Surgery scheduling guide

Comprehensive surgical scheduling guide including how to use surgery scheduling software or checklists for procedures, referrals, appointments, prior authorizations etc.

Published

Table of Contents

Summary

How to organize surgery scheduling? Follow this comprehensive surgical scheduling guide to reduce or eliminate surgery cancellations, no-shows. This is based on my experience of managing surgeries for a group of 12 surgeons.

  1. Create a surgery care plan for each patient’s surgery. This helps group all related tasks together.
  2. Understand the interdependencies of each surgery scheduling task. Take a Gantt chart approach to surgery scheduling project management.
  3. Keep all the stakeholders on a surgery care team in the loop, all the time.
  4. Use Surgery scheduler checklist / spreadsheets diligently. Alternatively, use a surgery scheduling software.
  5. Treat your OR team as partners.

Surgery scheduling workflow

Below are the various tasks that are involved in a surgical scheduling process. There are preoperative, intra-operative and post operative tasks involved. Intra operative tasks are not covered in this guide.

Pre operative surgical scheduling workflow

Below are overall tasks that cover the pre operative surgery scheduling workflow.

Place Surgical procedure orders

  1. Send fax for Surgical procedure order precertification
  2. Update surgical procedure order with precertification proof
  3. Notify patient about precertification approval status
  4. Send fax for Surgical procedure order prior authorization
  5. Update surgical procedure order with prior authorization proof
  6. Notify patient about prior authorization approval status

Place Laboratory procedure orders

  1. Send fax for laboratory procedure order precertification
  2. Update laboratory procedure order with precertification proof
  3. Notify patient about precertification approval status
  4. Send fax for laboratory procedure order prior authorization
  5. Update laboratory procedure order with prior authorization proof
  6. Notify patient about prior authorization approval status
  7. Send fax for laboratory procedure request
  8. Update laboratory procedure request order with appointment date
  9. Notify patient about laboratory procedure appointment date
  10. Send patient reminders about laboratory procedure appointment
  11. Send patient laboratory procedure appointment prerequisites 
  12. Send patient reminders about laboratory procedure appointment prerequisites 
  13. Send fax for laboratory procedure results
  14. Update laboratory procedure request order with laboratory results

Place imaging procedure orders

  1. Send fax for imaging procedure order pre-certification
  2. Update imaging procedure order with precertification proof
  3. Notify patient about precertification approval status
  4. Send fax for imaging procedure order prior authorization
  5. Update imaging procedure order with prior authorization proof
  6. Notify patient about prior authorization approval status
  7. Send fax for imaging procedure request
  8. Update imaging procedure request order with appointment date
  9. Notify patient about imaging procedure appointment date
  10. Send patient reminders about imaging procedure appointment
  11. Send patient imaging procedure appointment prerequisites 
  12. Send patient reminders about imaging procedure appointment prerequisites 
  13. Send fax for imaging procedure results
  14. Update imaging procedure request order with laboratory results

Place Medical clearance referral orders

  1. Send fax for Medical clearance referral order
  2. Update medical clearance request order with appointment date
  3. Notify patient about medical clearance appointment date
  4. Send patient reminders about medical clearance appointment
  5. Send patient medical clearance appointment prerequisites 
  6. Send patient reminders about medical clearance appointment prerequisites 
  7. Send fax for medical clearance results
  8. Update medical clearance request order with laboratory results

Place specialist clearance referral orders

  1. Send fax for specialist clearance order precertification
  2. Update specialist clearance order with precertification proof
  3. Notify patient about precertification approval status
  4. Send fax for specialist clearance order prior authorization
  5. Update specialist clearance order with prior authorization proof
  6. Notify patient about prior authorization approval status
  7. Send fax for specialist clearance referral order
  8. Update specialist clearance request order with appointment date
  9. Notify patient about specialist clearance appointment date
  10. Send patient reminders about specialist clearance appointment
  11. Send patient specialist clearance appointment prerequisites 
  12. Send patient reminders about specialist clearance appointment prerequisites 
  13. Send fax for specialist clearance results
  14. Update specialist clearance request order with laboratory results

