Patient presents with symptoms suggestive of polycythemia vera, including headache, dizziness, pruritus, and erythromelalgia.  Physical examination reveals splenomegaly and plethora.  Complete blood count demonstrates elevated hemoglobin, hematocrit, and red blood cell count.  White blood cell and platelet counts are also elevated.  The patient denies any history of chronic hypoxia, carboxyhemoglobinemia, or erythropoietin-secreting tumors.  Bone marrow biopsy shows hypercellularity with trilineage hyperplasia.  JAK2 mutation analysis is pending.  Differential diagnoses include secondary polycythemia and other myeloproliferative neoplasms.  Assessment: Polycythemia vera, likely.  Plan: Initiate phlebotomy to reduce hematocrit.  Low-dose aspirin therapy will be started for thrombotic prophylaxis.  Patient education provided regarding disease management, potential complications including thrombosis and transformation to myelofibrosis or acute myeloid leukemia, and the importance of follow-up appointments.  Referral to hematology for further evaluation and management.  ICD-10 code D45.1, Polycythemia vera, is assigned.  Medical billing codes will reflect evaluation and management services, laboratory testing, and therapeutic phlebotomy.  The patient will be scheduled for regular monitoring of blood counts, JAK2 mutation status, and assessment for disease progression.