Effective August 1, 2019, Anthem Blue Cross and Blue Shield will upgrade to the 23rd edition of the 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 and 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

 

 



Featured In:
May 2019 Anthem Provider Newsletter - Virginia