Place pre operative Medication orders

  1. Send fax for preop medication order pre-certification
  2. Update preop medication order with precertification proof
  3. Notify patient about precertification approval status
  4. Send fax for preop medication order prior authorization
  5. Update preop 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 pre op medications adherence

Place Device orders

  1. Send fax for surgery device order pre-certification
  2. Update surgery device order with precertification proof
  3. Notify patient about precertification approval status
  4. Send fax for surgery device order prior authorization
  5. Update surgery device order with prior authorization proof

Place Transportation orders

  1. Send fax for transportation order pre-certification
  2. Update transportation order with precertification proof
  3. Notify patient about transportation approval status
  4. Send fax for transportation order prior authorization
  5. Update transportation order with prior authorization proof
  6. Notify patient about prior authorization approval status
  7. Send fax for transportation order
  8. Update transportation request order with appointment date
  9. Notify patient about transportation appointment date
  10. Send patient reminders about transportation appointment

Place surgery appointment request order

  1. Send fax for surgery appointment request order 
  2. Update surgery appointment request order with appointment date
  3. Notify patient about surgery appointment date
  4. Send patient reminders about surgery appointment
  5. Place surgery preoperative appointment request order
  6. Update surgery preoperative appointment request order with appointment date
  7. Notify patient about surgery preoperative appointment date
  8. Send patient reminders about surgery preoperative appointment

Place preoperative Nutrition Orders

  1. Notify patient about preoperative nutrition instructions 
  2. Remind patient about preoperative nutrition instructions adherence 

Place COVID clearance referral order

  1. Update COVID clearance request order with appointment date
  2. Notify patient about COVID clearance appointment date
  3. Send patient reminders about COVID clearance appointment
  4. Send fax for COVID clearance results
  5. Update COVID clearance request order with COVID lab results
  6. Update surgery center with COVID clearance report

Post operative surgery scheduling workflow

After the surgery procedure is completed, your job is to continue the surgical scheduling process by getting everything ready for the billing department. Your surgeon has to provide you the OR post op note. Alternatively, the OR or ambulatory surgery center can provide you the same as well.

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 

Place follow up post operative appointments orders

  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

Place post-operative Nutrition Orders

  1. Notify patient about post-operative nutrition instructions 
  2. Remind patient about post-operative nutrition instructions adherence 

Place post-operative Medication orders

  1. Send fax for post-operative medication order precertification
  2. Update post-operative medication order with precertification proof
  3. Notify patient about precertification 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

Place transition of care referral request order

  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

Stakeholders in a surgery scheduling workflow

The following is not a comprehensive list of the stakeholders in a surgical scheduling process. These stakeholders need to coordinate together for operational success of a surgery.

  1. Patient 
  2. Patient escort / vendor
    • Appointment scheduler
    • Attendant 
  3. Requesting physician office
    • Appointment scheduler
    • Medical assistant 
    • Scribe
    • Physician 
  4. Performing Physician / Surgeon office 
    • Appointment scheduler
    • Medical assistant 
    • Scribe
    • Physician 
    • Physician office Surgery scheduler 
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  5. Laboratory 
    • Appointment scheduler 
    • Lab technician 
    • Physician 
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  6. Imaging / diagnostics center
    • Appointment scheduler 
    • Technician 
    • Physician 
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  7. Pharmacy 
    • Pharmacy Technician 
    • Pharmacist 
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  8. Transportation vendor
    • Appointment scheduler 
    • Driver
  9. PCP office
    • Appointment scheduler 
    • Medical assistant 
    • Physician 
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  10. Specialist office
    • Appointment scheduler 
    • Medical assistant 
    • Physician 
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  11. Device vendor 
    • Logistics / order manager 
    • Device representative  
  12. Implants vendor
    • Logistics / order manager 
    • Implant / device representative  
  13. Surgery center 
    • Surgery scheduler 
    • Logistics/ supplies manager 
    • Anesthesiologist 
    • Nurse
    • Prior authorization staff
    • Denials staff
    • Coder / biller
  14. Insurance / payer office
    • Customer service representative 
    • Adjudicator

Surgery scheduling checklists

Organize your surgery scheduling process into two “surgical scheduling checklists” – pre operative checklist and post operative checklist.

