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Per AMA CPT guidelines, a patient is established if they have received professional services from the physician, or from another physician of the same specialty and subspecialty in the same group practice, within the past three years
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This includes a comprehensive systems-based history, age-appropriate physical examination, assessment of risk factors, counseling on health behaviors, screening recommendations, and preventive planning
The codes used to report counseling services are slightly different for symptomatic patients and asymptomatic patients
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