An insured individual had a break in coverage with the insurance company. The member went and saw an eye doctor and the records state the patient is returning to the clinic for an annual exam. The provider originally submitted the code 99214 for the visit of an established patient, and then submitted a corrected claim with a 99204 for a new patient. Whereas the member’s claim history does not go back past 3 years as the member has not been covered for an extended period of time. Would they still be considered an established patient due to what is documented, or could they be a new patient due to the fact that the insurance company and no 3 year history?