As a surgical 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.

Do not send/accept a post operative packet for billing unless the post operative checklist is marked completed.

Surgery scheduling plan – EZHCRM

Surgery scheduling checklist – pre-operative

The pre operative surgery scheduler 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. 

  • Allergy
  • Diagnosis
    • Chief complaint
    • Pre operative
    • Admission
    • Co-morbidities
    • Severity
    • Stage
  • Care Team
    • Surgeon
    • Co surgeon
    • Anesthesiologist
    • Nurses
    • Medical Assistants
    • Device representatives
  • Care plan
  • Care plan orders
    • Surgery order(s)
      • Surgery method
      • Surgery body position
      • Anesthesia type
      • Tissue
      • 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)
  • Insurance
    • Payment
    • Pre certification
    • Prior Authorization
  • Documentation
    • Consents
    • Releases
    • Identification
  • Surgery Packet
    • Each patient’s surgery order
    • Consolidated supply requisition
  • Patient reminders for
    • Medication order(s)
    • Nutrition order(s)
    • Fasting
    • Transportation before and after surgery

Surgical scheduling checklist – post-operative

The post operative surgery scheduler 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).

  1. Procedures
  2. Anesthesia
  3. Implants / Drains
  4. Specimens collected
  5. Diagnosis
  6. Complications
  7. Findings
  8. Follow up order
  9. Discharge details
    • Admission date/time
    • Discharge date/time
    • Transition of care date/time
    • Intubation days
    • ICU days
    • Hospital stay period
    • ISS score

Surgery scheduler checklist – how to organize surgeries

Learn how to organize surgical scheduling by following these steps. Your surgery scheduling workflow should go smoothly if you maintain surgical scheduling checklists using spreadsheets. Better yet, use a surgery scheduling workflow platform.

Surgery scheduling – Diagnosis

You will either have the surgical 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.

Surgery scheduling - Diagnosis
Surgery scheduling – Diagnosis

Surgery scheduling checklist – Allergies

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 surgical 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 surgery scheduling templates to the fullest.

surgery scheduling order sets
surgery scheduling order sets

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.

Surgery care team
Surgery care team

Surgical Care Plan

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.

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.

Surgery Care Plan
Surgery Care Plan

Complete all care plan orders

Your surgery care plan is bound to have one or more of the following orders

  1. Surgery procedure order
  2. Imaging/diagnostics order(s)
  3. Laboratory order(s)
  4. Referral orders (medical, COVID, specialist etc)
  5. Medication order(s)
  6. Appointments order(s)
  7. Devices / implants order(s)
  8. Counseling order(s)
  9. Transportation order(s)

Surgery scheduling checklist – 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 - complete surgery order
Surgery scheduling – complete surgery order

Surgery scheduling checklist – Imaging / Diagnostics order

Capture each surgery imaging / diagnostic order while planning the surgery. For example, in a major orthopedic surgery, you might have to place multiple imaging or diagnostic orders.

Keep in mind that each of those diagnostic orders have pre-requisites for patients to perform before they go in for the specified tests.

Unless you obtain the results for each diagnostic tests, 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.

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 scheduling - Imaging / Diagnostics order
Surgery scheduling – Imaging / Diagnostics order

Surgical schedule planning – 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 – PT, PTT, UA, CHEM 8, CHEM 14, EKG, CBC, X-RAY etc.

