Patient presents with complaints consistent with heart failure with reduced ejection fraction (HFrEF).  Symptoms include dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.  Physical examination reveals bibasilar crackles, jugular venous distension, and pitting edema in the lower extremities.  The patient reports a history of hypertension and coronary artery disease.  An echocardiogram demonstrates left ventricular systolic dysfunction with an ejection fraction of 35%, confirming the diagnosis of HFrEF.  The patient's current medications include lisinopril, metoprolol succinate, and furosemide.  The treatment plan includes optimization of guideline-directed medical therapy for heart failure, including titration of current medications and consideration for the addition of a mineralocorticoid receptor antagonist.  Patient education provided regarding sodium restriction, fluid management, and the importance of medication adherence.  Follow-up scheduled in two weeks to assess response to therapy and adjust medications as needed.  Differential diagnoses considered included chronic obstructive pulmonary disease and valvular heart disease, but were ruled out based on clinical findings and diagnostic testing.  ICD-10 code I50.1 for heart failure with reduced ejection fraction assigned.  Medical billing codes will be generated based on the evaluation and management services provided.