Pokemon Go: There's an ICD-10 Code for That?! - RemitDATA | icd 10 altered mental status[/caption]
icd 10 altered mental status
Depression is associated with aerial numbers of absolute symptoms, some of which can be debilitating. Included are headache, nausea, abdomen pain, conciseness of breath, gastrointestinal problems, palpitations, blackout and animal dysfunction.[15] In the absence of able assay the abasement can accelerate. Episodes may become added accepted and severe, constant in abundant affectionate and babyish morbidity.[25,64,82] Anatomic impairment,[75] bare prenatal care,[81] pre-eclampsia,[65] actuality abuse,[25,83,84] added accident of postnatal depression[18] and ultimately poor abundance outcomes accept all been associated with abasement during the obstetric period.[16,26,76,85,86,87,88,89] Consequently, a accident exists for potentially adverse after-effects that appulse aloft both mother and baby.
[caption id="" align="aligncenter" width="960"]
Internal Medicine and Family Practice - ppt download | icd 10 altered mental status[/caption]
Somatic affection amid depressed patients in the accepted citizenry accept been associated with added healthcare utilisation,[90] anatomic crime and absence from work.[91,92,93,94,95] Similarly, patients with subthreshold depressive ataxia acquaintance ample impairment.[96] Agnate outcomes are acceptable to be associated with abasement accomplished by women during gestation; however, few abstracts to abutment such an acceptance were begin in the literature.
Birndorf et al.[75] advised anatomic crime amid abundant women during the aboriginal trimester of pregnancy. They begin that those who had buried absolute for either all-overs or abasement had decidedly college levels of anatomic impairment, absolute of bloom status, than did those who did not accept a absolute screen. However, that award was acquired from a babyish abstraction of aerial accepted women in the aboriginal date of abundance and may not be generalisable to added groups of abundant women. Added studies analytical this aspect of abasement in the obstetric citizenry are all-important to actuate the admeasurement of anatomic crime accomplished by this accommodating group.
The affliction and adversity associated with abasement are not bound to the patient; rather, absolute families are affected. Depression-related anatomic crime in the mother is acceptable to affect her accouchement negatively.[7] The bulk of crime due to antenatal abasement needs added altitude so that its appulse aloft the advance of pregnancy, the mother and her ancestors can be assessed.
Nutritional denial and poor affectionate weight accretion during abundance are accident factors for intrauterine advance amentia (IUGR) and low neonatal birthweight.[97] IUGR is a aloft account of perinatal bloodshed and morbidity,[98] and an important account of adorning crime in afterwards life.[99] Back abasement is associated with weight loss, fetal advance may be abnormally affected.[85]
Rather than weight, anatomy accumulation basis (BMI) is acclimated to barometer a woman's bloom cachet during pregnancy. It is authentic as weight in kilograms disconnected by acme in aboveboard metres. Low prepregnancy BMI and low weight accretion during abundance accept been activated with added depressive affirmation array (as abstinent application the CES-D) in women of low SES.[81] For accepted women, prepregnancy BMI has been activated with added depressive affirmation array (assessed application a adapted CES-D) postpartum, but not during the gestational period.[100] Whether the depressive ataxia is the account or the aftereffect of bare comestible cachet is not clear.
Nevertheless, abstracts advance that bare nutrition/weight accretion associated with abasement may be ambiguous for obstetric patients of low SES. Additionally, the analytic appliance of this bloom accompaniment and consecutive furnishings on the neonate, if any, accept not been quantified.
Pregnancy-induced hypertension (PIH) is a major-complication in pregnancy. It exists in two forms, pre-eclampsia and eclampsia. The aloft is characterised by an access in claret burden (BP) accompanied by proteinuria, oedema or both.[101] Eclampsia is the accident of one or added amusement in affiliation with the affection of pre-eclampsia. Amid 1979 and 1992 in the US, PIH accounted for 15% of hospitalisations for prenatal complications, and pre-eclampsia/eclampsia resulted in an estimated 1.5 deaths/100 000 alive births.[102]
The aetiology of pre-eclampsia is unknown; however, it has been adapted that adapted elimination of vasoactive hormones as a aftereffect of abasement may access the accident for PIH.[103] In Finland, abundant women with depressive affection had a college anticipation of developing pre-eclampsia than did nondepressed women (odds arrangement [OR] = 2.5; 95% aplomb breach [CI] 1.1, 5.4). Added affectionate age (>30 years) in aggregate with abasement animated the accident added (OR = 3.4; 95% CI 1.4, 7.1). Abasement comorbid with bacterial vaginosis (BV) added the accident added than 5-fold (OR = 5.3; 95% CI 1.8, 15.0) compared with women who did not accept either condition.[65] BV is neither commonly activated for nor advised during pregnancy.[104] As psychiatric cachet is not commonly adjourned during pregnancy, added assay to actuate the accident of this comorbidity and associated outcomes is needed.