Your surgery package will not be complete until the laboratory results have been obtained with no variances found or all variances addressed appropriately.

Surgery planning - Laboratory order
Surgery planning – Laboratory order

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 (ASAP, STAT, Next month etc). 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 - Appointments orders
Surgical planning – Appointments orders

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
Surgical planning – Referral / clearance orders

Surgical planning – Medication orders

Make sure to place an order for each medication that is 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 - Medication orders
Surgical planning – Medication orders

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 - Device / implants orders
Surgical planning – Device / implants orders

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.

Surgical planning - Transportation orders
Surgical planning – Transportation orders

Surgery related papers

Print and hand over the following papers to the patient before they leave your office. My suggestion is to deliver these papers electronically. I’ve seen better compliance when patients have instructions / papers in electronic format.

Print the History and physical request

History and physical request (requirements) handed over to the patient. It is preferred that you personally fax this over to the primary care physician office as well.

Surgery scheduling forms
Surgery scheduling forms

Print the Anesthesia Fact Sheet (MUST)

Anesthesia Fact Sheet printed and handed over to the patient. Your patient will have to sign the anesthesia consent paperwork as well.

Print Medication Reconciliation List

The Medication Reconciliation List has to be printed and handed over to the patient. This has to be filled out before they go in for the surgery. You would have already completed the medication reconciliation by this time. The patient can also add other medications they forgot to tell you about.

Print the Patient bill of rights

This might also contain the advanced directive of the patient. Make sure that your patient is handed this before they leave the office.

Pre and postoperative appointments

Do not forget to print out the Preoperative and postoperative appointments with the surgeon / your office. This is just a back up for patients. You will be sending them reminders for their appointments as well.

Get patient and surgeon signatures

This is very important and many a time, easily missed. Make sure each surgery document has the appropriate signatures. This might include the surgeon/ performing provider’s signature, ordering provider’s signature, patient’s signature, etc as appropriate for the document in question.

Patient and surgeon signatures
Patient and surgeon signatures

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.

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.

Surgical planning – prior authorizations

Get the surgery pre-certification / eligibility done as soon as possible.

Pre certification is a quick check and does not require you to wait to submit documents. This step 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.

Surgical planning - prior authorizations
Surgical planning – prior authorizations

Upload proof of prior authorization

It’s best to have a separate fax number for surgical scheduling. In my 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.

Upload proof of prior authorization
Upload proof of prior authorization

Update your surgery scheduling 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.

surgery scheduling records prior authorization number
surgery scheduling records prior authorization number

Update EMR with clearances

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. 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 surgery scheduling 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 Post 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.

Post Operative Report
Post Operative Report

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.

Surgery scheduling prior authorizations

Here are my recommendations

  1. Always perform eligibility checks or pre-certification checks before starting the cumbersome process of prior authorizations.
  2. Handle as many Prior authorizations as you can by yourself. Do these on behalf of your partners before sending them your order.
  3. Always submit as much supporting documentation as possible. Do this for each care plan order prior authorization request. This reduces denials and delays.
  4. Automate the prioritization process as much as possible. Spend your time only on reviewing the outcomes of automation. I recommend using a surgical scheduling system / surgery scheduling software.
  5. Maintain correct statuses of each prior authorization needed/submitted. Either use a spreadsheet with Reminders, or a Calendar with Reminders, or simply use a surgical scheduling workflow platform like EZHCRM.

Handle ALL the prior authorizations yourself

As a surgery scheduler, you are expected to get prior authorizations only for the procedures your office will perform and bill for. 

So, why do I recommend handling prior authorizations for orders that your office will not deliver nor bill for?

Simple. Do this to reduce surgical delays. You retain more control of your surgery scheduling process.

Let’s say that your surgeon ordered a laboratory procedure to be done. Your surgeon needs results gathered before the surgery date. 

