Patient presents with complaints consistent with hiatal hernia, including heartburn, acid reflux, regurgitation, chest pain, and dysphagia.  Symptoms are exacerbated by bending over, lying down, or eating large meals.  The patient reports experiencing GERD symptoms, specifically nighttime reflux and a sour taste in the mouth.  Differential diagnoses considered include gastroesophageal reflux disease (GERD), esophageal spasm, angina, and peptic ulcer.  Physical examination reveals epigastric tenderness upon palpation.  No palpable masses noted.  Auscultation of the heart and lungs unremarkable.  Diagnosis of hiatal hernia is suspected based on patient history and physical examination findings.  Further investigation with upper endoscopy or barium swallow study is recommended to confirm the diagnosis and evaluate the extent of the hernia.  Treatment plan may include lifestyle modifications such as dietary changes, weight loss, elevation of the head of the bed, and avoidance of trigger foods.  Medical management may include antacids, H2 blockers, proton pump inhibitors (PPIs), or prokinetic agents.  Surgical intervention, such as laparoscopic hiatal hernia repair or Nissen fundoplication, may be considered for patients with large hernias, severe symptoms, or complications such as strangulation or obstruction.  Patient education regarding hiatal hernia symptoms, treatment options, and potential complications was provided.  Follow-up appointment scheduled to discuss diagnostic results and formulate a definitive treatment plan.  ICD-10 code K44.9 for hiatal hernia without obstruction or gangrene will be used for billing and coding purposes.  CPT codes for procedures, such as 43235 for upper endoscopy and 74240 for barium swallow, will be applied as appropriate.