Implementing a Clinical Rules Engine to Enhance Blood Pressure Control Reporting by Automating CPT Code Assignment in Charts of Patient’s Diagnosed with Essential Hypertension

Purpose: Hypertension is a primary risk factor for many disease processes, making accurate and comprehensive documentation of blood pressure (BP) measurements important for both effective medical management and health plan compliance. Manual processes for assigning BP-related CPT codes can result in documentation gaps, impacting the quality of reported data and potentially leading to missed opportunities for improved patient care. This study aimed to evaluate the impact of implementing our organization’s first clinical rules engine (CRE) within our electronic health record (EHR) system to automatically assign blood pressure CPT codes to charts of patients with an essential hypertension diagnosis to improve BP control capture rates in health plan reports.

Description: A set of six clinical rules were developed to identify patients with both an I10 essential hypertension ICD-10 code and blood pressure measurement documented in their chart. The CRE automatically added corresponding CPT codes for the most recently documented systolic and diastolic blood pressure values to a patient’s chart when the rules criteria were met. This automated process was integrated directly into the EHR workflow, minimizing the need for manual CPT assignment. We analyzed BP control capture rates before and after implementing the CRE to measure its effectiveness in improving reportable data quality.

Evaluation/outcome: At the time of this submission, we are three weeks out from initial implementation. Preliminary results demonstrate an increase from 2.86% to 87% in capture of blood pressure values of patients with essential hypertension through CPT code assignment. The 13% of patients not captured by the CRE has been determined to be a result of the current code level of our electronic health record, which limits our ability to prevent user workflows from interfering with the CRE function. Final results are pending and will be available by the time of the conference. This improvement in data capture will support improved health plan reporting in addition to reducing the administrative burden for staff. Integrating a CRE for CPT code assignment significantly enhances the capture of BP control data in patients with essential hypertension, facilitating better compliance with health plan requirements and providing a more complete view of patient care needs. Automation of this process minimizes manual errors and supports clinical staff by reducing their documentation task burden, thereby improving both data quality and enabling for more efficient care delivery.