Patient presents with complaints of sharp, stabbing, or aching chest pain, localized to the intercostal muscles, possibly described as a pulled muscle in the rib cage.  Pain may be exacerbated by deep breathing, coughing, sneezing, or twisting movements.  Onset may be associated with recent strenuous activity, trauma to the chest wall, or prolonged poor posture.  Physical examination reveals tenderness to palpation along the affected intercostal spaces, with possible palpable muscle tightness or spasm.  No evidence of crepitus or rib deformity noted.  Lung sounds are clear.  Differential diagnosis includes costochondritis, pleurisy, rib fracture, and myocardial infarction.  ECG and cardiac enzymes within normal limits, ruling out cardiac etiology.  Chest x-ray negative for acute pathology.  Diagnosis of intercostal muscle strain or intercostal muscle spasm is made based on clinical presentation and exclusion of other potential causes.  Treatment plan includes rest, ice, heat therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management, and gentle stretching exercises.  Patient education provided on proper posture and body mechanics to prevent recurrence.  Follow-up recommended if symptoms persist or worsen.  ICD-10 code M79.1 Intercostal neuralgia or M62.831 Muscle spasm of chest wall and abdomen and CPT code for evaluation and management services will be used for billing purposes depending on complexity of the visit.