  1. You ask the patient to get you the laboratory procedure results before the surgery date or before the pre operative appointment date. The patient gets the laboratory order script from you / your office.
  2. The patient takes their own sweet time in making an appointment with the laboratory. Ultimately, the laboratory’s appointment scheduler books an appointment for your patient. 
  3. The laboratory then has to gather accurate patient information from the patient. The laboratory also has to obtain actual laboratory order script that your doctor wrote, from the patient.
  4. Based on your surgery patient’s insurance, the laboratory billing team or coordinators will need to handle laboratory orders’ prior authorizations. This follows the same number of steps along with the same chances of denials as mentioned before.
  5. In case of denials, the laboratory staff has to resubmit the prior authorization. They have to submit additional, supporting documentation. This documentation comes from your doctor (ordering physician).
  6. The laboratory staff then asks the patient to gather this information. Or, they fax/call your office to get the additional information. Once the laboratory receives additional information, they restart the prior authorization process.

To avoid this back / forth, handle all necessary eligibility and prior authorization steps yourself.

Surgery scheduling prior authorization steps

During surgery scheduling, you will have one or more of the following care plan orders.

  1. Surgery procedure orders 
  2. Laboratory procedure orders
  3. Imaging procedure orders
  4. Medical clearance referral order
  5. Specialist clearance referral order
  6. COVID clearance referral order
  7. Medication orders
  8. Diet / Nutrition orders
  9. Device / Implant requisition orders
  10. Transportation orders
Surgery scheduling care plan order for prior authorization
Surgery scheduling care plan order for prior authorization

Based on your surgery patient’s insurance, you will need to handle surgery prior authorizations .

  1. Check patient eligibility (pre-certification) for each line item in the care plan order. If the payer responds to the pre-certification request with a denial, discuss next steps with the patient and the surgeon.
  2. If the patient is eligible, check the insurance plan documentation. Each insurance payer has their own rules, conditions etc. These rules do change often. Do not rely on an old copy of the payer’s documentation. Each time, find out whether a care plan order item (procedure, device, medication, transportation etc) requires prior authorization.
  3. Pre certification does not guaranteed for the surgery. Submit prior authorization request for each care plan order line item. Make sure to send medical records and physician documentation to prove medical necessity. 
  4. Each insurance payer has their own response timelines. On a regular basis, check for approvals or denials.
  5. On receiving a denial, appeal the payer decision by submitting even more supporting documentation. Enlist the help of your physician for this. Otherwise, submit a prior authorization request for an alternative / substitute as suggested in your payer denial response or by your surgeon.

Handling emergency procedure prior authorizations

If it is an emergency procedure, the surgical coordinator can skip the pre-certification process. You can try to get the prior authorization retroactively after the surgery. 

Various payers stipulate that such prior authorizations should be obtained between 24 and 72 hours after admission.

Surgery scheduling – handling allergies

You and your staff should be educated or at least made aware of the various allergies, including, food, latex, mold, and drugs.

It is impossible for a surgery center to anticipate all possible patient allergies. Hence, it considered best practice to document and update patient allergies at each encounter.  Keep in mind that patients do not themselves know about their own allergies until the event actually occurs.

Suggestions

  1. Make sure anaesthetists and allergists are part of your patient care team.
  2. When in doubt or if you don’t have evidence, create an allergist referral order.
  3. Gather allergy information early on, and at each encounter. Preoperative appointments are your final chance to identify prior allergic reactions.
  4. Use a surgery scheduling software to automatically collect patient allergies over the peri operative period.

Medication reconciliation 

During surgery scheduling, you will invariably have to perform medication reconciliation. Allergies reconciliation is a sub part of medication reconciliation. When you are documenting a patient’s allergies make sure that you document the type of allergic reaction and the severity of that allergic reaction as well. Severe anaphylactic reactions are the not the only ones to be wary of.

