Surgery scheduling guide

Comprehensive surgery scheduling guide including surgery scheduler checklists, workflow, automation software options, best practices.

Published

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.

Pre-operative surgery scheduling checklist

Postoperative

The postoperative surgical workflow includes the following:

  1. Surgery postoperative note by the surgeon.
  2. Postoperative orders by surgeon. This could include procedures, laboratory, diagnostics, medication, nutrition, postoperative followup appointments, transition of care referral order(s).
  3. Billing for the surgery procedure.
Post-operative surgery scheduling checklist

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
Combined surgery scheduling checklist

Comprehensive surgical scheduling checklist

Here’s a format you can follow / change according to your needs.

Task idParent  Task IdDepends on task idTask TitleSuggested due dates
1Surgery care plan for pt 1234
211Place Surgical procedure order
322Send fax for Surgical procedure order precertificationDate the order was created, due by 5 pm
423Update surgical procedure order with precertification proofAbove date + 3 days , 5 pm
524Notify patient about precertification approval statusAbove date + 1 day , 5 pm
625Send fax for Surgical procedure order prior authorizationSame as above
726Update surgical procedure order with prior authorization proofAbove date + 7 days , 5 pm
827Notify patient about prior authorization approval statusAbove date + 1 day , 5 pm
91Place Laboratory procedure order
109Send fax for laboratory procedure order precertificationDate the order was created, due by 5 pm
119Update laboratory procedure order with precertification proofAbove date + 3 days , 5 pm
129Notify patient about precertification approval statusAbove date + 1 day , 5 pm
139Send fax for laboratory procedure order prior authorizationSame as above
149Update laboratory procedure order with prior authorization proofAbove date + 7 days , 5 pm
159Notify patient about prior authorization approval statusAbove date + 1 day , 5 pm
169Send fax for laboratory procedure requestAbove date + 1 day , 5 pm
179Update laboratory procedure request order with appointment dateAbove date + 1 day , 5 pm
189Notify patient about laboratory procedure appointment dateAbove date + 1 day , 5 pm
199Send patient reminders about laboratory procedure appointmentThis 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
209Send patient laboratory procedure appointment prerequisitesThis task can be created only if an appointment date is received. Appt date minus 7 days , 8 am
219Send patient reminders about laboratory procedure appointment prerequisitesThis 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
229Send fax for laboratory procedure resultsThis task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm
239Update laboratory procedure request order with laboratory resultsThis task can be created only if an appointment date is received. Above date plus 1 day, 5 pm
24Place imaging procedure order
25Send fax for imaging procedure order precertificationDate the order was created, due by 5 pm
26Update imaging procedure order with precertification proofAbove date + 3 days , 5 pm
27Notify patient about precertification approval statusAbove date + 1 day , 5 pm
28Send fax for imaging procedure order prior authorizationSame as above
29Update imaging procedure order with prior authorization proofAbove date + 7 days , 5 pm
30Notify patient about prior authorization approval statusAbove date + 1 day , 5 pm
31Send fax for imaging procedure requestAbove date + 1 day , 5 pm
32Update imaging procedure request order with appointment dateAbove date + 1 day , 5 pm
33Notify patient about imaging procedure appointment dateAbove date + 1 day , 5 pm
34Send patient reminders about imaging procedure appointmentThis 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
35Send patient imaging procedure appointment prerequisitesThis task can be created only if an appointment date is received. Appt date minus 7 days , 8 am
36Send patient reminders about imaging procedure appointment prerequisitesThis 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
37Send fax for imaging procedure resultsThis task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm
38Update imaging procedure request order with laboratory resultsThis task can be created only if an appointment date is received. Above date plus 1 day, 5 pm
39Place Medical clearance referral order
