Patient presents with scarring alopecia, also known as cicatricial alopecia, characterized by permanent hair loss due to destruction of hair follicles and their replacement with scar tissue.  The patient reports [onset and duration of hair loss; e.g., gradual hair loss over the past six months].  Examination reveals [description of affected area; e.g., well-defined patches of smooth, shiny skin on the vertex scalp] with [description of specific findings; e.g., absence of follicular ostia, perifollicular erythema, and scale].  The patient denies [relevant negatives; e.g., itching, burning, pain].  Differential diagnosis includes lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, pseudopelade of Brocq, discoid lupus erythematosus, and folliculitis decalvans.  A scalp biopsy is recommended to confirm the diagnosis and determine the specific subtype of scarring alopecia.  Initial treatment plan includes [mention specific medications, procedures, or referrals; e.g., referral to a dermatologist for further evaluation and management, consideration of intralesional corticosteroid injections].  Patient education provided on the chronic nature of the condition and the importance of adherence to the prescribed treatment plan.  Follow-up appointment scheduled in [timeframe; e.g., four weeks] to assess response to treatment and adjust management as needed.  ICD-10 code L61.9, Nonspecific cicatricial alopecia, is provisionally assigned, pending biopsy results.  This diagnosis and associated treatment plan are medically necessary to prevent further progression of hair loss and address any associated symptoms.