scheduling mistakes made, steps missed and time taken to place orders + plan surgeries.
In your healthcare setting, you might even have pre-approved groups of orders that apply to specific diagnosis.
Use templates to the fullest.
- Set up the surgery care team
Creating a patient Care Team for the surgery is important. All these participants need to be kept in sync all the time.
Typically the care team should consist of (at least):
– Surgeon and Co surgeon (if any)
– Medical Assistants
– Device representatives
You will find that many a time, your surgeon will want the device / implant reps to be present during the surgery. Make sure that you have a list of device representatives and their contact information. You are going to need to inform them accordingly.
As a surgery scheduler you may or may not be able to assign the following staff to the care team. However, these roles / actors need to be added to a surgery planning process to keep everyone in the loop. In addition to this, in the post operative / OR notes, your surgeon would have to note the following anyway.
- Create a surgery Care Plan if not already created
The importance of a surgery care plan cannot be stressed enough. A patient’s care doesn’t start and stop at your healthcare setting. It is a continuum.
As patients move from one caregiver to another caregiver – this might happen across various departments in your own healthcare setting or may be outside your hospital.
Unless a care plan is in place, there’s bound to be knowledge gaps and inconsistencies, clinical errors or even redundancies – due to information not traveling “with” the patient.
Give it a name – it helps you identify the patient’s care plan tasks and activities based on the name you provide here
- Surgery scheduling – complete surgery order
When you are capturing the surgery order itself, make sure you obtain information on the following:
– Surgery method (e.g. open surgery, arthroscopy, bronchoscopy, colonoscopy, cystoscopy, laser, sigmoidoscopy etc).
– Surgery body position (e.g. supine, prone, orthostatic, lithotomy, knee-chest etc). Make sure you tell the patient as well.
– Anesthesia type (e.g. MAC, General, Local, regional etc)
– Tissue (e.g. no tissue expected, abnormal, additional tissue required, basal cell carcinoma, insufficient tissue etc.)
– EBL (estimated blood loss .. make sure that you note this because the blood bank would need to be contacted and/or the surgery care team needs to be prepared for it)
– Vital signs (whether the surgeon has specific vital signs order.. e.g. per unit routine or other. If the vital signs are not to be collected per unit routine, make sure you note down how it is to administered)
– Pain management (e.g. whether the anesthesiologist is going to make pain, whether the patient will be prescribed pain medications etc)
– Diet order (e.g. NPO or “Nil Per Os”, for solids and liquids after midnight before receiving general anesthesia. Or whether there are specific Nutrition Orders (e.g. carbs, protein etc) before the surgery.
- Surgery scheduling – Imaging / Diagnostics order
Capture each surgery imaging / diagnostic order while planning out the surgery. E.g. for a major orthopedic surgery, you might have to enter / create multiple imaging or diagnostic orders. Capture each of those.
Keep in mind that each of those diagnostic orders have pre-requisites for patients to perform before they go in for the specified tests.
Additionally, unless those diagnostic tests are done and results are obtained + added to the patient surgery packet, the surgery will not proceed.
Based on the results of the diagnostic tests, changes might also need to occur to your surgery planning process as well.
Finally, patients are notorious for forgetting procedures / pre-requisites. You will need to remind the patient for each such appointment as well.
In our experience of handling 1000s of surgeries, we have noticed that when the surgery coordinator handles planning for the diagnostic procedures on behalf of the patient, chances of surgery date slippage is minimized.
Try to not leave any TODOs in the hands of the patient themselves.
- Surgery planning – care plan order – Laboratory order
You will rarely run into surgery orders without laboratory orders associated with it. If you use surgery order sets / templates, your life will be a lot easier.
Make sure you capture each laboratory order that’s placed by the surgeon themselves. In addition to this, check if there are standard lab orders that are expected for the surgery CPT / procedure in question. Your surgeon might not have ordered those, thinking that you already know what those are.
Your typical diagnostic / lab order set will probably contain Examples – PT, PTT, UA, CHEM 8, CHEM 14, EKG, CBC, X-RAY etc.
Based on our experiences managing surgeries, we recommend that you handle the laboratory order appointment request, follow up with the laboratory to obtain results etc. In other words, do not leave these in the hands of the patients.