40Send fax for Medical clearance referral orderDate the order was created, due by 5 pm
41Update medical clearance request order with appointment dateAbove date + 3 days , 5 pm
42Notify patient about medical clearance appointment dateAbove date + 1 day , 5 pm
43Send patient reminders about medical clearance appointmentThis 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
44Send patient medical clearance appointment prerequisitesThis task can be created only if an appointment date is received. Appt date minus 7 days , 8 am
45Send patient reminders about medical clearance appointment prerequisitesThis 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
46Send fax for medical clearance resultsThis task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm
47Update medical clearance request order with laboratory resultsThis task can be created only if an appointment date is received. Above date plus 1 day, 5 pm
48Place specialist clearance referral order
49Send fax for specialist clearance order precertificationDate the order was created, due by 5 pm
50Update specialist clearance order with precertification proofAbove date + 3 days , 5 pm
51Notify patient about precertification approval statusAbove date + 1 day , 5 pm
52Send fax for specialist clearance order prior authorizationDate the order was created, due by 5 pm
53Update specialist clearance order with prior authorization proofAbove date + 3 days , 5 pm
54Notify patient about prior authorization approval statusAbove date + 1 day , 5 pm
55Send fax for specialist clearance referral orderDate the order was updated, due by 5 pm
56Update specialist clearance request order with appointment dateAbove date + 3 days , 5 pm
57Notify patient about specialist clearance appointment dateAbove date + 1 day , 5 pm
58Send patient reminders about specialist clearance appointmentThis 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
59Send patient specialist clearance appointment prerequisitesThis task can be created only if an appointment date is received. Appt date minus 7 days , 8 am
60Send patient reminders about specialist clearance appointment prerequisitesThis 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
61Send fax for specialist clearance resultsThis task can be created only if an appointment date is received. Appt date plus 1 day, 5 pm
62Update specialist clearance request order with laboratory resultsThis task can be created only if an appointment date is received. Above date plus 1 day, 5 pm
63Place pre operative Medication order
64Send fax for preop medication order precertification
65Update preop medication order with precertification proof
66Notify patient about precertification approval status
67Send fax for preop medication order prior authorization
68Update preop medication order with prior authorization proof
69Send fax for medication order
70Notify patient about prior authorization approval status and RX order
71Ask patient about RX fill status
72Update medication order with RX fill status
73Send patient reminders about pre op medications adherenceEach day the medication order is valid for
74Place Device order
75Send fax for surgery device order precertification
76Update surgery device order with precertification proof
77Notify patient about precertification approval status
78Send fax for surgery device order prior authorization
79Update surgery device order with prior authorization proof
80Place Transportation order
81Send fax for transportation order precertification
82Update transportation order with precertification proof
83Notify patient about transportation approval status
84Send fax for transportation order prior authorization
85Update transportation order with prior authorization proof
86Notify patient about prior authorization approval status
87Send fax for transportation order
88Update transportation request order with appointment date
89Notify patient about transportation appointment date
90Send patient reminders about transportation appointment
91Send transportation provider reminders about transportation appointment
92Place surgery appointment request order
93Send fax for surgery appointment request orderDate the order was created, due by 5 pm
94Update surgery appointment request order with appointment dateAbove date + 3 days , 5 pm
95Notify patient about surgery appointment dateAbove date + 1 day , 5 pm
96Send patient reminders about surgery appointmentThis 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
97Send surgery partner reminders about surgery appointmentThis 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