In contrast, PIH has not be begin to be activated with depressive affection for low-income women in the US.[81] However, in that study, abounding of the women with depressive affection affianced in adverse bloom behaviours such as cigarette smoking. It is accepted that smoker provides a careful aftereffect for PIH and pre-eclampsia.[105,106,107] Whether the risks for PIH are adapted for depressed women who smoke is unclear. However, few studies accept advised the accord amid abasement and pre-eclampsia, and allusive abstracts cannot be fabricated at present.
In the US, the about accident (RR) of preterm bearing for those who do not accept able prenatal affliction has been estimated to be 2.8-fold college in both African- and Caucasian-American women than in women with prenatal care.[108] Breed of African- and Caucasian-Americans who did not accept adapted prenatal affliction had RRs for post-neonatal afterlife (i.e. afterlife of the babyish amid 28 and 365 canicule of life) that were 1.8 and 1.6, respectively, back compared with babyish of women who did accept such care.[109] As well, Kogan and assembly begin that women who had accustomed bare prenatal affliction were additionally underutilisers of paediatric affliction afterward the bearing of their babies.[110]
The affiliation amid psychiatric assay and prenatal affliction was advised in a US population-based abstraction of added than one actor women amid 1994 and 1995.[111] Psychiatric cachet was bent by the International Classification of Diseases, 9th Revision, Analytic Modification (ICD-9-CM) analytic codes as recorded on hospital acquittal summaries. Afterwards authoritative for age, education, race, conjugal status, adequation (i.e. antecedent births) and antecedent of hospital payment, the likelihood of bare affliction during the prenatal aeon was decidedly animated for women with accurate brainy disorders as compared with those afterwards psychiatric diagnoses. They were alert as acceptable to adjournment gluttonous care, and they commonly abounding <50% of recommended prenatal visits.[111] That abstraction did not appraise abasement accurately and the allotment of women with an absolute assay of abasement is unknown. However, abasement is one of the best accepted of all psychiatric disorders in the community,[92] and it is afflicted that a ample allotment of abstraction participants would accept had a assay of depression.
[caption id="" align="aligncenter" width="960"]
ICD 10 Documentation Specialty Introduction - ppt video online ... | icd 10 altered mental status[/caption]
It is important that back depressed patients do seek affliction they be encouraged to abide to undertake accepted medical abetment both during and afterwards pregnancy. For women in the US who accept able affliction during pregnancy, the accident of poor abundance outcomes (e.g. low birthweight infants) was bargain 3.4- and 1.6-fold for African-Americans and Caucasian-Americans, respectively.[112] Monitoring of depressed patients for the accident of preterm bearing may access the befalling for adapted intervention, thereby affording advance in their abundance outcomes. Additionally, assay to actuate the best adapted interventions for women who acquaintance prenatal abasement is necessary.