One way of handling this could be to ask the patient to bring in all the medications they are taking, during their next encounter. This allows the provider to sort out the drugs and to perform reconciliation. However, that only covers the drug related allergies and leaves out others. 

Standard processes

You can standardize your processes and ensure that the same format of questions are asked at each patient encounter. Or if you use a medical CRM, the system can call the patient on a regular basis to gather all allergies related information. Such medical CRM systems can also perform medication reconciliation on your behalf.

Penicillin related allergies

Keep in mind that Up to 98% of penicillin-allergy labels are incorrect when actual testing was done. In other words, your surgery patient might tell you that they are not allergic to penicillin but unless they can substantiate the claim with a relatively recent test result, make sure to order this test.

As you’re scheduling a surgery, make sure that you ask the patient 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 “.

According to research, penicillin remains a leading cause of drug-induced hypersensitivity and anaphylaxis. Amongst fatal drug-induced anaphylaxis, penicillin was the most commonly identified culprit drug in a recent US study.

While penicillin related allergy has reduced from 15% to approximately 3% over the years, the evidence of harm still looms large.

Penicillin allergy outcomes include infection and antimicrobial resistance, hospital readmission rates, length of hospital stay (increased use of critical care beds). Postoperative surgical site infections (SSIs) are major contributors to patient morbidity and mortality, and therefore, costs. 

Preoperative penicillin allergy questionnaire

Keep it simple

  1. Does the patient know if they’re allergic to penicillin? 
  2. How does the patient know their penicillin allergy status? 
  3. Has the patient ever had a penicillin allergy skin test?
  4. When did the reaction occur?
  5. Penicillin to which patient reacted?
    1. Unknown
    2. Penicillin
    3. Amoxicillin
    4. Amoxicillin-clavulanate
    5. Ampicillin
    6. Ticarcillin
    7. Piperacillin
    8. Cloxacillin
  6. What was the reaction from this allergy?
    1. Hives – red, raised, itchy bumps
    2. Shortness of breath/wheezing
    3. Swelling of the eyes, face, lips, tongue
    4. Hypotension
    5. Nausea, vomiting, diarrhea, cramping
    6. Severe cutaneous reaction
    7. Other type of rash
  7. How soon after taking the medication did the reaction occur?
  8. Has the patient received penicillin since the reaction?

Latex related allergies

Many surgical supplies, devices, gloves, syringes, catheters contain natural rubber latex (NRL). Over the years, NRL (latex) has become a major problem for patients (surgical or non surgical) due to allergies to latex (known or unknown to the individual). These allergic reactions can be minor (redness, itchiness) or can be as severe as asthma or anaphylaxis.

Latex allergy has no cure, but can certainly be managed.

If you have a surgical patient labeled as latex allergic, it’s best to schedule their surgery as early during the week and day as possible. This minimizes your risks.

An OR team typically has to assemble a latex-free supply cart for such patients. Hence, identifying surgical patients with allergies allows for proper preparation.

Preoperative latex allergy questionnaire

You need to know which patients are more prone to latex allergies. These include but are not limited to 

  1. Healthcare workers (they frequently wear latex gloves)
  2. Individuals that have undergone multiple surgeries 
  3. Non healthcare workers that have frequent contact with latex gloves owing to their profession (eg cleaning personnel, individuals working in plants, hairdressers etc)
  4. Children with birth defects, born prematurely
  5. With food allergies (avocado, banana, chestnut – high risk. Apple, carrot, celery, kiwi, melon, papaya, potato, tomato – intermediate risk. Low risk – apricot, cherry, fig, grape, hazelnut, mango, nectarine, passion fruit, peach, peanut, pear, pineapple, plum, rye, soybean, strawberry, walnut, wheat).
  6. Patients that have or had asthma, dermatitis or eczema

Ask the patient a few simple questions. If there’s any doubt, create a specialist order (allergist).

