99204 is a New Patient visit. Any and all services done on the date of the initial visit are reported with the New Patient code. If the patient returns for any reason, those services are added to the previous services and the "work" of those two visits is added up to calculate your new visit code. You can't bill a new and established patient visit on the same date. The problem is not your diagnosis coding, but your procedure coding. The insurance company is correct in denying the second visit on the same date. I hope that this helps.
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