AdministrativeCommercialApril 30, 2019

MCG care guidelines 23rd Edition

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective August 1, 2019, Empire will upgrade to the 23rd edition of MCG care guidelines for the following modules: Inpatient & Surgical Care (ISC), General Recovery Care (GRC), Chronic Care (CC), Recovery Facility Care (RFC), Behavioral Health Care (BHC).

 

Goal Length of Stay (GLOS) changes for Inpatient & Surgical Care (ISC)   

 

Guideline

MCG Number

23rd Edition GLOS

22nd Edition GLOS

Neurology- Traumatic Brain Injury, Nonsurgical Treatment

M-78

Ambulatory or 2 days

2 days

Orthopedics-Lumbar Fusion

S-820

2 days postoperative

3 days postoperative

 

New Optimal Recovery Guidelines (ORGs), Common Complications and Conditions (CCC) and Level of Care (LOC) Guidelines

 

Module

Guideline

Title

MCG Number

ISC

ORG

Anorexia Nervosa, Child or Adolescent

P-585

ISC

ORG

Substance-Related Disorders, Child or Adolescent

P-596

ISC

ORG

Left Atrial Appendage Closure, Percutaneous

M-333

ISC

ORG

Abdominal Pain, Undiagnosed, Pediatric

P-05

ISC

ORG

Craniotomy for Traumatic Brain Injury or Intracerebral Hemorrhage, Pediatric

P-414

ISC

ORG

Craniotomy, Supratentorial, Pediatric

P-411

ISC

ORG

Headaches, Pediatric

P-185

ISC

ORG

Hernia Repair (Non-Hiatal), Pediatric

P-1305

ISC

ORG

Inflammatory Bowel Disease, Pediatric

P-565

ISC

ORG

Pelvic Inflammatory Disease (PID), Acute, Pediatric

P-260

ISC

ORG

Spine, Scoliosis, Posterior Instrumentation, Pediatric

P-1056

ISC

ORG

Supraventricular Arrhythmias, Pediatric

P-510

ISC

CCC

Pain: Common Complications and Conditions

CCC-050

RFC

ORG

Degenerative Joint Disease (DJD)

M-7030

BHC

LOC

Obsessive-Compulsive and Related Disorders, Adult: Inpatient Care

B-030-IP

BHC

LOC

Obsessive-Compulsive and Related Disorders, Child or Adolescent: Inpatient Care

B-029-IP

BHC

LOC

Obsessive-Compulsive and Related Disorders: Residential Care

B-030-RES

BHC

LOC

Obsessive-Compulsive and Related Disorders: Partial Hospital Program

B-030-PHP

BHC

LOC

Obsessive-Compulsive and Related Disorders: Intensive Outpatient Program

B-030-IOP

BHC

LOC

Obsessive-Compulsive and Related Disorders: Acute Outpatient Care

B-030-AOP

 

Empire Customizations to MCG care guideline 23rd Edition

Effective August 1, 2019, the following MCG care guideline 23rd edition customizations will be implemented.

  • Left Atrial Appendage Closure, Percutaneous (W0157) - customized to refer to SURG.00032 Transcatheter Closure of Patent Foramen Ovale and Left Atrial Appendage for Stroke Prevention
  • Spine, Scoliosis, Posterior Instrumentation, Pediatric (W0156) - customized to refer to Musculoskeletal Program Clinical Appropriateness Guidelines, Level of Care Guidelines and Preoperative Admission Guidelines

 

To see a more detailed summary of customizations click on this Link.

For questions, please contact the provider service number on the back of the member's ID card.

PUBLICATIONS: May 2019 Empire Provider Newsletter