Patient presents with a chief complaint of chest pain, consistent with non-ST elevation myocardial infarction (NSTEMI).  Symptoms include pressure, tightness, and discomfort in the chest, radiating to the left arm and jaw.  Onset occurred approximately two hours prior to arrival.  Patient denies shortness of breath, diaphoresis, or nausea.  Past medical history significant for hypertension, hyperlipidemia, and a family history of coronary artery disease.  Current medications include lisinopril and atorvastatin.  Physical exam reveals a heart rate of 88 bpm, blood pressure of 14090 mmHg, and regular rhythm.  Lungs are clear to auscultation.  Electrocardiogram (ECG) demonstrates ST segment depression and T wave inversion in leads V2-V4.  Cardiac biomarkers, including troponin I and CK-MB, are elevated.  Diagnosis of NSTEMI is confirmed based on clinical presentation, ECG findings, and positive cardiac biomarkers.  Treatment plan includes aspirin, clopidogrel, heparin, nitroglycerin, beta-blocker therapy, and oxygen.  Patient will be admitted for continuous cardiac monitoring, serial cardiac enzyme measurements, and further evaluation for coronary angiography and possible percutaneous coronary intervention (PCI).  Differential diagnosis includes unstable angina, pericarditis, and musculoskeletal chest pain.  Medical coding will utilize ICD-10 code I21.4 for NSTEMI.  This documentation meets clinical documentation improvement (CDI) standards and supports accurate medical billing and coding.