How To Use CPT Code 97546

CPT 97546 describes the work hardening/conditioning program for patients who need additional hours of structured treatment to improve their physical condition and prepare them for a safe return to work. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97546?

CPT 97546 can be used to report each additional hour of a work hardening/conditioning treatment session after the initial two hours. This code is used when a provider guides the patient through a structured program designed to increase strength, improve physical condition, and enhance neuromuscular efficiency, cardiovascular endurance, and flexibility. The goal is to prepare the patient for a safe return to their workplace after an injury.

2. Official Description

The official description of CPT code 97546 is: ‘Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 97545, which is used to report the initial two hours of a work hardening/conditioning treatment session.

3. Procedure

1. The provider designs a structured treatment program tailored to the patient’s needs, focusing on increasing strength, improving physical condition, and enhancing neuromuscular efficiency, cardiovascular endurance, and flexibility.
2. The patient undergoes a work hardening/conditioning treatment session, which may involve real or simulated work tasks to prepare them for a safe return to their workplace.
3. The provider guides the patient through the session, utilizing strength and conditioning techniques to progressively improve their physical abilities.
4. The provider also educates the patient on safety measures and injury prevention specific to their workplace.
5. If the patient requires additional hours of treatment beyond the initial two hours, each additional hour should be reported using CPT code 97546.

4. Qualifying circumstances

CPT 97546 is appropriate for patients who require additional hours of work hardening/conditioning treatment to improve their physical condition and prepare for a safe return to work. This treatment is typically provided to individuals who have experienced an injury and need to regain strength and physical abilities necessary for their specific job requirements. The program is structured and individualized, focusing on the patient’s specific needs and goals.

5. When to use CPT code 97546

CPT code 97546 should be used when reporting each additional hour of a work hardening/conditioning treatment session beyond the initial two hours. This code is not used for the initial two hours, which should be reported using CPT code 97545. It is important to accurately document the total number of additional hours provided to the patient.

6. Documentation requirements

To support a claim for CPT code 97546, the provider must document the following information:

• Total number of additional hours of work hardening/conditioning treatment provided
• Description of the structured treatment program and its goals
• Date, start and end time of each additional hour session
• Details of the exercises, techniques, and activities performed during each session
• Progress made by the patient and any adjustments made to the treatment program
• Education provided to the patient regarding workplace safety and injury prevention
• Signature of the provider administering the treatment

7. Billing guidelines

When billing for CPT code 97546, ensure that the provider has already reported the initial two hours of work hardening/conditioning treatment using CPT code 97545. This code should only be used to report each additional hour beyond the initial two hours. It is important to follow the specific guidelines provided by the payer regarding the appropriate use of this code and any modifiers that may be required.

8. Historical information

CPT code 97546 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates or changes to the code since its addition.

9. Examples

1. A physical therapist providing an additional hour of work hardening/conditioning treatment to a patient recovering from a back injury.
2. An occupational therapist guiding a patient through a structured program to improve their physical abilities after a hand injury, for an additional hour.
3. A chiropractor supervising a patient’s work hardening/conditioning treatment session to help them regain strength and flexibility after a car accident, for an additional hour.
4. A sports medicine physician overseeing a patient’s work hardening/conditioning program to prepare them for a safe return to their athletic career, for an additional hour.
5. A rehabilitation specialist providing an additional hour of work hardening/conditioning treatment to a patient recovering from a knee surgery.
6. A physical therapist guiding a patient through a simulated work task to prepare them for their job as a construction worker, for an additional hour.
7. An occupational therapist helping a patient improve their physical abilities and endurance for their job as a pianist, for an additional hour.
8. A sports trainer supervising a patient’s work hardening/conditioning treatment session to enhance their performance as a professional athlete, for an additional hour.
9. A physical therapist providing an additional hour of work hardening/conditioning treatment to a patient recovering from a shoulder injury.
10. An occupational therapist guiding a patient through a structured program to improve their physical abilities after a wrist fracture, for an additional hour.