98Send surgery provider reminders about surgery appointmentThis 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
99Send device product rep reminders about surgery appointmentThis 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
100Place surgery preoperative appointment request order
101Update surgery preoperative appointment request order with appointment date
102Notify patient about surgery preoperative appointment date
103Send patient reminders about surgery preoperative appointment
104Place preoperative NutritionOrder
105Notify patient about preoperative nutrition instructionsDate the order was created, due by 5 pm
106Remind patient about preoperative nutrition instructions adherenceThis 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
107Place COVID clearance referral order
108Send fax for COVID clearance appointment request orderDate the surgery date was finalized / updated, due by 5 pm
109Update COVID clearance request order with appointment dateAbove date + 3 days , 5 pm
110Notify patient about COVID clearance appointment dateAbove date + 1 day , 5 pm
111Send patient reminders about COVID clearance appointmentThis 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
112Send fax for COVID clearance resultsDate the clearance appointment order was updated, due by 5 pm
113Update COVID clearance request order with COVID lab resultsAbove date + 3 days , 5 pm
114Update surgery center with COVID clearance reportAbove date + 1 day , 5 pm
115Update post-operative results
116Update actual surgery procedures performedSurgery date + 1 day, due by 5 PM
117Update post-operative diagnosesSurgery date + 1 day, due by 5 PM
118Update operative complicationsSurgery date + 1 day, due by 5 PM
119Update implants / devices administeredSurgery date + 1 day, due by 5 PM
120Update specimens collectedSurgery date + 1 day, due by 5 PM
121Update anesthesia medications administeredSurgery date + 1 day, due by 5 PM
122Update tissues replacedSurgery date + 1 day, due by 5 PM
123Update estimated blood lossSurgery date + 1 day, due by 5 PM
124Update findingsSurgery date + 1 day, due by 5 PM
125Place follow up post operative appointments ordersSurgery date + 1 day, due by 5 PM
126Place surgery post-operative appointment request order
127Update surgery post-operative appointment request order with appointment dateSurgery date + 3 day, due by 5 PM
128Notify patient about surgery post-operative appointment dateAbove date + 1 day, due by 5 PM
129Send patient reminders about surgery post-operative appointmentThis 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
130Place post-operative NutritionOrder
131Notify patient about post-operative nutrition instructionsSurgery date + 1 day, due by 5 PM
132Remind patient about post-operative nutrition instructions adherenceSurgery date + each day the nutrition order is valid for
133Place post-operative Medication order
134Send fax for post-operative medication order precertificationSurgery date + 1 day, due by 5 PM
135Update post-operative medication order with precertification proofSurgery date + 3 day, due by 5 PM
136Notify patient about precertification approval statusAbove date + 1 day, due by 5 PM
137Send fax for post-operative medication order prior authorizationAbove date + 1 day, due by 5 PM
138Update post-operative medication order with prior authorization proofAbove date + 3 day, due by 5 PM
139Send fax for medication orderAbove date + 1 day, due by 5 PM
140Notify patient about prior authorization approval status and RX orderAbove date + 1 day, due by 5 PM
141Ask patient about RX fill statusAbove date + 1 day, due by 5 PM
142Update medication order with RX fill statusAbove date + 1 day, due by 5 PM
143Send patient reminders about post-operative medications adherenceEach day medication order is active
144Place transition of care referral request order
145Update transition of care appointment request order with appointment dateSurgery date + 1 day, due by 5 PM
146Notify patient about transition of care referral appointment dateSurgery date + 1 day, due by 5 PM
147Send patient reminders about transition of care referral appointmentThis 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
148Send fax for transition of care consult noteAppointment date + 1 day, due by 5 PM
149Update transition of care request order with visit note resultsAppointment date + 3 day, due by 5 PM
150Place specimen analysis request order
Comprehensive surgical scheduling checklist