Your surgery package will not be complete until the laboratory results have been obtained with no variances found or all variances addressed appropriately.
Just a hint – the more you get used to entering the HCPCS codes for each procedure ordered, the easier billing is going to be (with less back/forth)
- Surgical planning – Appointments orders
Try to set up patient expectations around the surgery appointment, the preoperative and postoperative appointments by setting these dates while you’re in contact with the patient.
Pick a surgery date (tentative)
Pick a surgery date based on what the surgeon recommended. For non-urgent cases, pick a surgery date (for non urgent cases) that’s at least 30 days away.
Keep in mind that without prior authorizations, lab reports, diagnostic reports or clearances, your surgery will not happen (in most non-urgent cases).
This takes time. 30 days gives you enough time to book everything and have a small window for delays/rescheduled appointments.
Pick pre-operative date(s) based on chosen surgery date
Some surgeons do not understand the importance of preoperative appointments. These pre-operative appointments offer a final chance to “dot the Is and cross the Ts”.
In addition, the preoperative appointment also allows your team to counsel the patient, reinforce preoperative instructions, tie up any remaining loose ends.
Pick post-operative date(s) based on chosen surgery date
Your healthcare settings may or may not have its own set of required appointments for post operative care. Some practices have post operative appointments 1 day after, 7 days after, 1 month after, 3 months after and 6 months after the surgery date.
You should create appointment requests based on your healthcare setting choices or the order set that your team might already have created.
Pick transition of care date(s) based on chosen surgery date
Again, your surgeons might have preferences on when the transition of care should happen. This could be a transition of care based on surgical co-management. Or, this could be a transition of care from a specialist to another specialist or a specialist to a primary care physician. Set up those appointment dates in advance.
- Surgical planning – Referral / clearance orders
You will have to refer patients out for COVID/Medical clearance appointments. Very rarely is it acceptable for the performing provider to do the clearance procedures as well.
Make sure to plan for those referral appointments. These may or may not be outside your healthcare setting.
In addition, keep in mind , you and your patient will need reminders accordingly. You will need reminders to collect the visit notes / results from the patient or the provider you have referred them to.
If you can add the CPT and DX codes in your referral orders, things will go a lot more smoothly. A few suggestions:
Medical Clearance reason – primary dx would be Z01.818, secondary dx the reason for surgery
COVID clearance – R05, R06.02, R50.9, J12.89, J20.8, J22, J40, J80, J96.01, J98.8
- Surgical planning – Referral / clearance orders
Make sure to place an order for each medication that are important for and relevant for your patients prior to the procedure. Your healthcare setting might already have predefined surgery order sets ready to go. If not, try to create these because medication orders might be quite a few.
As you plan the patient’s surgical procedure, you will have to ensure that you have the complete medication history of the patient. Usually, this is already done by your clinical colleagues and are available in your EMR.
Depending on specific patient cases, you might also need to provide the specialty medication history as well.
Double check w.r.t the histories – you, as a surgery scheduler are going to have to provide this as part of your “surgery package” to ensure acceptance by the OR.
Ordering the post operative medications is generally considered best practice. Encourage your patient to pick up these medications prior to the surgery, if possible.
Double check whether any medications require prior authorization or not.
- Surgical planning – Device / implants orders
Your surgeons might have predefined templates for each surgery procedure and patient diagnosis. However, they might also place more specific orders for devices or implants depending on the patient case.
Make sure that you note these – as there’s nothing worse than the patient laying on the operating table while the device is not available (because it wasn’t ordered).
- Surgical planning – Transportation orders
We handle 1000s of surgeries for patients resident in medically underserved areas. For our patient cases, we find that arranging for surgery transportation helps tremendously in reducing no-show rates.
Your healthcare setting may or may not be engaged in the practice of arranging transportations the patient may be eligible for.
Make sure you order any transportation that your patient qualifies for. Please be aware of the authorization requirements for your state as well.
Make sure to remind your patients about the transportation arrangements for their clearances or surgery procedure or laboratory / imaging procedures.
Make sure you remind yourself for those date/times as well.
- Do not forget patient and surgeon signatures !!
