Patient presents with metastatic breast cancer, confirmed by biopsy and imaging studies.  The primary breast cancer diagnosis was invasive ductal carcinoma, originally diagnosed in [Date].  Current metastatic sites include [List metastatic sites, e.g., bone, lung, liver].  Patient reports [Symptoms, e.g., bone pain, shortness of breath, fatigue].  Physical examination reveals [Clinical findings, e.g., palpable lymph nodes, tenderness to palpation].  Staging workup, including CT chest, abdomen, and pelvis, and bone scan, confirms the extent of metastatic disease.  Laboratory results show [Relevant lab values, e.g., elevated alkaline phosphatase, anemia].  The patient's performance status is ECOG [ECOG score].  Treatment plan includes [Treatment plan, e.g., chemotherapy, hormone therapy, targeted therapy, radiation therapy, palliative care].  Patient education provided regarding prognosis, treatment options, and potential side effects.  Follow-up scheduled in [Timeframe].  Differential diagnosis included [Differential diagnoses, if relevant].  ICD-10 code C50.9 (Malignant neoplasm of breast, unspecified) and appropriate codes for metastatic sites are documented.  Medical necessity for treatment is established.  This documentation supports medical billing and coding for metastatic breast cancer management.