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Connecticut Children's Medical Center - Policy and Procedure Manual Fiscal NICU Level Designation Approved By: Finance Administration, Compliance Committee Date Effective: Date of Origin: Date Approved: June 01, 2009 February 01, 2009 June 01, 2009

I.Purpose Neonate patient acuity designation and subsequent staffing assignments and billing must be based on defined criteria to enhance patient safety and allow for accurate billing. This patient acuity designation shall be outlined through this policy. II.Policy It is the policy of Connecticut Children's Medical Center (Connecticut Children's) to designate a neonate a specific level, based on acuity and interventions needed for care, and bill for services rendered in a compliant and timely manner. Connecticut Children's has established processes for billing for neonatal intensive care unit (NICU) services based on patient level of acuity, which in turn, shall be based on Uniform Billing Editor (UB) guidelines. Assigned acuity levels shall reflect the predominant level of care provided during a specific 24-hour period and shall be reviewed on a daily basis. III.Criteria IV.Procedure A.Admission and Staffing 1.Patients shall be admitted and registered in the patient registration system (Siemens Management System (SMS))with a patient type based on level of acuity: (1)Level 3 (Special Care) = Pt Type I; RN staffing usually 1:3 or 1:4 (2)Level 4 (NICU) = Pt Type J; RN staffing 1:1 or 1:2 2.Acuity Designations (1)Level 3 ­ Patients requiring (a) less than 2 liter/minute flow of respiratory support, (b) every 3-4 hour feeds, (c) advancing in feeds without difficulty, or (d) absence of any criteria that would qualify the patient for a level 4. (2)Level 4 ­ Patient requiring (a) mechanical ventilation, (b) CPAP, (c) chest tube care, (d) > 2 liter/min flow of respiratory support, (e) invasive line care, (f) NPO status care, (g) vaso-active medication, (h) post procedure-until back to baseline care, or (i) instability with CV/respiratory status requiring frequent nursing intervention. 3.Above criteria may be modified at the patient's care team's discretion based on critical judgment and assessment of the patient. B.Daily acuity level assessment 1.NICU level assessments shall be done daily. 2.Acuity level shall be recorded on the "white board" at each nurse's station (and in SMS as the patient's status changes).

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Connecticut Children's Medical Center - Policy and Procedure Manual Fiscal NICU Level Designation Approved By: Finance Administration, Compliance Committee Date Effective: Date of Origin: Date Approved: June 01, 2009 February 01, 2009 June 01, 2009

C.SMS Updates 1.NICU Health Unit Coordinator (HUC)/Resource RN second shift shall update SMS prior to 23:45 (11:45 pm). (Recommended time for completion is between 22:00 (10:00pm) and 23:00 hours (11:30pm)) 2.Second shift HUC/Resource RN shall print a complete patient list for the NICU from SMS that contains the current patient type for each patient 3.HUC/Resource RN shall reconcile list with NICU "white board" level assessments 4.HUC/Resource RN shall update patient type in SMS as necessary to reflect NICU level of acuity D.Billing 1.Room & board charges shall be auto-generated based on patient type in SMS V.References VI.Related Documents Uniform Billing Editor June 2007

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