Patient presents with opioid-induced constipation (OIC), characterized by infrequent bowel movements, straining, and hard stools.  The patient reports reduced stool frequency since initiating opioid therapy for chronic low back pain.  Current opioid regimen includes oxycodone 10mg twice daily.  Abdominal examination reveals mild distension and tenderness to palpation in the lower quadrants.  Bowel sounds are present but hypoactive.  Rectal examination reveals hard stool in the rectal vault.  Diagnosis of opioid-induced constipation is consistent with Rome IV criteria and the patient's opioid use.  Differential diagnosis includes other causes of constipation such as hypothyroidism, irritable bowel syndrome with constipation predominance, and medication side effects from non-opioid medications.  Plan includes increasing fluid intake, encouraging dietary fiber, and initiating a bowel regimen with docusate sodium and senna.  Patient education provided on the importance of bowel regularity and potential complications of untreated constipation.  Follow-up scheduled in two weeks to assess response to treatment.  ICD-10 code K59.04 for opioid-induced constipation will be used for billing and coding.  Consideration for peripheral mu-opioid receptor antagonists if conservative measures fail.