MCG Care Guidelines 24th edition customization

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 view a detailed summary of customizations, select: Customizations to MCG Care Guidelines 24th Edition (path: https://www.anthem.com/provider/policies/clinical-guidelines > Change state. Scroll down to Other Criteria > Customizations to MCG Care Guidelines 24th Edition.)

 

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

 

ABSCRNU-0201-20                   516850MUPENMUB