So if a patient is elderly, probably sundowning, winds up in our psych ward due to change in patients mental status and abilities, and the doc finds out that the patient is "disoriented to all realms", how do you fit that into your MDM? Patients like this usually have two to four chronic medical conditions that the doc has to manage besides the mental diagnosis. But if the patient is "disoriented to all realms" would that make it High MDM? Or how do you code this out there. Any thoughts would be helpful. Thanks.