Patient presents with a complaint of abnormal urine odor.  Chief complaint documented as foul-smelling urine, strong urine odor, or unusual urine smell.  Onset, duration, and character of the odor were explored, including descriptors such as ammonia-like odor, fishy urine smell, sweet urine odor, or other specific characteristics.  Associated symptoms were queried, including dysuria, urinary frequency, urgency, hematuria, flank pain, fever, chills, recent infection, dietary changes, new medications, or changes in fluid intake.  Medical history, surgical history, family history, and social history were reviewed, noting any relevant conditions such as diabetes mellitus, urinary tract infection, liver disease, metabolic disorders, or inherited metabolic diseases.  Physical examination findings documented, including assessment of hydration status, abdominal examination, and costovertebral angle tenderness.  Differential diagnosis includes urinary tract infection, dehydration, asymptomatic bacteriuria, diabetes mellitus, liver failure, maple syrup urine disease, phenylketonuria, trimethylaminuria, and dietary influences.  Urinalysis ordered to assess for leukocytes, nitrites, bacteria, glucose, ketones, blood, and specific gravity.  Urine culture and sensitivity may be indicated if infection is suspected.  Metabolic workup may be considered if initial urinalysis is unremarkable and clinical suspicion for metabolic disorder exists.  Patient education provided regarding appropriate hydration, hygiene practices, and follow-up based on diagnostic results.  Treatment plan will be tailored to underlying cause once identified.  Follow-up appointment scheduled to review results and discuss further management.  ICD-10 code R82.89 (other specified abnormal findings in urine) may be considered depending on the underlying etiology.  CPT codes for urinalysis (81000, 81001, 81002, 81003) and urine culture (87086) may be applicable depending on the tests performed.