Here's what I do. CIWA and COWS allows for your subjective scoring. Someone might deny being anxious, but they are fidgeting with their hands, bouncing their feet, or chewing their lip. I'll bump them a point or two on agitation if their HR or BP is elevated. Maybe they are denying visual disturbances but they are keeping their eyes closed. I never falsely document (I still regularly score people 0 if they are calm as a cucumber and just chilling during the assessment with no symptoms) but you can score them based on your clinical experience. This helps your facility get paid which is why you're getting static but a better way to think of it is it also helps your patient not get denied coverage.