Patient presents with signs and symptoms suggestive of hypercalcemia.  Presenting complaints may include fatigue, weakness, constipation, nausea, vomiting, abdominal pain, polyuria, polydipsia, and or cognitive changes such as confusion or lethargy.  On physical exam, the patient may exhibit dehydration, altered mental status, or decreased deep tendon reflexes.  Laboratory results reveal elevated serum calcium levels, exceeding the normal reference range.  Differential diagnosis includes primary hyperparathyroidism, malignancy, granulomatous diseases such as sarcoidosis, medications such as thiazide diuretics, vitamin D toxicity, milk-alkali syndrome, and familial hypocalciuric hypercalcemia.  Further investigations may include serum parathyroid hormone (PTH) level, ionized calcium, vitamin D levels (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D), serum creatinine, and phosphate.  ECG may be performed to assess for shortened QT interval. Imaging studies, such as neck ultrasound or sestamibi scan for parathyroid adenoma, or chest X-ray for malignancy or granulomatous disease, may be indicated based on clinical suspicion.  Initial management includes intravenous hydration with normal saline to promote calcium excretion.  Treatment plan will be determined based on the underlying cause of the hypercalcemia and may include bisphosphonates for severe hypercalcemia or calcimimetics for parathyroid-mediated hypercalcemia.  Patient education provided on dietary modifications including limiting calcium intake and increasing fluid intake.  Follow-up appointments scheduled for monitoring of serum calcium levels and assessment of treatment response.  ICD-10 code E83.52, hypercalcemia, is recorded.  Medical necessity for diagnostic testing and treatment is documented.