AI in Surgery Starts With the Hidden Admin Work Behind Every Case

Say “AI in surgery” and most people picture a robotic arm in the operating room. That technology is real, and it’s changing outcomes. For most surgeons, though, the heaviest drag on the day sits outside the OR, in the documentation, coding, approvals, and billing work wrapped around every case.

That hidden workload is where AI makes an immediate difference for a surgical practice, and it’s the focus of EP 03 of Truly Integrated. Dr. Brett Raynor, an orthopedic surgeon and sports medicine specialist at Texas Orthopaedic Associates in Dallas, joined iScribe CEO Pat Williams to talk about the pressures private practices face and why the future of surgical technology is nearly invisible.

Prefer to listen? Hear Dr. Raynor’s full conversation on Truly Integrated, EP 03: episode page · Apple Podcasts · Spotify

Key Takeaways

• Documentation demands reach the entire surgical team. Approvals, billing, and reimbursement all depend on the note.
• Private practices are constantly adapting their workflows just to secure payment for appropriate care.
• Coding and billing rules change often, making it nearly impossible for a busy surgeon to stay current without support.
• Ambient AI reduces clicks, manual note entry, and repetitive admin work while protecting precision.
• The next frontier is real-time guidance that catches missing details before a claim is ever submitted.
• AI in surgery isn’t only about the operating room. The notes, codes, and claims around every case are where it makes an immediate difference.

The Workload Nobody Sees

Dr. Raynor specializes in arthroscopic surgery and complex knee, shoulder, and hip injuries, including revision ligament reconstruction, cartilage procedures, and hip arthroscopy for athletes. He trained at Vanderbilt, completed his fellowship at the Steadman Philippon Research Institute, and has practiced at Texas Orthopaedic Associates since 2015.

His practice is high-volume by design. And in a high-volume surgical practice, every note is load-bearing. It supports the surgical decision. It supports prior authorization. It supports the code. It supports the claim. When the note is thin, the whole chain downstream absorbs the cost. Staff chase missing details, billing teams rework claims, and surgeons get pulled back into charts they closed days ago.

None of it shows up on the surgical schedule, but it shapes every hour of the week.

The national numbers show how much of the week this work takes. In AMA survey data drawn from nearly 18,000 physician responses, physicians reported a 57.8-hour workweek in 2024, including 13 hours on indirect patient care such as order entry and documentation, plus 7.3 hours on administrative tasks such as prior authorization and insurance forms.

When the System Sets the Rules, the Note Has to Be Perfect

Dr. Raynor spoke candidly about the pressure private practices face from large payers and evolving coding requirements. He was describing a system where the documentation burden tied to reimbursement keeps growing, and where the rules change faster than any surgeon can track between cases.

The rules really do keep moving. The AMA’s CPT 2026 code set alone brought 418 total changes, including 288 new codes, 84 deletions, and 46 revisions.

That forces a choice no surgeon should have to make, between documenting longer to protect revenue and seeing patients while accepting the risk.

Surgical-grade documentation removes the choice. When the note captures the full encounter with precision, it holds up under scrutiny without asking the surgeon to become a part-time coder.

Making AI Work for Surgeons

The episode title says it plainly. AI has to work for surgeons, not against them. Too much healthcare technology has done the opposite, adding screens, clicks, and logins in the name of efficiency.

Dr. Raynor has used iScribe through all of its iterations. Here’s his verdict.

“I have the benefit of seeing a lot of people, and it’s a high-volume practice. And so iScribe has been really important to me so that I can keep on seeing a lot of people and be efficient with it, but have my time spent seeing people instead of dictating notes or spending time afterwards dictating notes and not seeing my family,” he said. “And so I’ve been using iScribe for a long time and all of its different iterations, and it keeps on getting better, which makes my life better, which is all I care about.”

We’d argue that’s what AI in surgery looks like when it’s built for surgeons. Fewer clicks, less manual entry, and less cognitive load, with precision intact.

What Surgical-Grade AI Actually Does

For a surgical practice, the value of AI shows up in specific, measurable places.

Notes finished before the next patient. iScribe AI delivers a processed note in roughly 30 seconds, so surgeons leave the room with documentation complete.

Macros built for one surgeon. Every iScribe macro is provider-specific and specialty-tuned. A sports medicine surgeon’s knee exam reads like their knee exam.

Coding support grounded in the guidelines. iScribe Code Intelligence gives completed notes an E&M code recommendation with 95% audited accuracy, supported by detailed analysis of the AMA MDM guidelines. It’s available for orthopedic and urology practices on athenahealth or NextGen as an add-on to iScribe AI.

