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If a client returns after a gap of more than a year or with a substantially new clinical picture, a new 90791 is usually defensible, but verify

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[29] Since most cases of AF are secondary to other medical problems, the presence of chest pain or angina, signs and symptoms of hyperthyroidism (an overactive thyroid gland) such as weight loss and diarrhea, and symptoms suggestive of lung disease can indicate an underlying cause