Patient presents with labile mood characterized by significant mood swings, fluctuating between periods of elevated mood (euphoria, hypomania) and depressed mood (dysthymia, low mood).  These mood shifts are not sufficiently severe or prolonged to meet criteria for Bipolar Disorder, Major Depressive Disorder, or Persistent Depressive Disorder.  Onset of mood swings is noted to be (recent onset, gradual onset, insidious onset) and frequency is described as (daily, weekly, episodic).  Symptoms impacting daily functioning include (e.g., irritability, difficulty concentrating, sleep disturbances, fatigue, changes in appetite, emotional lability).  Patient denies suicidal ideation or homicidal ideation.  Differential diagnoses considered include cyclothymia, borderline personality disorder, substance-induced mood disorder, and medical conditions impacting mood regulation.  Assessment includes screening for contributing factors such as stress, hormonal changes, medications, and comorbid medical or psychiatric conditions.  Current medications are documented.  Treatment plan includes (e.g., psychotherapy, cognitive behavioral therapy CBT, counseling, stress management techniques, sleep hygiene education).  Patient education provided on mood tracking, symptom management, and coping strategies.  Follow-up scheduled to monitor symptom progression and treatment efficacy.  ICD-10 code R45.86 (Other specified symptoms and signs involving emotional state) is considered, with further assessment needed to confirm diagnosis. Medical billing codes for evaluation and management services will be determined based on the complexity of the visit and time spent with the patient.  Referral to psychiatry may be indicated if symptoms persist or worsen.