State & FederalMedicaidFebruary 28, 2021

MCG Care Guidelines 24th edition customization

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

Effective June 1, 2021, the following new customizations will be implemented:
  • Gastrointestinal Bleeding, Upper (W0170, previously ORG M-180) — Customized the Clinical Indications for admission to inpatient care by revising the hemoglobin; systolic blood pressure; pulse; melena; orthostatic hypotension; and BUN criteria.
  • Gastrointestinal Bleeding, Upper Observation Care (W0171, previously OCG OC-021) — Customized the Clinical Indications for observation care by revising the systolic blood pressure and hemoglobin criteria and adding melena or hematochezia and suspected history of bleeding.

 

To access a detailed summary of customizations, select: Customizations to MCG Care Guidelines 24th Edition (path: visit https://www.empireblue.com/provider/policies/clinical-guidelines > Other Criteria > MCG > Customizations to the MCG Care Guidelines 24th Edition.)

 

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 1-800-450-8753.

 

NYE-NU-0282-20 January 2021

PUBLICATIONS: March 2021 Empire Provider News