how do I score this??

[Sara Hayden RN,C]

I have a resident on Medicare A that is a hospital return following surgery for an above the knee amputation due to irreversible critical ischemia.  In the 7 day window, since his return, he has had 4 periods of complete unresponsiveness with flaccidity.  These periods have lasted from 2 hours to 16 hours.  When he comes out of these episodes, he is totally alert and oriented, communicates clearly, makes his own decisions, feeds himself, jokes with staff, etc.  My question is on scoring section B - cognition and memory.  Do I score the way he is when he is unresponsive or do I score for the alert and oriented, awake person?  The episodes of each is about 50% of the window period so neither one is a true picture of the resident throughout the window as they are so completely polar of status.   Sara Hayden RN,C St. Mark's Lutheran Home Austin, MN   Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.