  1. Has a physician ever told you that you had a latex allergy? 
  2. Are you aware of being allergic to foods like avocado, banana, chestnut, apple, carrot, celery, kiwi, melon, papaya, potato, tomato?
  3. Have you ever had allergies, asthma, hay fever, eczema, or problems with rashes?
  4. Have you ever had any allergy symptoms after being in contact with a diaphragm, condom, balloon, rubber gloves, dental exam etc?
  5. Have you ever had respiratory distress, rapid heart rate or swelling?

Your job is to make sure that your patient and your healthcare setting is de-risked. Don’t make clinical decisions yourself- refer that patient out to an allergy specialist.

Allergist referral order in surgical scheduling 

If your patient cannot substantiate not being allergic to penicillin, order an allergist referral while scheduling their surgery. Order a skin prick test (SPT) / intradermal test (IDT). The skin test pre-screens patients for a drug provocation test (DPT). Patients who do not react to SPT or IDT are unlikely to react severely to the DPT. It’s better to be safe than sorry. 

Transition of care – handling allergies

Make sure to share all allergy information with both the primary care provider and the pharmacy of your patient’s care team. This enables higher levels of transition of care – inevitably, better continuity of care as well.

Urgent surgeries – handling allergies

If surgery cannot wait, make sure that the patient gets their testing done before the surgery, at the surgical healthcare setting. If by any chance you have access to the patient’s prior records, make sure that your anesthesiologist gets access to that. They might want to avoid all drugs used in the previous surgery. Otherwise, anaesthesia should proceed using the lowest risk drugs (I.e  no neuromuscular blocking agents NMBAs , no chlorhexidine, no latex).

Post surgery workflow

Follow these post surgery steps/guidelines. This will ensure your billing is error free. It also ensures there are less complications after a surgery.

Get post-operative note for billing

On the day of the surgery, ensure that you also deliver a surgery package to your surgeon.

This is a back up – just in case the surgery center / hospital is missing any paperwork (I have seen that happen a few times).

After the surgery, ensure that your surgeon hands you the surgery op-note. You are going to need this for billing.

surgery scheduling post operative procedure note
surgery scheduling post operative procedure note

Get the pre and post operative diagnoses

Ensure that the operative note has enough information and highest levels of specificity for you to be reimbursed in full without any denials.

Make sure that the note contains both the pre-op and post-op diagnoses (just in case it has changed). If the preop and postop diagnoses are the same, document that. If there’s a new finding, document it in the post operative diagnosis. If the pre operative diagnosis is not relevant anymore or if the diagnosis has changed intra-operatively, note that in the post operative section as well.

surgery scheduling post operative diagnosis complications
surgery scheduling post operative diagnosis 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.

Get the CPT terminology (not just CPT code)

Operative note should contain CPT terminology as much as possible but not the CPT code itself. Sometimes, this clashes with billing codes – make sure you collect these in your post surgery workflow.

Get indications for surgery and complexity

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).

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).

Get detailed “description” of the surgery

Finally, the note, of course, has to have the description of the surgery. Make sure your post surgery workflow covers this as well.

Collect all the implants/devices used

This is needed for billing, for patient records, continuity of care during / after transition of care.

surgery scheduling post operative implants
surgery scheduling post operative implants

Capture all post operative instructions

The postoperative instructions in your surgeon’s post operative note might contain

  • Follow up appointments
  • Referrals to other specialists
  • Diagnostic / Lab tests
  • More surgery orders
  • Patient post operative care instructions

Follow up with patient

Following up with a patient after the day of surgery to ensure no complications occurred is crucial.

surgery scheduling post operative followups
surgery scheduling post operative followups

Followup with operative care instructions

Usually, the surgery center provides all post operative care instructions, however, care instructions specific to your speciality should be followed through by you or someone in your team.

This could include the medications the patient can and cannot take, the correct way to take medications, wound care, the appropriate emergency contact information that the patient needs.

surgery scheduling post operative medications
surgery scheduling post operative medications

Make sure the patient shows up for post-operative appointment

The surgery scheduler should also ensure that the patient does show up for their post-operative appointment the next day after the surgery.