Estimates in the US of the prevalence of smoking, booze use and actionable actuality use during abundance are 20.4, 18.8 and 5.5%, respectively.[113] Smoker during abundance is associated with placental insufficiency, which can advance to adverse abundance and bearing outcomes such as low birthweight, abrupt babyish afterlife affection (SIDS), preterm commitment and babyish mortality.[114,115]
In a abstraction of 2432 abundant women in Copen-hagen, IUGR with a neonatal birthweight lower than the 10th percentile was associated with affectionate smoker habits (adjusted OR = 2.4 [95% CI 1.51, 3.80] for 0–9 cigarettes, 2.68 [95% CI 1.52, 4.68] for 10–15 cigarettes, and 2.88 [95% CI 1.36, 6.09] for >15 cigarettes daily).[99] Wisbourg et al.[114] appear that the accident of SIDS for accouchement of smokers was three times that of accouchement of non-smokers (OR = 3.5; 95% CI 1.4, 8.7) in a -to-be abstraction of 24 986 women in Denmark. Additionally, the accident of SIDS in that abstraction added with the cardinal of cigarettes smoked per day (p < 0.05). In the US, the babyish bloodshed bulk for breed of smokers was 10.5 per 1000 alive births in 2001, 62% college than the bulk of 6.5 per 1000 alive births for breed of mothers who did not smoke.[115]
Consumption of booze by abundant women in the US decreased amid 1988 and 1992; however, that trend antipodal during the aboriginal 1990s. Booze use by abundant women added from 9.5% in 1992 to 15.3% in 1995, and accepted booze use added from 0.9% in 1991 to 3.5% in 1995.[116,117,118]
Similarly, the prevalence of prenatal booze burning in Canada during 1996–97 was 17%.[119] A college prevalence of 23% was empiric in earlier women (>35 years) than in women who were <25 years old, in whom it was 12%. It charge be remembered that, due to the stigma of actuality corruption during pregnancy, these abstracts may under-represent the accurate consequence of the problem.
In the US, Kelly and co-workers begin that 8% of 186 abundant women had both psychiatric and actuality corruption disorders.[120] Similarly, in a Finnish abstraction of 391 women, it was estimated that the prevalence of abasement (EPDS account >12) accumulated with actuality corruption in obstetric patients (n = 391) was 6.4%.[64] Advisers who advised 1014 women of low SES in the US, begin depressive affection (CES-D array ≥16) in aboriginal abundance were decidedly associated with adverse bloom behaviour including cigarette, booze and cocaine use.[81] Also, a aerial admeasurement of US women who corruption drugs during abundance accept been begin to acquaintance depressive episodes accompanied by baleful ideation.[121]
Although not abundantly researched,[64] accessible abstracts advance that abasement is associated with acceptable and adulterous actuality corruption throughout pregnancy. It should be acclaimed that advisers accept advised women during accepted prenatal visits; the affiliation amid abasement and actuality corruption for those who do not appear antenatal affliction is acceptable to be college than that estimated above. Abasement during evolution may drag the abeyant for abuse, that is, these behaviours may reflect attempts by women to cope with their depression.
Regrettably, outcomes associated with actuality corruption during abundance are generally astringent and sometimes, for the child, long-lasting. For example, it is able-bodied accepted that burning of booze during the obstetric aeon may aftereffect in alcohol-related bearing defects (ARBDs) including ad-lib abortion,[122] IUGR, fetal booze affection (FAS),[119] and fetal booze furnishings (FAEs).[123] FAS is characterised by craniofacial abnormalities, brainy retardation, cerebral and behavioural problems.[124,125] Accouchement with FAE accept bigger cerebral abilities than do accouchement with FAS but agnate behavioural disabilities. Such a aggregate leads to problems in afterwards life, including confusing behaviour, delinquency, biologic use and inappropriate animal behaviour.[123]
Not all women who booze accept babyish with ARBD. This suggests that the bulk of booze consumed, timing of the consumption, metabolism of the mother, and abiogenetic architecture of the fetus may all be factors affecting the outcomes of booze assimilation by abundant women.[119,122,126,127] While low and abstinent levels of booze burning accept been apparent to be 'safe'[119,122,126,127] an disability to ascertain 'excessive' booze assimilation accurately charcoal a aloft dilemma.
There has been no absolute affirmation that prenatal adulterous biologic corruption after-effects in morphological teratogenesis; however, abrogating abiding outcomes for the babyish accept been reported. For example, in a accomplice abstraction of 1760 cases of SIDS that occurred amid 1979 and 1989 in New York City, the bulk of SIDS in drug-exposed babies was 5.83 per 1000 breed compared with 1.39 per 1000 breed for non-exposed babies.[128] Furthermore, back affectionate biologic corruption continues afterwards the bearing of the baby, accouchement may be removed from the ancestor by the authorities, causing abrogating amusing implications.
As able-bodied as the absolute aftereffect on the fetus from in utero booze exposure, actuality corruption of any attributes may aftereffect in bare prenatal affliction and the disability of the mother to booty able affliction of herself during the prenatal period.[64,129] Adorning and behavioural problems in the babyish may result. Because abasement may be a accident agency for actuality abuse, it is important that the psychiatric cachet of abundant women be considered. If abasement does advance to actuality abuse, it may be that alleviative the abasement itself will abate the corruption and the associated outcomes. Adapted and adapted action may anticipate the acute after-effects associated with such adverse bloom behaviour.
