Patient presents with complaints consistent with pancreatic adenocarcinoma symptoms, including jaundice, abdominal pain radiating to the back, unexplained weight loss, and loss of appetite.  Physical examination reveals palpable abdominal mass and possible Courvoisier's sign.  Initial differential diagnosis includes pancreatic cancer, pancreatitis, choledocholithiasis, and other pancreatic masses.  Preliminary laboratory findings demonstrate elevated bilirubin, alkaline phosphatase, and CA 19-9 tumor marker.  Imaging studies, including abdominal ultrasound, CT scan of the abdomen with contrast, and or MRI of the pancreas, were ordered to evaluate for pancreatic lesions and assess for potential metastasis to the liver, regional lymph nodes, or peritoneum.  Based on the patient's clinical presentation, laboratory results, and imaging findings, a presumptive diagnosis of pancreatic adenocarcinoma is made.  The patient was counseled regarding the diagnosis, prognosis, and treatment options, including surgical resection (Whipple procedure or distal pancreatectomy), chemotherapy, radiation therapy, palliative care, and clinical trials.  Referral to oncology, gastroenterology, and surgery for further evaluation and management was initiated.  Further diagnostic procedures, including endoscopic ultrasound with fine needle aspiration biopsy or percutaneous biopsy, are planned to obtain tissue for histopathological confirmation of pancreatic adenocarcinoma staging and grading.  Patient education regarding pain management, nutritional support, and potential complications, such as pancreatic insufficiency and diabetes, was provided.  Follow-up appointment scheduled to discuss biopsy results and finalize the treatment plan based on disease stage and overall health status.  Medical coding will utilize ICD-10 code C25.9 for malignant neoplasm of pancreas, unspecified, and appropriate CPT codes for procedures performed.