Simplifying Documentation and Billing for Sex and Intimacy Goals

Documentation and billing are often the perceived showstoppers for doing sex and intimacy interventions.  Let me tell you, I get a ton of questions about this, so you are not alone if you’re wondering,

“how the heck do I bill for, ‘Ronnie will mount Sammie during sex with mod I”?

So here is a quick and dirty blog post about documentation and billing to match the actual simplicity of this task.   

Goals:

First off, I don’t write goals like the one above. (Although straight to the point, it doesn't quite meet the expectations of a S.M.A.R.T. goal ;) )

But, here are some examples of goals I do write, which specifically have to do with sex and intimacy.  Please note, they are generalized so you'll want to modify them to the clinic you work in and the assessments you typically use:

1. Client will engage in sexual activity with a decrease (insert pain scale) in self-reported pain. 
2. Client will engage in sexual activity with a decrease (insert anxiety scale) in self-reported anxiety.
3. Client will independently utilize 3 adaptive strategies to manage energy levels in preparation for sexual activity.
4. Client will be independent with role playing giving and receiving sexual consent with 100% accuracy.
5. Client will engage in sexual activity preparation and clean up activities with mod I.
6. Client will identify 5 conversation starters for sex and intimacy. 
7. Client will manipulate a smartphone to take and send a selfie with mod I.

Goals can be about sex, but they don’t have to be. 

We can focus on sexual and intimate occupations and roles without specifically detailing them in a goal.  See below for some examples of this:

1. Client will access public transportation to eat at a restaurant with min A.
2. Client will plan a community outing to a museum with mod I.
3. Client will complete full ADL routine while maintaining hip precautions with mod I.
4. Client will increase finger dexterity (insert scale).
5. Client will complete bathing/toileting hygiene with mod A.
6. Client will engage in medication management with min A.

Billing:

The billing codes I use most often include:

• ADL retraining
• Cognitive re-education
• Community re-integration. 

All of these codes have been accepted by insurance companies. Clients who are private pay have also been reimbursed and I am currently in the process of becoming a Medicaid provider (blog on that to come!).

Since we don’t talk about sex and intimacy in school, OTs & OTAs are often left with the feeling of, “am I even allowed to do this?”, “what setting do I do this in?”, and then “how would I ever bill for it?”  I totally get it! 

As I always say, the perception of complexity is really high, but the execution is a bit more simple!  Hopefully this blog post is helpful in understanding how we bill for the work we’re doing and that OT is perfectly situated to address sex and intimacy with your clients!