If your surgery scheduler cannot do it, make sure your call center or front-desk calls the patient to show up.

Remind the patient about their 1 week post op appointment

When the patient shows up for their post-op appointment, make sure that the patient has follow up appointments.

I recommend post operative appointments one week after surgery, one month after surgery, and three months after the patient’s surgery.

As the patient shows up for each follow up appointment, remind them of the next appointment.

Get patient reviews

Technically speaking, this is not really a post operative workflow.

However, in my experience, the day after the surgery is typically the best time to follow up with a patient satisfaction survey

Treat your OR team as partners

Your surgery center partners have significant investments in equipment and need your help in achieving their revenue targets as well. Understand that clearly and follow these steps.

  1. Book block times if possible.
  2. Make sure financial responsibilities and payment guarantees are in place before sending cases to the OR manager / surgery scheduler.
  3. Complete ALL surgery pre-requisites. Do not send patient cases with pending pre-requisites.
  4. Do not send one surgery patient case at a time. Prepare all the cases and send the surgery packet in one shot (for each surgery day).
  5. Submit all lab and diagnostic results as part of the surgery package.
  6. Provide accurate surgery case counts.
  7. Follow up with patient every 3-4 days.

Provide best case, worst case, most likely surgery case counts

Do not overbook and underdeliver. You cannot promise 30 patients, get a block time for your surgeon and show up with 10 patients.

When you book a surgery list with your ambulatory surgery center partner or your hospital partner, make sure you that at least 90% of your surgery candidates will show up.

I have found that giving my surgery partners a “best case”, “worst case” and “most likely” number work beautifully.

Reduce/eliminate no-shows/cancellations

Follow up with the patient constantly so they don’t cancel nor back out. Bake this into your surgery scheduling process as an integral step.

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.

The better your surgery no-show rates are, the more advantageous block times your surgeons get.

Over time, I have noticed that some ASCs end up dropping some associated surgical partners because of the no show and cancellation rates.Complete payment guarantees

Make sure you finish the prior authorizations (after pre-certification). If there’s a denial, make sure the patient knows it.

Either the payer promised to pay (i.e you got the prior authorization).

Or, the patient promised to pay (self-pay patients).

Surgery pre-operative appointment

Add a preoperative step in your surgery scheduling workflow – do not skip this step.

This will ensure that you get another chance to counsel the patient, prepare them for the surgery, get all loose ends tied up.

Revisit medical history with the patient

Wait to receive the surgical / medical clearance from the PCP office.

Then call the patient to go over the medical history with the patient.

Often patients do not understand what a surgery is and what is not (a classic example is a C section).

Here’s a checklist sample to follow

Go over medication history with the patient

Dig deeper into the patient’s medications.

Specifically ask for any over the counter “herbal medication” the patient might be taking.

Most patients do not think that herbal medication can interfere with anything related to their surgeries.

However, some herbal medications might interfere with anesthesia.

Order missed diagnostic tests

First, look for any diagnostic tests your doctor has ordered. In case, your surgeon forgot to, you can also remind the surgeon to order specific tests.

These diagnostic tests might be needed based on the age, medical history of the patient.

This is almost never a standard list. However these are prerequisites of your particular surgery.

Spend time educating the patient

Patients are, understandably, anxious and might delay their care / surgery. You need to educate your patient multiple times. This helps reduce costly surgery no-shows and cancellations.

Explain preoperative fasting, medications, anesthesia, and postoperative care

The surgery scheduler should be advising the patient on preoperative fasting, medications, anesthesia, and postoperative care that the patient should expect.

The reasons for fasting should be explained to the patient repeatedly. This is main reason why most of your surgery cancellations occur.

Patients simply do not understand that not fasting opens them up to chances of vomiting, nausea post operatively.