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Common clinical drivers include: Vitamin B12 deficiency Folate deficiency Chronic liver disease Alcohol use disorder Medications (e.g., methotrexate) Bone marrow disorders Chronic inflammatory disease Hypothyroidism Key ICD-10 principle: Cell size is a laboratory observation

Initial hyperglycemia may give way to hypoglycemia and worsening CNS symptoms

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Use CPT 90837 when the session involves only the identified patient receiving individual psychotherapy for 53 minutes or more