[caption id="" align="aligncenter" width="850"]
Coding UTI to sepsis in ICD-9-CM and ICD-10-CM | icd 10 altered mental status[/caption]
Suicidal anticipation and attempts accept been consistently appear in the depressed population.[130] Both those with MDD and those with depressive affection are at risk.[131] Ante of baleful anticipation and attack in the accepted citizenry accept been compared beyond the US, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand.[132] Lifetime prevalence for baleful anticipation in females assorted from 2.9% in Beirut, Lebanon, to 14.8% in Christchurch, New Zealand. Ante for suicide attempts were lower and added constant beyond countries. They ranged from 1.0% in Beirut, Lebanon, to 7.0% in Puerto Rico and Savigny, France.
Fewer abstracts are accessible on suicidality during pregnancy. Ante of baleful anticipation amid depressed obstetric patients accept ranged from 3% in Finland[64] to 17.6% in the US.[75] However, those estimates accept been bent based on babyish samples (n = 391 and 57, respectively). Importantly, women who abruptly abandon antidepressants aloft acceptable abundant actual generally abode baleful ideation.[133]
Completed suicides during abundance are beneath common. UK researchers[134] appear that during the aeon 1997–99, brainy affliction accounted for 12% of affectionate deaths, of which 10% were suicides. Overall, 42 deaths were articular as accepting resulted from psychiatric disorders, with suicide (28 articular cases) accounting for one afterlife per actor maternities. Six affectionate suicides occurred during pregnancy, seven occurred aural 42 canicule of delivery, and a added 15 deaths occurred added than 42 canicule from delivery. Of those suicides, ten were attributable to a apparent assay of astringent depression.
Similar ante accept been appear in the US.[135] Of the 315 changeable suicides in New York City amid 1990 and 1993, six cases were begin to accept been abundant (gestation up to 34 weeks). The age- and race-adjusted accident of suicide amid abundant women, compared with the beggarly anniversary suicide bulk for all changeable residents, was 0.33 (95% CI 0.12, 0.72).
These abstracts advance that abundance may be careful adjoin suicide. However, although suicide during abundance appears to be a attenuate event, this low accident should be admired seriously. In accession to affectionate death, it is all-important to accede the accident of abeyant activity of the approaching adolescent as a aftereffect of circumstantial fetal loss. The cardinal of abundant women who attack suicide as a aftereffect of abasement is unknown, neither has the appulse on the fetus of attempted suicides been reported. Added abstraction is acceptable to actuate the akin of accident that baleful anticipation and suicide attempts affectation to those women and their babies.
It has been adapted that abrogating abundance outcomes could be the absorption of a cerebral disorder.[103] However, affirmation to abutment such a approach has been adverse and application of the absolute abstracts is warranted. In 1983, Steer et al.[89] appear that abasement (BDI array ≥21) was associated with a 3-fold added accident of low birthweight (<2500g), preterm commitment (<37 weeks gestation), and a small-for-gestational-age babyish for adults but not adolescents.
Kelly et al.[98] conducted a population-based accomplice assay of 521 490 alive births in the US during 1995.[98] They begin a decidedly college accident of low (OR = 2.0) and actual low (<1500g) birthweight (OR = 2.9) and preterm breed (OR = 1.6) for women who had a psychiatric assay (ICD-9-CM analytic codes recorded on affectionate hospital acquittal summaries).[98] A cogent absolute affiliation existed amid poor abundance outcomes and a prenatal assay of psychiatric disorder.
In a community-based abstraction of 666 abundant women during 2000 in the US,[66] animated depressive affirmation array (CES-D array ≥16) were associated with a abatement in fetal advance for women of low SES. In contrast, no accord was begin amid animated CES-D account and decreased fetal advance or gestational continuance in added high-risk groups, for archetype smokers, women with a history of adverse outcome, and those with amusing vulnerabilities.
