Patient presents with complaints of bilateral knee pain consistent with osteoarthritis.  Symptoms include chronic knee pain, stiffness, creaking, and limited range of motion in both knees.  Onset of symptoms was gradual over several years, exacerbated by weight-bearing activities and prolonged standing.  Patient reports morning stiffness lasting less than 30 minutes, improving with movement.  Physical examination reveals bony crepitus, mild joint effusion without warmth or erythema, and pain with palpation of the medial joint line bilaterally.  Radiographic imaging of bilateral knees demonstrates osteophyte formation, joint space narrowing, and subchondral sclerosis, confirming the diagnosis of osteoarthritis.  Assessment: Bilateral knee osteoarthritis.  Plan: Conservative management including weight management counseling, regular low-impact exercise such as swimming and cycling, and over-the-counter pain relievers like ibuprofen or naproxen.  Patient education provided regarding osteoarthritis management, including joint protection strategies.  Follow-up scheduled in six weeks to assess symptom response and discuss further treatment options if needed, including physical therapy referral, viscosupplementation, or referral to orthopedics for surgical intervention consideration.  ICD-10 code K25.9 Osteoarthritis, unspecified of knee,  will be utilized for billing.