AdministrativeCommercialMarch 31, 2020

MCG Care Guidelines 24th Edition

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

Effective July 1, 2020, we will upgrade to the 24th edition of MCG care guidelines for the following modules: Inpatient & Surgical Care (ISC), General Recovery Care (GRC), Chronic Care (CC) and Recovery Facility Care (RFC). The below tables highlight new guidelines and changes that may be considered more restrictive.

 

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

 

Guideline

MCG Code

24th Edition GLOS

23rd Edition GLOS

Aortic Valve Replacement, Transcatheter

S-1320 

2 days postoperative

3 days postoperative

Appendectomy, with Abscess or Peritonitis, by Laparoscopy

S-185

Ambulatory or 2 days postoperative

2 days postoperative 

Appendectomy, without Abscess or Peritonitis, by Laparoscopy

S-175

Ambulatory postoperative

Ambulatory or 1 day postoperative 

Repair of Pelvic Organ Prolapse

S-1020

Ambulatory postoperative

Ambulatory or 1 day postoperative 

Urethral Suspension Procedures

S-850

Ambulatory postoperative

Ambulatory or 1 day postoperative 

Appendectomy, with Abscess or Peritonitis, by Laparoscopy, Pediatric

P-30

Ambulatory or 2 days postoperative

2 or 3 days postoperative 

Appendectomy, without Abscess or Peritonitis, by Laparoscopy, Pediatric

P-20

Ambulatory postoperative

Ambulatory or 1 day postoperative 

Tibial Osteotomy, Child or Adolescent

S-1131

Ambulatory or 1 day postoperative

1 day postoperative 

 

New Optimal Recovery Guidelines (ORGs) for Inpatient & Surgical Care (ISC) and New Behavioral Health Care (BHC) New Guidelines

Body System

Guideline Title

MCG - Code

Pediatrics

Appendectomy, with Abscess or Peritonitis, Pediatric

P-35

Pediatrics

Appendectomy, without Abscess or Peritonitis, Pediatric

P-25

 

Empire Customizations to MCG care guideline 24th Edition

Effective July 1, 2020, the following MCG care guideline 24th edition customizations will be implemented.

  • Carotid Artery Stenting (W0165) – Clinical Indications were customized to reference CG-SURG-76 Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty

 

Visit empireblue.com/provider to view the Customizations to MCG Care Guidelines 24th Edition.

 

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

PUBLICATIONS: April 2020 Empire Provider News