Patient presents with complaints consistent with an irregular heart rate, including palpitations, skipped beats, and occasional lightheadedness.  Onset of symptoms is reported as approximately two weeks prior, with increasing frequency and intensity noted in the last few days.  Patient denies chest pain, shortness of breath at rest, or syncope.  Physical examination reveals an irregular heart rhythm with a documented heart rate of 88 beats per minute with notable pauses and irregularities in rhythm.  Electrocardiogram (ECG or EKG) performed shows evidence of sinus arrhythmia with premature atrial contractions (PACs).  Differential diagnosis includes atrial fibrillation, atrial flutter, and other supraventricular tachycardias.  Assessment of the patient's medical history reveals no known cardiac conditions, hypertension, or diabetes.  Current medications include a daily multivitamin.  The patient is alert and oriented, and vital signs are stable, aside from the irregular heart rate.  Plan includes cardiac monitoring via Holter monitor to further evaluate the nature and frequency of the arrhythmia, along with laboratory studies including a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid stimulating hormone (TSH) to rule out underlying metabolic or endocrine causes.  Patient education provided on lifestyle modifications, including stress management techniques and caffeine reduction.  Follow-up appointment scheduled in one week to review Holter monitor results and discuss further management based on diagnostic findings.  Medical coding will be determined based on the final diagnosis and may include ICD-10 codes I49.8 (Other specified cardiac arrhythmias) or I49.9 (Cardiac arrhythmia, unspecified), along with relevant CPT codes for the ECG and Holter monitor.  Patient understands the plan and agrees to follow-up.