This is very important and many a time, easily missed. Make sure each surgery document has the appropriate signatures – the surgeon/ performing provider’s signature, ordering provider’s signature, patient’s signature, etc as appropriate for the document in question.
- Surgical planning – prior authorizations
Get the surgery pre-certification / eligibility done as soon as possible. This does not require you to wait to submit documents and it at least tells you whether the patient’s payor would even “consider” reimbursing you for the patient procedure.
Keep in mind that just because you get a positive pre-certification response, you are not guaranteed to receive a positive prior authorization response.
Payers always double check whether the recommended procedures and medications can safely occur in an outpatient setting, or whether lower cost alternatives exist.
Each payer has their own “rules” and the rules will be found in paper documentation, PDFs, or the payer’s web portal(s).
Make sure that no details are left out – those are usually the TOP reasons for denials. Even simple things like missing a middle initial or entering an incorrect address or not filling out an ADL form might trigger a denial or delay in obtaining a prior authorization response.
- Fill out the surgery center’s pre admission surgery form
This will contain the surgery details and the patient’s insurance information.
If the patient does not have insurance coverage, this will contain the financial responsibility details in it.
Keep in mind that at this point, you do not have the prior authorization number yet.
You will have to update this document with the PA number once you receive the prior authorization from the patient’s payer.
- Get pre-operative instructions signed
Your surgery center partner may or may not have a requirement to get surgery pre-operative instructions signed by the patient.
If this is a requirement for your surgery partner, get these signed from the patient.
- Give the patient their medical clearance forms
Our recommendation is that you fax the medical clearance forms directly to the primary care physician.
We recommend that in addition to this, you print out the History and physical (medical clearance) form and transfer the patient information, surgery information (ICD, CPT), surgery center details on to the H&P form.
Tell the patient to get this form signed and dated by the primary care physician.
This should include the Preoperative Medical Consultation, Lab and EKG if your surgeon has ordered them.
- Surgery center specific forms
If there are any further instruction forms that are specific to your ASC or your own practice print those out, explain to the patient.
After this, the patient’s part is done and they can go home.
- Upload ALL the scanned forms to your EMR
At this point, you should scan all the signed documents and upload them to the patient record in the EMR.
- Start the prior authorization process
As soon as possible, start the prior authorization process.
Each payer has their own set processes. Some payers have their prior authorization requests done online.
Some payers have a standard form that you have to fill out and fax to them.
Fill out the patient, surgery details and send the prior authorization request to the payer.
Of course, with some payers, you will not need prior authorizations and their response will advise you the same.
- Upload proof of prior authorization
It’s best to have a separate fax number for your surgery coordinator. In our opinion, you should get a separate, dedicated fax number for surgeries.
As soon as you get a fax response for the prior authorization, make sure you note the start and expiration date of the prior authorization.
You cannot have the surgery before the PA start date nor can you have the surgery after the PA expiration date.
Upload the prior authorization request to the patient record in the EMR.
- Update your records with prior authorization number
Make sure to update the pre admission patient information and insurance sheet with this prior authorization number.
Do keep in mind that if the patient case involves worker’s compensation, you need to record the Adjuster’s name and the adjuster contact information as well.
- Update EMR with the medical clearance
The next step would be to wait for the medical clearance form from the patient’s primary care physician office.
My advice is to reach out to the PCP office a day after the patient’s medical clearance appointment and ask for the fax to be sent.
The PCP office might ask you to send over the patient record release (as they should). Once you get the medical clearance form along with the pre admission test results from the primary care physician office, print them out and attach them to the patient record in the EMR.
- Update materials request form
Your next step would be to fill out the Materials Request Form. This will also depend on your specialty.
Collaborate with your surgeon to find the answers for this form.
Once you get the responses, fill out the materials request form (one form) for ALL the surgeries that you are sending across to the ASC or hospital partner.
- Attach the Operative Report Request Form
This would be a good time to attach the Operative Report Request Form for each patient and surgeon as well.
You are going to need it to fill out the post operative section to ensure successful billing of this patient procedure.
- Send surgery packet to the surgery center
Once you have all these papers signed, packaged together, you can send the entire patient packet to your surgical partners.