Patient presents with irritability, characterized by increased agitation, frustration, and a lowered threshold for anger.  Symptoms include excessive crying, restlessness, emotional lability, and difficulty coping with minor stressors.  Onset of irritability was noted (date of onset), and the patient reports a duration of (duration of symptoms).  Potential contributing factors explored include sleep disturbances, stress, anxiety, pain, medication side effects, hormonal changes, and underlying medical conditions.  Differential diagnoses considered include depression, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), oppositional defiant disorder (ODD), and medical conditions such as hypothyroidism or chronic pain.  The patient's medical history is significant for (relevant medical history).  Current medications include (list medications).  Mental status examination reveals (observations regarding affect, mood, thought process, etc.).  Assessment suggests a diagnosis of irritability secondary to (likely cause if identifiable, otherwise state "unknown etiology").  Plan includes (treatment plan, e.g., behavioral interventions, stress management techniques, sleep hygiene recommendations, medication adjustments if applicable, referral to specialist if necessary), with a focus on improving coping mechanisms and reducing environmental triggers.  Patient education provided on irritability management strategies.  Follow-up scheduled for (date of follow-up) to assess treatment response and adjust plan as needed.  ICD-10 code (appropriate ICD-10 code, e.g., R45.4 for irritability and anger) is considered for this encounter, along with relevant CPT codes for evaluation and management (e.g., 99213, 99214, depending on complexity).  Medical necessity for services rendered is documented.