Reason Code 5J503: No Orders for Inpatient Admission
Reason Code 5J503 indicates that the documentation submitted did not include a signed physician’s order or documentation to support intent to order.
Refer to Internet-Only Manual, Pub 100-08, Chapter 3, Section 126.96.36.199 Social Security Act Section 1842(p)(4), and Section 188.8.131.52, 42 CFR 410; and Internet-Only Manuals 100-02, Chapter 15, Section 80.6.1.
The claim has been fully or partially denied as the documentation submitted for review did not include a physician’s order to admit the patient. Services that are not ordered by the physician are not reasonable and necessary.
To Prevent This Denial
Documentation and tips that may be helpful to avoid future denials for this reason may include, but are not limited to, the following:
- Physician’s order to admit to inpatient services should be clearly identified in the medical records. This order may be located within the history and physical, progress note, emergency room report and/or verbal order signed and dated by the physician.
- The signature must be legible and should include the practitioner’s first and last name. Also include applicable credentials such as M.D., P.A., or D.O.
- Electronic signatures are acceptable. Valid examples include, but are not limited to: “Electronically signed by John Smith, M.D.,” “Authenticated by John Smith, M.D.” or “Verified by John Smith, M.D.”
- Orders for inpatient admission written by a nonphysician practitioner must be cosigned by the attending physician
For more information, refer to CMS Internet-Only Manuals (IOMs), Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 184.108.40.206.