Patient presents with complaints consistent with a periumbilical hernia.  Examination reveals a palpable bulge or protrusion localized to the periumbilical region, adjacent to the umbilicus (navel).  The patient may report associated symptoms such as abdominal pain, discomfort, or a sense of pressure, particularly with straining, coughing, or lifting.  The hernia may be reducible, spontaneously reducing when supine, or may require manual reduction.  The size of the hernia defect is documented, and the presence of any overlying skin changes, such as erythema or discoloration, is noted.  Differential diagnoses considered include umbilical hernia, epigastric hernia, and incisional hernia.  Assessment includes evaluation for complications such as incarceration or strangulation, indicated by severe pain, tenderness, nausea, vomiting, and irreducible hernia.  Current treatment plan includes patient education on hernia management, observation for changes in symptoms, and discussion of surgical options such as herniorrhaphy or hernia repair, if indicated.  Risks and benefits of surgical intervention were explained, and the patient's understanding was confirmed.  Follow-up is scheduled to monitor hernia progression and address any further concerns.  ICD-10 code K42.0 is considered for umbilical hernia, while K42.9 may be appropriate if documentation specifies periumbilical location.  CPT codes for potential surgical repair may include 49580, 49585, or others depending on the specific procedure performed.  Medical necessity for surgical intervention is documented based on patient symptoms, hernia characteristics, and potential complications.