R40.4 - Transient alteration of awareness

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Decreased level of consciousness
• Feeling faint
• Fluctuating level of consciousness
• Transient alteration of awareness

Convert to ICD-9 Code

Patient Education

Delirium

What is delirium?

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

• Hypoactive, where you are not active and seem sleepy, tired, or depressed
• Hyperactive, where you are restless or agitated
• Mixed, where you change back and forth between being hypoactive and hyperactive

What causes delirium?

There are many different problems that can cause delirium. Some of the more common causes include:

• Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol abuse.
• Dehydration and electrolyte imbalances
• Dementia
• Hospitalization, especially in intensive care
• Infections, such as urinary tract infections, pneumonia, and the flu
• Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be withdrawal after stopping a medicine.
• Metabolic disorders
• Organ failure, such as kidney or liver failure
• Poisoning
• Serious illnesses
• Severe pain
• Sleep deprivation
• Surgeries, including reactions to anesthesia

Who is at risk for delirium?

Certain factors put you at risk for delirium, including:

• Being in a hospital or nursing home
• Dementia
• Having a serious illness or more than one illness
• Having an infection
• Older age
• Surgery
• Taking medicines that affect the mind or behavior
• Taking high doses of pain medicines, such as opioids

What are the symptoms of delirium?

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include:

• Changes in alertness (usually more alert in the morning, less at night)
• Changing levels of consciousness
• Confusion
• Disorganized thinking, talking in a way that doesn't make sense
• Disrupted sleep patterns, sleepiness
• Emotional changes: anger, agitation, depression, irritability, overexcitement
• Hallucinations and delusions
• Incontinence
• Memory problems, especially with short-term memory
• Trouble concentrating

How is delirium diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• Physical and neurological exams
• Mental status testing
• Lab and diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse and can last for hours or weeks. On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable and may last for months or years.

What are the treatments for delirium?

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:

• Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
• Medicines, including those that control aggression or agitation and pain relievers if there is pain
• If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

Can delirium be prevented?

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person.

Mental Disorders

What are mental disorders?

Mental disorders (or mental illnesses) are conditions that affect your thinking, feeling, mood, and behavior. They may be occasional or long-lasting (chronic). They can affect your ability to relate to others and function each day.

What are some types of mental disorders?

There are many different types of mental disorders. Some common ones include:

• Anxiety disorders, including panic disorder, obsessive-compulsive disorder, and phobias
• Depression, bipolar disorder, and other mood disorders
• Eating disorders
• Personality disorders
• Post-traumatic stress disorder
• Psychotic disorders, including schizophrenia

What causes mental disorders?

There is no single cause for mental illness. A number of factors can contribute to risk for mental illness, such as:

• Your genes and family history
• Your life experiences, such as stress or a history of abuse, especially if they happen in childhood
• Biological factors such as chemical imbalances in the brain
• A traumatic brain injury
• A mother's exposure to viruses or toxic chemicals while pregnant
• Use of alcohol or recreational drugs
• Having a serious medical condition like cancer
• Having few friends, and feeling lonely or isolated

Mental disorders are not caused by character flaws. They have nothing to do with being lazy or weak.

Who is at risk for mental disorders?

Mental disorders are common. More than half of all Americans will be diagnosed with a mental disorder at some time in their life.

How are mental disorders diagnosed?

The steps to getting a diagnosis include:

• A medical history
• A physical exam and possibly lab tests, if your provider thinks that other medical conditions could be causing your symptoms
• A psychological evaluation. You will answer questions about your thinking, feelings, and behaviors.

What are the treatments for mental disorders?

Treatment depends on which mental disorder you have and how serious it is. You and your provider will work on a treatment plan just for you. It usually involves some type of therapy. You may also take medicines. Some people also need social support and education on managing their condition.

In some cases, you may need more intensive treatment. You may need to go to a psychiatric hospital. This could be because your mental illness is severe. Or it could be because you are at risk of hurting yourself or someone else. In the hospital, you will get counseling, group discussions, and activities with mental health professionals and other patients.

Code History

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)