Retired CPT guard

reference ⏱ 5 min read Billing Admin clinical Updated 2026-08-31

The AMA retires or replaces CPT codes every January. Medipyxis handles retired codes with a deliberate split: the coder can never pick one from a dropdown or receive one as a suggestion, but the system will still recognize a retired code on a signed historical note so old records resolve correctly. This page documents the split, names the codes it currently covers, and explains why the split is the shape it is.

The rule

For any CPT code that has been retired by the AMA:

The code is removed from every dropdown, suggestion, and recommender. Coders cannot select it. The E/M recommender never emits it. The auto-coder never returns it.
The code is kept in the recognition tables. If a note was signed carrying that code — before it was retired, or before the recognition set was updated — the note still resolves to the correct MDM level and correct description when a biller opens it.

The one-sentence version: recognize history, never offer it going forward.

Codes currently under the guard

CPT 99343 — retired 2023-01-01

99343 was the moderate-MDM new-patient home-visit code. The AMA deleted it effective January 1, 2023 as part of the E/M home-visit collapse: the pre-2023 five-rung ladder (99341/99342/99343/99344/99345) was compressed to four rungs, with 99344 promoted to the moderate slot and 99345 remaining the high-complexity code.

The corrected 2023 ladder for new patient, home visit (POS 12/13/14/16):

CPT	MDM level
99341	straightforward
99342	low
99344	moderate
99345	high

Established-patient home visits (99347/99348/99349/99350) were not affected by the 2023 change.

Where 99343 currently lives in the repo:

Removed from the coder dropdown (frontend/src/utils/dropdownOptions.ts) — the E/M home-visit block skips 99343 explicitly.
Removed from the E/M recommender (s13_emLevel.ts) — new-patient home moderate now returns 99344.
Removed from the downcode suggestion (s13_emLevel.ts W9 gate) — a note billed too high for its documented time is downcoded to 99344, not 99343.
Removed from the deterministic coding service (medicalCodingService.ts) — the code is not offered as a suggestion.
Kept in the recognition set (s11_codingLedger.ts EM_CODES_NEW_HOME, s13_emLevel.ts NEW_PATIENT_CODES / TIME_THRESHOLDS / EM_MDM_LABELS). A biller opening a historical note billed with 99343 sees "New patient, home visit, moderate MDM (CPT retired 2023-01-01)".

The guard-relevant commit is 0f880abfc, "stop emitting CPT 99343, retired by the AMA on 2023-01-01" (Aug 25, 2026).

Why not just delete it everywhere

The obvious move is to strip the retired code from every table. The reason we don't:

Production carried three real notes billed with 99343 between 2026-07-04 and 2026-07-21, before the code was removed from the recommender. Those notes are signed clinical records tied to submitted claims. If the recognition set drops the code, mapEMLevel stops trusting the stored value and silently substitutes a different CPT when the note is re-rendered — for example, the coding review drawer could show 99349 next to a note that was signed and billed with 99343. That is a documentation-integrity failure: the note-of-record and the platform's rendering of the note-of-record would disagree.

The recognition-vs-recommendation split is the whole point. History is read as it was. Anything going forward is offered only from the current ladder.

When the AMA retires a code

The workflow, whenever a code is retired or replaced:

Confirm the effective date and the replacement (if any) against the AMA CPT descriptor list or an authoritative summary (AAPC's deleted-codes page is the fastest secondary source).
Remove the code from the dropdowns (frontend/src/utils/dropdownOptions.ts).
Remove the code from the recommender surface — for E/M codes, that is frontend/src/services/perfectNote/s13_emLevel.ts (the "NEW_" and "ESTABLISHED_" maps that get read by recommendEMCode), plus the downcode suggestions in the W9 gate.
Remove the code from the deterministic coding service (frontend/src/services/procedureBillingService.ts) if it is offered there.
Do not remove the code from the recognition sets — EM_CODES_*, EM_MDM_LEVEL, EM_MDM_LABELS, EM_DESCRIPTIONS, TIME_THRESHOLDS, NEW_PATIENT_CODES, ESTABLISHED_PATIENT_CODES. Add a comment naming the retirement date so the intent is legible to the next developer to read the file.
Verify: run the s11 and s13 tests. Pull a live note billed with the retired code (if one exists) and confirm it still renders the correct MDM level and description.

What the biller sees

Adding a code to a claim. The dropdown skips retired codes. If a coder types the retired code directly, the field validates against the current ladder and rejects with a message naming the current equivalent.
Opening a historical claim. The claim renders with the retired code intact. The MDM level and description come from the recognition set. A small "(CPT retired YYYY-MM-DD)" trailer is appended to the description so the biller isn't confused about why the code looks unusual.
Auto-coding a new visit. The E/M recommender never emits a retired code. The W9 downcode gate never suggests one. The auto-coder never returns one.

Auto-rendered from related: in frontmatter.

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