Effective September 1, 2021, we will upgrade to the 25th 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) for Inpatient & Surgical Care (ISC)

 

Guideline

MCG Code

24th Edition GLOS

25th Edition GLOS

Aortic Coarctation, Angioplasty

S-152

Ambulatory or 1 day postoperative

Ambulatory

Cardiac Septal Defect: Atrial, Transcatheter Closure

W0016

Ambulatory or 1 day postoperative

Ambulatory

Esophageal Diverticulectomy, Endoscopic

S-445

Ambulatory or 1 day postoperative

Ambulatory

Gastrectomy, Partial - Billroth I or II

S-510

4 or 6 days postoperative

5 days postoperative

Hernia Repair (Non-Hiatal)

S-1305

Ambulatory or 1 day postoperative

Ambulatory

Pancreatectomy

S-1200

5 or 7 days postoperative

6 days postoperative

Pyloroplasty and Vagotomy

S-990

4 or 6 days postoperative

4 days postoperative

Cervical Laminectomy

W0097

2 days postoperative

Ambulatory or 2 days postoperative

Lumbar Diskectomy, Foraminotomy, or Laminotomy

W0091

Ambulatory or 1 day postoperative

Ambulatory

Removal of Posterior Spinal Instrumentation

S-530

1 day postoperative

Ambulatory or 1 day postoperative

Shoulder Hemiarthroplasty

W0138

1 day postoperative

Ambulatory or 1 day postoperative

Spine, Scoliosis, Posterior Instrumentation, Pediatric

W0156

4 days postoperative

3 days postoperative

Bladder Resection: Cystectomy with Urinary Diversion, Conduit or Continent

S-190

5 or 6 days postoperative

5 days postoperative

Prostatectomy, Transurethral Resection (TURP)

S-970

Ambulatory or 1 day postoperative

Ambulatory

Urethroplasty

S-1172

Ambulatory or 1 day postoperative

Ambulatory

 

New Guidelines for Recovery Facility Care (RFC)

 

Body System

Guideline Title

MCG - Code

Cardiology

Hypertension

M-5197

Cardiology

Peripheral Vascular Disease (PVD)

M-7087

Nephrology

Rhabdomyolysis

M-7095

Nephrology

Encephalopathy

M-7100

Thoracic Surgery

Rib Fracture

M-5545

 

To view a detailed summary of customizations click on this link, scroll down to other criteria section and select Customizations to MCG Care Guidelines 25th Edition.

 

For questions, please contact the Provider Services at 1-800-450-8753.

 

* MCG Health is an independent company providing care guidelines on behalf of Empire BlueCross BlueShield HealthPlus.

NYE-NU-0307-21

 



Featured In:
June 2021 Newsletter