Patient presents with Skin Picking Disorder (Excoriation Disorder, Dermatillomania) characterized by recurrent skin picking resulting in skin lesions.  The patient reports an inability to stop picking at their skin, despite repeated attempts.  Areas of focus include the face, arms, and hands, with observable skin damage ranging from minor excoriations to deeper, infected lesions.  The patient acknowledges significant emotional distress and impairment in social functioning related to the skin picking behavior.  Symptoms meet DSM-5 diagnostic criteria for Skin Picking Disorder, including recurrent skin picking resulting in skin lesions, repeated attempts to decrease or stop skin picking, and clinically significant distress or impairment in social, occupational, or other important areas of functioning.  Differential diagnoses considered included obsessive-compulsive disorder, body dysmorphic disorder, and other body-focused repetitive behaviors.  Treatment plan includes cognitive behavioral therapy (CBT) focusing on habit reversal training, stimulus control, and relapse prevention.  Patient education provided on skin care and wound management techniques.  Referral to a dermatologist for evaluation and management of skin lesions is recommended.  Prognosis is guarded but favorable with consistent adherence to the treatment plan.  Follow-up scheduled in two weeks to assess treatment response and adjust plan as needed.  ICD-10 code L98.1 (Dermatitis factitia) and CPT codes for psychotherapy (e.g., 90837, 90834) will be utilized for billing and coding purposes.