Systolic congestive heart failure diagnosed.  Patient presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.  Physical exam reveals pulmonary rales, peripheral edema, and an S3 gallop.  The patient reports a history of hypertension and coronary artery disease.  Ejection fraction is reduced, confirmed by echocardiogram demonstrating [EF percentage].  Left ventricular systolic dysfunction noted.  Diagnosis of systolic heart failure confirmed based on patient symptoms, clinical findings, and reduced ejection fraction.  Treatment plan includes diuretics for fluid management, ACE inhibitors to reduce afterload, beta-blockers to reduce cardiac workload, and patient education regarding sodium restriction and fluid management.  Patient advised on lifestyle modifications including regular exercise as tolerated and smoking cessation.  Follow-up scheduled to monitor response to therapy and adjust medications as needed.  Differential diagnoses considered included chronic obstructive pulmonary disease and valvular heart disease.  ICD-10 code I50.2 for heart failure with reduced ejection fraction assigned.  Medical billing codes for echocardiogram, office visit, and prescribed medications documented.