Scheduling by CPT: Key to Improving On-Time Starts and OR Revenues

More than likely you’ve tried most, if not all, of the following initiatives:

Department Goal: Improve On-Time Starts (On Time @ or > 90%)
Check Mark Upgrade to Latest Scheduling Software
Check Mark Establish Policy for Use of Historical Averages for Case Times
Check Mark (Painstakingly) Revise Block Schedule and Closely Monitor Utilization
Check Mark Implement Tracking Board
Check Mark Conflict-Check Equipment Supplies
Check Mark Conduct Lean Event(s) for Turnovers
Question Mark What else is there?

Having checked-off most, if not all, of these initiatives, why is it that you continue to struggle with poor case time reliability as the day progresses and/or on-time start averages that are well below 90%?

-CPT coded procedures

 

#1 Effective Way to Improve on-time starts.

One of the most overlooked yet effective options for improving on-time starts is to schedule by CPT coded procedures. Scheduling by CPT provides a much more accurate case time estimate; more accurate case time estimates translate into increased prime-time OR utilization, improved ability to staff to volume (reduce overtime) and increased patient/physician/staff satisfaction scores. Additional benefits of scheduling by CPT include enhanced analytics (helping quality, financial, and performance improvement departments) and greater drill-down capabilities into case complexity.

Studies have found CPT codes to be the most accurate way to predict surgical case duration.  For example  Li et al. (2010) state, “Our research is motivated by the fact that CPT codes describe how a surgical case should be performed, and thus provide specific knowledge and information relevant to individual surgical cases.”

Illustrating the problem; comparing similar named cases

Shoulder Arthroscopy: If you currently use a generic procedure for Shoulder Arthroscopy and then free text in the specifics, there could be as much as 30-60 minutes total room time (total room time is defined as “patient  in to patient out”) difference depending on the complexity of the procedure:

CPT CodeProcedureApprox Total Room Time
29805 Arthroscopy, shoulder, DX, w/wo synovial bx 90 min
29824 Arthroscopy, shoulder, surgical; distal claviculectomy w/articular surface 130 min
29827 Arthroscopy, shoulder surgical; w/rotator cuff repair 175 min
  variance 40-85 min per case

 

By scheduling the surgical case using CPT coded procedures, this time difference can be applied and better time utilization achieved.

Laparoscopic Cholecystectomy:  A straight forward lap chole and a lap chole with common bile duct exploration can vary in time by as much as 20-40 minutes:

CPT CodeProcedureApprox Total Room Time
47562 Laparoscopy, surgical; cholecystectomy 120 min
47564 Laparoscopy, surgical; cholecystectomy w/exploration of common duct 160 min
  variance 40 min

 

Lumbar Spinal Fusion: Depending on complexity, this procedure can vary 60 minutes or more:

CPT CodeProcedureApprox Total Room Time
22630

Arthrodesis, post interbody w/laminectomy &/or diskect, prep interspace, single interspace, lumbar

90 min
22612 Arthrodesis posterior/posterolateral technique, single level lumbar 130 min
  variance 40-85 min per case

 

As a result, delays begin to stack up as the surgery day progresses… or, conversely, prime OR time goes unused. Either way, the hospital is negatively impacted.

CPT codes are readily available from the Surgeons’ offices as Surgeons’ office livelihood relies on two sets of codes:  CPT and ICD.  The offices are gathering this data when the patient consults for surgery – so the data is available at the point of scheduling – and you should grab it; leaving far less room for interpretation of the actual procedure being performed (your schedule and your multi-million dollar business is at the mercy of the newest surgeon office clerk).

Already using CPT (or perhaps you are an over-achiever)?
Take it a step further… Add the ICD diagnosis code at the time of scheduling and think of the benefits to your hospital precertification department when the CPT and ICD code is readily available in the surgery software program. No more searching H&Ps or, surgeon notes for this information.

Where to Start

So, by now you may be asking yourself, “Why didn’t I know about this?”

Well, that may be because it’s not easy to get it organized and established …but don’t stop reading… as the benefits outweigh the costs and efforts associated with getting the structure in place.  And, once the CPT coded procedure files are created, they are no more difficult to maintain than your current procedure dictionary.  Because of the complexities and time involved, we strongly recommend outsourcing the transition – or, at a minimum, partnering with experts to facilitate the project. The successful implementation and roll out benefits from experience, expertise dedicated resources and outsourcing keeps your staff focused on their more pressing day-to-day responsibilities.

Conclusion

Will CPT coded procedures end surgery case time delays and discrepancies?  Not completely, there will always be the human factors:  unusual patient findings, surgical team productivity, etc. that cannot be controlled, especially in tertiary care hospitals where case complexity increases.  But, CPT coding can significantly improve procedure time estimates for the majority of straight forward surgical procedures performed in surgery departments and ambulatory surgery centers. Even if your on-time starts are at or above 90 percent, your OR can still benefit from making this change.

Tips
Greater ease of web-based scheduling; automating the scheduling process is easier to implement and affords greater surgeon buy-in when using CPT to schedule cases. Most surgery software has the ability to create generic procedure group doctor preference cards; if you are booking by CPT, the process of attaching similar CPT coded procedures to one card allows for effective preference card maintenance while still allowing for accurate case time estimates through CPT procedure booking in the scheduling module.

Leave the dirty work to us…

Our team of experts can assist your organization with minimal impact on your staff’s time.
The return on investment comes in the form of improved on-time starts, reduced overtime…

Contact us for more information on:

  • Creating CPT coded procedure file.
  • Mapping CPT coded procedures to generic procedure group preference cards.
  • Assisting with implementation and education of scheduling staff/ surgeon offices.
  • Creating custom reports.