Best practices

Following is based on my experience of managing a high volume of surgeries.

  1. Use surgery scheduling checklists – a surgery scheduling software works best. Try to eliminate spreadsheets or paper based scheduling.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Use surgery scheduling templates (order sets) as much as possible. This reduces errors and omissions in the preoperative process. 
  7. Eliminate paper based surgeon preference cards. Use a surgery scheduling software to manage your surgeons’ preference cards in real time. 
  8. 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.
  9. 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.
  10. 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.
  11. 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. 
  12. 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.
  13. 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.
  14. 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.
  15. 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.

AORN also has some guidelines published here.

How to organize surgery scheduling

If you manage multiple surgeons, I recommend using a surgical scheduling software. I organize surgery schedules by day, by provider, by surgery center following these guidelines. 

How to organize surgery scheduling infographic
How to organize surgery scheduling infographic

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

Surgical privileges matrix table
Surgical privileges table

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:

  1. STAT – highest priority, Life threatening situation. 
  2. ASAP – next highest priority, evident fast progression of disease.
  3. URGENT – next highest priority, Potential fast progression of disease.
  4. 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.

  1. Preoperative care team – This team that gets the patient to the operating room successfully, fully prepared.
  2. Peri-operative care team – this team ensures surgery procedure success and patient safety
  3. 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 software - care team
Surgical care team software – care team

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.

Surgical care team software - communications
Surgical care team software – communications

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
surgery scheduling software transportation order
surgery scheduling software transportation order

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 software - authorizations
Surgical care team software – authorizations

Surgical care team

The surgical care team that’s actually performing the procedure includes the following team members:

  1. Surgeon
  2. Anesthesiologist
  3. Certified registered nurse anesthetist (CRNA)
  4. Operating room nurse
  5. Surgical technician(s)
  6. Residents or medical students (depends on whether it is a teaching hospital or not)
  7. Physician assistant
  8. 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:

  1. Your surgeons plan/order the same surgery procedure / CPT for a given set of diagnoses and co-morbidities..
  2. Surgeons order the same pre-admission laboratory tests (PAT) for a given set of diagnoses, patient demographics and co-morbidities.
  3. 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.
  4. Your surgeons have a preference of a surgery facility or have specific hospital privileges.
  5. Surgery block times and days of week are already specified for your surgeons.
  6. Your surgeons order the same medications before and/or after the surgery procedure.
  7. History and physical / medical clearance, COVID clearance tests are always accompanied with the surgery orders (as they should be).
  8. The surgeon orders the same specialist clearances for a given set of diagnoses, patient demographics and co-morbidities.
  9. Your surgeons order the same diet(s) / place the same nutritional orders before and/or after the surgery procedure.
  10. 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.

Nisos Surgery scheduling template
Nisos Surgery scheduling template

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.

Nisos Surgery scheduling template diagnosis
Nisos Surgery scheduling template diagnosis

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.

Nisos Surgery scheduling template care team
Nisos Surgery scheduling template 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.

Nisos Surgery scheduling template care plan
Nisos Surgery scheduling template 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:

  1. Surgery procedure order(s)
  2. Laboratory procedure order(s)
  3. Imaging / Diagnostics procedure order(s)
  4. Medication order(s)
  5. Referral order(s) to primary care and specialists for clearances
  6. Appointments that may include preoperative and postoperative ones
  7. Devices and implants orders that might contain
    • Supplies and Custom Packs
    • Instruments and Trays
    • Equipment
    • Gloves
    • Sutures
    • Implantable Items
  8. Diet/Nutrition order(s)
  9. Transportation order(s)
Nisos Surgery scheduling template order set
Nisos Surgery scheduling template order set

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 tasks management
Nisos Surgery scheduling template tasks

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. 

Surgery scheduling workflow infographic
Surgery scheduling workflow infographic

High Level steps

  1. Surgeon places order for surgery case
  2. Surgery scheduler and patient discuss prerequisites (financial, medical)
  3. Tentative surgery date is booked
  4. Patient finishes prerequisites (financial, medical)
  5. Surgical scheduler finishes prerequisites (financial, medical results)
  6. Surgery date is confirmed
  7. Patient arrives at surgery center / hospital and is admitted