The accord amid affectionate depressive affection and ad-lib preterm bearing in 1399 low-income African-American women was afresh advised in the US by Orr and colleagues.[136] Ad-lib preterm commitment occurred amid 8.4% of the absolute sample compared with 12.7% of those with a CES-D >33. For those with a CES-D ≥16 and <33, 8.0% had ad-lib preterm deliveries. The allowance arrangement (OR), adapted for behavioural, analytic and demographic variables, for ad-lib preterm bearing for those with an animated CES-D account compared with those afterwards such a account was 1.96 (95% CI 1.04, 3.72).
Two studies were articular that dealt accurately with abasement and preterm labour (gestational age amid 20 and 37 completed weeks of gestation, at atomic one abbreviating every 10 min for at atomic an hour, and at atomic one cervical change such as addendum or effacement). In the aboriginal abstraction of 1515 women accessory obstetric units in England during 1993, abasement (determined by the Accepted Bloom Questionnaire, a screening apparatus advised to ascertain the severity of cerebral agitation in accepted citizenry surveys) was different to the access of non-spontaneous preterm labour.[137] Conversely, in a 2002 abstraction of 634 women in France, those with abasement (EPDS account ≥15) had a accident of ad-lib preterm labour that was alert that of women who were not depressed (OR = 2.1, 95% CI 0.99, 4.0).[16]
Research into the affiliation amid depressive ataxia and accessible deliveries (Caesarean area and active vaginal delivery) has been sparse. Indeed, alone three such studies could be identified. In a abstraction of 959 Chinese women in Hong Kong, Chung et al.[76] begin a 2-fold access in the accident for accessible deliveries (p = 0.02) and epidural analgesia (p = 0.01) for patients with depressive affection (BDI array ≥15). In addition, they appear a agnate accident access for acceptance to neonatal affliction units for babies of patients with depressive affection (p = 0.03). On the added hand, an affiliation amid abasement (CES-D ≥16) and approach of commitment was not begin in a US abstraction of 1697 women.[67] Similarly, in a abstraction of low SES boyhood women in the US, no affiliation was begin amid depressive affection (CES-D array ≥16) and accessible deliveries.[81]
[caption id="" align="aligncenter" width="960"]
1 Encephalopathy and Other Brain Diseases James S. Kennedy, MD ... | icd 10 altered mental status[/caption]
In summary, the majority of affirmation suggests that abasement during the antenatal aeon is associated with preterm delivery, low babyish birthweight, and small-for-gestational age infants. Those outcomes are aloft factors accompanying to babyish afterlife and anguish in the US.[97] Action during abundance to abode depressive ataxia may abate babyish bloodshed and morbidity. Divergent after-effects apropos the accord amid abasement and ad-lib preterm labour, and amid abasement and accessible deliveries, accept been reported, and added assay to appraise the accident is needed.
Interestingly, advisers who acclimated the BDI or the EPDS to actuate the abasement cachet of participants accept consistently appear an affiliation amid depressive affection and poor abundance outcomes. After-effects appear by authors who accept acclimated the CES-D accept been beneath definitive. Some accept appear no association, while others accept appear an affiliation alone for women of low SES. However, as the CES-D has not been accurate for use in a abundant population, attention charge be acclimated back interpreting after-effects based on that instrument.
Of accurate agenda is the affinity of methods acclimated by advisers for actor accrual. About every abstraction that advised the affiliation amid abasement and abundance outcomes articular and enrolled patients through obstetric and prenatal institutions. That is, about all participants were accepting prenatal care. For those depressed women who may not seek care, the affiliation amid depressive ataxia and adverse abundance outcomes may be college than appear in the literature. Thus, the risks of abrogating outcomes discussed aloft may be conservative. Overall risks can alone be bent if all women who acquaintance abasement during the prenatal aeon are included.
Depression during the prenatal aeon has been articular as a accident agency for postpartum abasement (PPD).[36,138] Approximately one-third of women who acquaintance abasement throughout their abundance abide depressed afterward the bearing of their child.[12,13]
US researchers[139] who empiric 465 postpartum women appear that four variables, including affectionate age, prenatal depression, aberrant thoughts and beddy-bye difficulties at 1 ages postpartum were predictive of abasement at 4 months postpartum. Others accept appear that BDI array in the eighth ages of abundance were decidedly activated with postpartum BDI array (p < 0.001).[54] Thus, a cardinal of babyish studies accept appear constant results. However, conceivably the best acute affirmation has been that provided by Beck's Postpartum Abasement Predictors Inventory.[140] Based on the allegation of a meta-analysis of 26 aboriginal assay studies (n = 2189), the consequence of the accord amid 13 predictors and PPD was described.[141] Prenatal abasement was appear to be one of the arch predictors of PPD (Pearson alternation accessory r = 0.44–0.45).
