Patient presents with complaints consistent with lipodermatosclerosis.  The patient reports chronic venous insufficiency symptoms including aching, heaviness, and swelling in the lower extremities, particularly the lower legs.  Physical examination reveals induration, hyperpigmentation, and erythema of the skin in the affected area, characteristic of lipodermatosclerosis.  The skin appears thickened, and there is a palpable inverted champagne bottle or bowling pin appearance to the lower leg.  The patient denies ulceration at this time.  Differential diagnoses considered include cellulitis, venous eczema, and other causes of chronic venous disease.  Assessment includes lipodermatosclerosis secondary to chronic venous insufficiency.  Plan includes compression therapy with graduated compression stockings, leg elevation, and weight management counseling.  Patient education provided regarding the importance of adherence to compression therapy and regular exercise.  Follow-up scheduled to monitor the progression of lipodermatosclerosis and assess the effectiveness of treatment.  Referral to a vascular specialist may be considered if symptoms persist or worsen.  ICD-10 code I87.2 for chronic venous insufficiency with lipodermatosclerosis is documented.  Medical necessity for compression therapy and patient education related to venous disease management was established.