Patient presents with clinical features suggestive of Tetralogy of Fallot.  The patient exhibits cyanosis, a prominent symptom of Tetralogy of Fallot, along with dyspnea on exertion and shortness of breath.  Physical examination reveals a systolic murmur consistent with a ventricular septal defect, a key component of the Tetralogy of Fallot diagnosis.  Echocardiography confirms the presence of the four defining characteristics of Tetralogy of Fallot:  ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.  The degree of pulmonary stenosis contributes significantly to the severity of symptoms.  Differential diagnosis includes other cyanotic congenital heart defects, but the echocardiographic findings are specific for Tetralogy of Fallot.  Treatment plan includes discussion of surgical repair of Tetralogy of Fallot, focusing on closure of the ventricular septal defect and relief of the pulmonary stenosis.  Risks and benefits of surgical intervention were discussed with the patient and family.  Referral to a pediatric cardiologist specializing in congenital heart disease and Tetralogy of Fallot management has been made.  Patient and family demonstrate understanding of the diagnosis, Tetralogy of Fallot, and the proposed management plan.  Follow-up appointment scheduled to monitor symptoms, oxygen saturation levels, and overall cardiac function in the context of Tetralogy of Fallot.  ICD-10 code Q21.3 (Tetralogy of Fallot) is documented for medical billing and coding purposes.  CPT codes for echocardiography and other diagnostic tests performed will be documented separately.  This documentation supports the medical necessity of services rendered for the management of Tetralogy of Fallot.