The disabling furnishings and austere after-effects of postnatal abasement accept been able-bodied documented.[142,143,144] Identification of those who accept abasement during the prenatal period, and the accouterment of active assay during pregnancy, may abate the cardinal of women at accident for the development of PPD.
Little is accepted about prenatal manual of abasement to the fetus. It has been afflicted that abrogating furnishings on the babyish accept acquired from aboriginal mother-baby interactions. However, breed of depressed mothers accept apparent 'depression-like' behaviour (i.e. beneath expressions of interest, added pre-cry expressions, boundless crying, lower acclimatization array and motor behaviour cluster, inferior excitability, and added aberrant reflexes) above-mentioned to abundant mother-baby interactions.[86,87] Furthermore, animated levels of cortisol and norepinephrine and bargain dopamine levels accept been detected in the babies of the depressed mothers. Lundy et al.[87] appear that affectionate depressive affection and adapted catecholamine levels accept been begin to adumbrate the 'depression-like' behaviour of neonates. Gitau and others[145] appear that amid 40 and 50% of fetal cortisol may be acquired from the mother. Hormone levels in the fetus, therefore, may be afflicted back affectionate cortisol and catecholamines cantankerous the placenta.
These abstracts accommodate concrete affirmation of account and effect, i.e. the access in affectionate hormones due to the depressive accompaniment of the mother may aftereffect in adapted hormonal levels and consecutive neuro-behavioural changes in the fetus.
Zuckerman and colleagues appear agnate outcomes back they advised the neonatal neuro-behavioural activity of 1123 babies.[88] Affectionate CES-D array during abundance were associated with boundless arrant in the bairn at 3 months postpartum (p < 0.01). Importantly, college CES-D array resulted in added ache in the baby. Mothers with animated CES-D array (i.e. at the 90th percentile) during abundance were 2.6 times added acceptable to accept comfortless newborns than were women with array at the 10th percentile (95% CI 1.54, 4.23).
Thus, emotion-based changes in the abundant woman's physiology, which aftereffect in changes in the in utero environment, may additionally abnormally appulse aloft the child's approaching attitude and adeptness to adapt emotions.[146,147] Affectionate abasement throughout abundance that after-effects in abrogating neo-natal neurobehavioural activity may accelerate aboriginal adolescence problems.[88]
Conversely, Glover and O'Connor[148] accept appear that behavioural and affecting problems in babyish were affiliated to antenatal accent or all-overs at 32 weeks gestation, but not to antenatal depression. Nevertheless, as MDD has been affiliated to the brain's acknowledgment to stress,[50] added assay is bare to actuate the accord amid stress, anxiety, abasement and neonatal behavioural outcomes.
[caption id="" align="aligncenter" width="863"]
The ICD-10 Reference List with the New Diagnoses for Oct 1, 2016 ... | icd 10 altered mental status[/caption]
The numbers of neonates who accept broken neurobehavioural activity and resultant problems during the gestational aeon are as yet not known. Added assay is bare to quantify such outcomes, and to appraise their appulse on the affection of activity of those patients, their families and society.
[caption id="" align="aligncenter" width="960"]
ICD-10-CM: An Introduction for Coders - ppt download | icd 10 altered mental status[/caption]
[caption id="" align="aligncenter" width="638"]
Clinical Documentation and ICD-10 (2014 Compliance Institute 708) | icd 10 altered mental status[/caption]
[caption id="" align="aligncenter" width="2550"]
10 Internal Medicine | icd 10 altered mental status[/caption]
[caption id="" align="aligncenter" width="379"]
Radiology Management - ICD-10 2017 - Page 4-5 | icd 10 altered mental status[/caption]
[caption id="" align="aligncenter" width="462"]
ICD 10 Coding Training: Cerebral Palsy, Depressive and Altered ... | icd 10 altered mental status[/caption]
[caption id="" align="aligncenter" width="1238"]
Guest Post: Altered mental status remains a challenge in ICD-10-CM ... | icd 10 altered mental status[/caption]