I have an issue where pt comes in for an annual exam and complains of pain, so 76700,76770, and 76856 may be ordered. The problem arises when billed out. They are denying the ultra. codes because it was done with an "annual " exam. I have not seen any documentation for the visit, but seems to me it should be coded as an established pt (9921*) e/m rather than an annual e/m (9938*). Any thoughts on this are appreciated.