Detailed steps

  1. In case of an elective surgery, the patient might call in to start the preoperative workflow
  2. A surgical case might also be referred in by a provider / doctor that’s not part of the surgeon’s healthcare organization
  3. First the patient has a preoperative consult appointment with the surgeon that will be performing the procedure
  4. 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
  5. 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)
  6. 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.
  7. The schedulers advise the patient about the costs of the surgery, what’s covered by the patient’s insurance (if any), financial responsibilities etc.
  8. If the patient decides to proceed with scheduling the surgery, the surgery scheduling staff then has the patient sign the necessary consent + release forms.
  9. 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)
  10. 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
  11. 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
  12. 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
  13. Next, the surgery scheduler might print out various forms, counseling guides for the patient. These can also be sent electronically to the patient
  14. 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
  15. 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
  16. 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. 
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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:

  1. Surgeon creates the surgery postoperative note.
  2. Your surgeon places postoperative orders (if any). This could include procedures, laboratory, diagnostics, medication, nutrition, postoperative followup appointments, transition of care referral order(s).
  3. 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.

postoperative surgical workflow software
Surgery scheduling software postoperative workflow

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.

postoperative surgical workflow software - procedure narrative
Surgery scheduling software procedure narrative

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

  1. Update actual surgery procedures performed 
  2. Update anesthesia medications administered 
  3. Update implants / devices administered 
  4. Update tissues replaced
  5. Update estimated blood loss
  6. Update specimens collected
  7. Update findings
  8. Update post-operative diagnoses
  9. 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.

  1. Update transition of care appointment request order with appointment date
  2. Notify patient about transition of care referral appointment date
  3. Send patient reminders about transition of care referral appointment
  4. Send fax for transition of care consult note
  5. Update transition of care request order with visit note results
postoperative surgical workflow software - opnote surgery team
Surgery Scheduling software – opnote surgery team

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 surgical workflow software - procedure narrative
Surgery scheduling software postoperative narrative

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.

Surgery scheduling software postoperative diagnosis
Surgery scheduling software postoperative diagnosis

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.

postoperative surgical workflow software - anesthesia administered
Surgery scheduling software anesthesia administered

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.

Surgery scheduling software postoperative complications
Surgery scheduling software – postoperative complications

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.

Surgery scheduling software postoperative estimated blood loss
Surgery scheduling software postoperative estimated blood loss

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 software -  postoperative findings
Surgery scheduling software postoperative findings

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.

Surgery scheduling software postoperative specimens
Surgery scheduling software postoperative specimens

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.

Surgery scheduling software postoperative implants
Surgery scheduling software postoperative implants

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.

Surgery scheduling software postop fluids
Surgery scheduling software postop fluids

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.

Surgery scheduling software discharge plan of care
Surgery scheduling software discharge plan of care

Postoperative surgical workflow – followup appointments

In our surgical scheduling software, you would document it like below. The software handles following tasks for you.

  1. Place surgery post-operative appointment request order
  2. Update surgery post-operative appointment request order with appointment date
  3. Notify patient about surgery post-operative appointment date
  4. Send patient reminders about surgery post-operative appointment
Surgery scheduling software postoperative followup appts
Surgery scheduling software postoperative followup appts

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.

  1. Notify patient about post-operative nutrition instructions 
  2. Remind patient about post-operative nutrition instructions adherence 
postoperative surgical workflow software - nutrition
Surgery scheduling software postoperative nutrition

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.

  1. Send fax for post-operative medication order pre-certification
  2. Update post-operative medication order with pre-certification proof
  3. Notify patient about pre-certification approval status
  4. Send fax for post-operative medication order prior authorization
  5. Update post-operative medication order with prior authorization proof
  6. Send fax for medication order
  7. Notify patient about prior authorization approval status and RX order
  8. Ask patient about RX fill status 
  9. Update medication order with RX fill status
  10. Send patient reminders about post-operative medications adherence
Surgery scheduling software postop medications
Surgery scheduling software postoperative medications

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.

  1. Update transition of care appointment request order with appointment date
  2. Notify patient about transition of care referral appointment date
  3. Send patient reminders about transition of care referral appointment
  4. Send fax for transition of care consult note
  5. Update transition of care request order with visit note results
postoperative surgical workflow software - referrals
Surgery scheduling software postoperative referral

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