Consider the following scenario:

A patient undergoes a surgical procedure (say, total knee arthroscopy). A few days later, the patient is readmitted for a complication, such as a pulmonary embolism or sepsis. The patient is treated for this complication and released. Maybe 20 days later, the patient goes in for another surgical procedure. The following concerns this second procedure, specifically the associated hospital claim form:

Question 1: What is the standard protocol for reporting recent prior complications? For example if the patient originally got sepsis, would it be reported during the second surgery claim as a diagnostic "present on admission?" Is there a cutoff (say, 30 days)?

Question 2: Assuming the doctor has access to the patients prior information, what is the standard protocol for deciding whether to proceed with the second surgery? Is there some kind of prior evaluation to determine if the last complication has been treated "beyond a reasonable doubt?" More generally, if a doctor proceeds with the surgery, and say, sepsis develops again, would this be considered a negative strike against the doctor (they should have checked the patient's medical history)?


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