sign change or not need help

[Shopqueen62]

hi      i have resident who has end stage cirrhosis. when he was admitted approx 20 or more days ago his was semi comatose. in the past 2 wks he came around and is receiving pt 5 x wks. his 30 day is pending shortly do i have to code this 30 day an sign change also because his rug changes for payment his last mds was cbi ?       it sounds like it to me for an improvement.  OR not  since it is expected that his condition will flucutate due to his dx and NH4 levels go up and down?  please guide me. thanks nancy