Learn the definition of work conditioning & work hardening, how to classify PT treatments for each, and the appropriate CPT codes for workers' comp billing.
It’s common for health professionals to get confused about the differences between work hardening vs. work conditioning when discussing the two in the physical therapy space. Though they might sound the same and are often thought to include the same treatment services, work conditioning vs. work hardening are pretty different — and have different billing codes.
After an injury on the job, patients rely on quality work conditioning and/or work-hardening therapy to allow them to safely and comfortably return to work. For the therapists who render such services, a thorough understanding of the proper work conditioning CPT code and work hardening CPT code are integral for appropriate treatment and adequate (and timely) reimbursement.
Here’s a breakdown of the differences between work conditioning vs. work hardening, along with helpful tips for using the proper physical therapy CPT codes for workers’ compensation billing.
For many labor-intensive professions, the employees who encounter disabling work-related injuries cannot return to work for an indefinite amount of time. Work conditioning and work hardening services are advised after traditional PT services, when necessary, to assist those who haven’t made a complete functional improvement and are unable to return to their specific job duties.
Work conditioning and hardening services help prepare a patient for a safe transition back to their position and prevent any worsening or new injuries. So, then, how exactly do they differ? These are the differences between the PT codes from specific patient needs to treatment duration.
According to the American Physical Therapy Association (APTA), work conditioning is an intensive, work-related, goal-orientated strengthening program designed to restore neuromusculoskeletal functions, motor function, and range of motion. A work conditioning program will often simulate work scenarios that require a patient to move or lift as they would on the job to help restore their ability to complete job duties and safely return to work.
For example, consider a warehouse stocker who has fallen off a forklift and suffered a spine injury. After a round of physical therapy, the patient requires work conditioning to help regain their strength. A work conditioning program can be customized to include weighted boxes, similar to what the patient lifts at work, as part of the exercise treatment to help regain these abilities.
According to the APTA, work hardening is also a goal-oriented and individualized intervention program designed to help patients return to work. However, work hardening is more structured and multidisciplinary in nature and is designed to restore physical, behavioral, and vocational functions. The work hardening’s multidisciplinary approach includes PT professionals and occupational therapists, psychologists, and vocational specialists depending on the patient’s needs.
For instance, consider a construction worker who sustained a severe head and neck injury. After initial treatment, the work-hardening program begins with the patient meeting with a psychologist for a functional capacity evaluation to understand treatment limits. Like work conditioning, the patient will undergo PT services that simulate typical job duties, such as hammering. Still, the patient may also meet with a speech-language pathologist for residual head injury effects.
A thorough understanding of the differences between work hardening and work conditioning can make it simpler for care providers to navigate PT billing codes and the billing and reimbursement process. Though there isn’t a unique billing code for work hardening vs. work conditioning, there are two separate billing codes that rely on the number of billable hours:
Providers must use xx545 first — APTA states that xx546, the code for additional hours of treatment, cannot be utilized alone. Likewise, you must provide at least two hours of care to bill either xx545 or xx546. Payers may argue that you are not at the level of a work hardening or conditioning program if you only provide only one hour of care, so codes like xx530 or xx110 may be more appropriate.
Likewise, be sure to check your regional fee schedule and payment rules before billing for a work hardening billing code or work conditioning CPT code. Certain fee schedules may have local codes for a work hardening or conditional program, so verifying the correct CPT codes is essential.
With so many CPT codes for physical therapy and some varying by location, the workers’ compensation billing process can become vulnerable to billing errors and reimbursement delays. These three tips can help streamline the workers’ comp billing process for physical therapists.
PT providers need to verify patient eligibility before providing treatment, especially when billing for a workers’ compensation injury with CPT codes for work conditioning and hardening. Failure to confirm patient eligibility and obtain treatment authorization from the patient's coverage provider could significantly complicate the billing and reimbursement process for both you and the patient.
An initial understanding of where and how a work-related injury occurred helps PT practices determine treatment eligibility and protect against later billing complications. Furthermore, APTA advises that you verify the name of the worker's comp adjuster, claim number, injury date, and a bodily location of injury provided on the claim before moving forward with treatment.
When dealing with workers’ compensation carriers, it’s common for PTs to encounter difficulties, such as claims rejections, with work conditioning CPT codes and work hardening CPT codes. To avoid reimbursement delays, distinguish between the work conditioning or work hardening services you provide by attaching appropriate documentation to each of your claims. Include details on the services provided in each session and the approved diagnosis being treated.
Treatment authorization from a WC carrier often comes with treatment visit and date restrictions. It’s crucial for PTs to accurately document and track each patient visit to ensure the practice remains within these established data and visit perimeters. If a patient's date and visit amount is set to expire, but they require additional treatment, it’s essential the PT practice first contacts the adjuster and gains additional further treatment authorizations before moving forward.
There are countless claims modifiers that physical therapists need to decipher and document every day, from work hardening billing codes to MRI billing codes. To better streamline and organize your physical therapy billing process, transition to physical therapy billing software equipped with built-in code and claim scrubbing to ensure you remain compliant.
Stop second-guessing your code choices, or worse, facing reimbursement delays due to otherwise avoidable billing errors. See MWTherapy live in action by scheduling a demo today.
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