Mary,

        I work in a small 5 bed level 3A NICU in Ephrata , Pa.  We have 5
LC's on staff however 3 work part time.  Two of us are fulltime.  We do a
home visit on any of our mothers who would like one after delivery.  Our
NICU is only one year old and it was decided when we opened we would do
home visits on the NICU infants through the home health department and
they would be billed to insurance.  The LC does the home visit for the
NICU kids.  We have had good success with reimbursement for the visit.
        Our LCs see all the breastfeeding moms each day.  (Our unit
currently does about 850 deliveries a year so we are small)  The Nicu
census is usually 2 - 3 infants.  Of our fulltime LC staff one is seeing
the inpatients and one is out doing home visits each day.  We usually see
5 mom babies in an 8 hour day on home visits.  We have coverage 6 days
and an on call person on Sunday.  Usually on Sunday we can handle the
problems by phone.  We have follow up charts on each mom we see.  We try
to call everyone at 2 weeks and one month.  Our goal is to call each mom
once a month up to 6 months.  We don't often achieve that.  I find that
follow up keeps people nursing longer and if we have called them they
will call us with a problem.
        We also see out patients, in hospital referrals, and referrals
from area MDs.  They unit tries to have us just be LCs, but at times due
to staffing or shortages in workers we fill in a mother/baby, l&D, or
NICU nurses.  Vicki has 25 years in OB and I have 28 years so we are
multi skilled at this point.  This is frustrating at times as when we do
staff work it is hard to give the patients help with nursing.  
        We spend the time we need with NICU moms.  Our neonatologists are
pretty aggressive feeder.  I am used to a slower approach to oral feeds,
but I am adjusting.  We finger feed or dropper feed all the breast
babies.  We usually send a baby weigh scale home with the premature
infants and manage them by phone until they are on all breast.  We do 1 -
2 visits at home depending on what the insurance will cover and what the
parent needs are.  We do a lot of teaching in the hospital, but it is
different when they get the kids home.
        We don't teach any special classes to the NICU moms.  It is all
individualized.  We do have a NICU packet we give the moms that deals
with pumping, preemie info,a pumping log, finger feeding, dropper
feeding, and hind milk separation.  If it is a baby with special needs
(Down's, cleft lip or palate etc) we have other info to give them.   We
see moms every day when in patient.  When moms are discharged we see them
any time they come in when we are working.  If we don't see them for 2 -
3 days we talk to the nurses, read the chart and then give the mom a call
to see how she feels things are going and if she is having any problems.
        We have 2.4 FTE for lactation.  As I said we also have to cover
all home visits as part of our job.  

        We do participate in the multi disciplinary rounds weekly and can
give any thoughts we have about feeding. Many of our babies are
discharged at 34 - 35 weeks so we are following up by phone closely for 2
- 3 weeks and then less frequently for a few more weeks.  Then they go
into the regular follow up program.

        We do bill for the inpatient services. 1 unit is 15 minutes of
time.  We usually bill the normal moms for a max of 6 units.  The NICU
moms we bill up to 20.  A unit is billed at $21.  We also have an
answering machine that people can call anytime.  We pick up messages
about every 2 - 3 hours from 8am-5pm.  We also have out patient billing. 
We charge everything under the mother as we have had some rejections when
 billing lactation services under male infants.  They say boys don't need
lactation services.  Crazy huh!

        Well that's all I know.  If you have more questions feel free to
e-mail me

Inez Curtis,RNC,IBCLC

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