Patient presents with symptoms consistent with a diagnosis of psychosis.  Presenting concerns include auditory hallucinations described as hearing voices commenting on the patient's actions, delusional beliefs centered around being monitored by an unknown entity, and disorganized thought processes evident in tangential and circumstantial speech.  The patient exhibits impaired reality testing and demonstrates difficulty differentiating between internal experiences and external reality.  Symptoms onset was reported approximately two weeks prior to this evaluation, and the patient denies any prior history of psychotic episodes.  Family history is significant for schizophrenia in a first-degree relative.  The patient denies current substance use and a urine drug screen was negative.  Medical history is unremarkable.  Mental status examination reveals a disheveled appearance, anxious affect, and guarded behavior.  Insight and judgment appear significantly impaired.  Differential diagnosis includes schizophrenia, schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, and substance-induced psychotic disorder.  Given the absence of substance use and the presence of positive symptoms including hallucinations and delusions, a preliminary diagnosis of psychosis NOS (not otherwise specified) is made pending further evaluation.  Treatment plan includes initiation of antipsychotic medication, referral for psychiatric evaluation, and close monitoring for symptom changes.  Patient education regarding psychosis, medication adherence, and available support resources was provided.  Prognosis is guarded and dependent upon treatment response and adherence.  Follow-up appointment scheduled in one week to assess medication efficacy and monitor for adverse effects.  ICD-10 code F29 is applied.  CPT codes for evaluation and management services will be determined based on time spent and complexity of medical decision making.