Hours back every day. iScribe providers save roughly two to four hours per day, and see 10+ more patients each week.

Catching Denials Before They Happen

Then the conversation turned to what comes next. Dr. Raynor described the value of real-time prompts that help physicians capture missing details before a claim is submitted and denied.

That’s where iScribe is headed. Documentation-related denials are a fundamental flaw of modern medicine, and correcting that flaw is iScribe’s mission. With Code Intelligence already live and real-time denial prevention in development, the goal is a note that is claim-ready the moment the surgeon leaves the room.

AI in Surgery: Inside the OR and Around Every Case

Search for AI in surgery and most of what comes up is about the operating room: robotic assistance, surgical imaging, and models that predict complications. That work is promising, but it is still finding its way into everyday practice. A scoping review in JMIR AI of AI models built to prevent surgical complications found that the models frequently showed strong technical accuracy, yet only a few were adopted routinely in clinical practice. The authors pointed to usability barriers, workflow misalignment, trust concerns, and financial and ethical constraints.

In our view, it’s the same lesson behind this episode’s title: AI has to fit the way surgeons already work. Here is how the two sides of AI in surgery compare.

• What it supports: AI in the operating room → Surgical planning, imaging, and the procedure. AI around the case → Notes, coding, approvals, and claims.
• Who feels it: AI in the operating room → The surgeon and OR team. AI around the case → The surgeon, clinic staff, and billing team.
• When it shows up: AI in the operating room → On surgery days. AI around the case → At every visit and every case.
• What success looks like: AI in the operating room → Support for decisions during the case. AI around the case → A complete note, ready before the next patient.

Both matter. But the AI around the case is where a surgical practice feels the difference right away, because it touches every visit on the schedule.

Technology That Stays Out of the Way

Dr. Raynor’s closing idea is the right standard for every piece of technology in a surgical practice. Better technology shouldn’t feel more invasive. It should quietly remove friction from care delivery.

The robot in the OR gets the headlines, and we think the AI handling the admin around every case deserves more attention than it gets. Disagree? We’d like to hear where you see AI paying off first in your practice.

Frequently Asked Questions

How is AI used in surgery today?

AI in surgery includes robotic and navigation systems in the OR, but much of its immediate impact is outside the OR, in ambient documentation, coding support, and workflow automation that reduce the administrative work around every case.

Can AI help surgical practices reduce claim denials?

Accurate, complete documentation is the foundation of a clean claim. iScribe AI produces surgical-grade notes, and iScribe Code Intelligence provides E&M code recommendations with 95% audited accuracy. Real-time denial prevention is in development.

Does ambient AI work for high-volume surgeons?

Yes. iScribe was founded inside orthopedic practices and built for high-volume, procedure-heavy specialties, with notes processed in roughly 30 seconds.

What is the hidden admin work in a surgical practice?

It’s the documentation, coding, prior authorization, and billing work wrapped around every case. It rarely shows up on the surgical schedule, but staff, billing teams, and surgeons all feel it when a note is incomplete.

Will AI replace surgeons?

No. The AI tools surgical practices use today support surgeons’ work, from flagging risks to drafting notes, while the surgeon stays in charge of clinical decisions. With ambient documentation, the surgeon still reviews the note before signing it.

How often do coding rules change?

Every year, when the AMA releases a new CPT code set. A note that captures the full encounter gives billing teams what they need without asking the surgeon to track every update.

How can AI cut after-hours charting for surgeons?

Ambient AI drafts the note from the visit conversation, so the surgeon reviews it instead of writing it from scratch later. iScribe AI delivers a processed note in roughly 30 seconds, so documentation can be finished before the next patient.

About Dr. Brett Raynor

Dr. M. Brett Raynor is a board-certified orthopedic surgeon and sports medicine specialist at Texas Orthopaedic Associates in Dallas, where he has practiced since 2015. He treats the knee, hip, and shoulder and is sought out for complex knee ligament injuries and minimally invasive arthroscopic surgery of the hip and shoulder. He earned his undergraduate degree at Duke University and his medical degree at UT Southwestern Medical School, where he was elected to Alpha Omega Alpha, then completed his orthopedic surgery residency at Vanderbilt University Medical Center and a sports medicine fellowship at the Steadman Philippon Research Institute in Vail, Colorado. He is a member of the U.S. Ski and Snowboard Team physician pool, a reviewer for the American Journal of Sports Medicine, and co-chairman of the DFW Sports Medicine Symposium.

Hear the Full Conversation

Listen to Dr. Brett Raynor on Truly Integrated, EP 03, “Making AI Work for Surgeons, Not Against Them.”

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