Patient presents with obtundation, demonstrating a decreased level of consciousness and alertness.  Assessment reveals reduced responsiveness to external stimuli, requiring increased stimulation for arousal.  The patient exhibits psychomotor retardation, delayed responses to questions, and drowsiness.  Differential diagnosis includes metabolic encephalopathy, drug intoxication, neurological disorders such as stroke or intracranial hemorrhage, and infections like sepsis or meningitis.  Initial laboratory studies including complete blood count, comprehensive metabolic panel, blood cultures, and urinalysis have been ordered to evaluate potential underlying etiologies.  Neurological examination reveals sluggish pupillary response and decreased deep tendon reflexes.  Imaging studies such as head CT or MRI may be indicated based on initial laboratory results and clinical suspicion.  Current plan includes close monitoring of neurological status, supportive care with intravenous fluids, and further diagnostic evaluation to determine the cause of obtundation.  Patient safety precautions implemented to prevent falls and aspiration.  Medical decision making complexity is moderate given the need to differentiate between various potential causes and initiate appropriate treatment.  ICD-10 code R40.0, unspecified stupor, will be used pending further diagnostic clarification.  CPT codes for evaluation and management services will be determined based on the time spent and complexity of medical decision making.  Continued reassessment and modification of the treatment plan will be based on the evolving clinical picture and diagnostic findings.