GIGI

DIAGNOSA KODE TINDAKAN KODE

ABSCESS K04.7 EXO /EXTRAXI/CABUT GIGI 23.09
GINGIVITIS K05.0 MEDIKAL 89.31
GP ( GANGGREN PULPA ) K04.1 OTOSCOPY 18.11
GR ( GANGGREN RADIX ) K08.3 PSA /PULP CAPPING/KETAC MOL23.71
IMPAKSI K01.1 RO.GIGI 87.11
KALKULUS K03.6 SCALNING/CURRET 96.54
KM ( CARIES OF DENTINE ) K02.1 TUP.GIC/TUMP COMPOSITE/TUM 23.2
KONTROL GIGI Z01.2 ODONTECTOMI 23.19
KP ( KARIES ) K02.8 dren 27.0
PARIODONTITIS ACUT K05.2 INCISI ABSES 24.0
PARIODONTITIS CRONIS K05.3 AFF HETING 97.89
PARIODONTITIS APICAL CRONIS K04.5 SPOLING 89.31
PARIODONTITIS APICAL ACUT K04.4 ENUKLEASI CYSTA 24.4
PULPITIS K04.0 heting 24.32
ULKUS DECUBITUS K05.1 EXKSISI EPULIS 24.31
FRACTURE MAHKOTA S02.5 EKSISI RANULA 26.29
POCKET K10.0 SPLINTING WIRING 93.55
PERSISTENSI/GOYANG K00.6 MASSUPIALISASI RANULA 26.21
SAKU GUSI K10.3 culdwell-luc 24.91 (penutupan dinding sinus)
MUKOSELE K13.7 EXCISI MUKOCELE 24.91
RADIX K08.3 KURETASE 96.54
KISTA DENTIGENIUSE K09.0 ALVEOLEKTOMI 24.5
MOBILITI K07.3
CYST RADIKULAR K04.8
EKSOSTOSIS TORUS PALATINUS K10.0
EPULIS K06.8
RANULA K11.6
GRANULOMA K04.5
PERIKONORITIS K05.2
SINUS MAXILLA PERPORASI K04.6
TMJ K07.6
TUMOR MANDIBULA D10.3
PENONJOLAN TULANG K10.8
an dinding sinus)
 MATA
DIAGNOSA KODE TINDAKAN KODE
NO
PTEREGIUM H11.0 SLIT LAMP 95.09
AFAKIA H27.0 VISUS 95.06 1.
ASTENOPIA H53.1 EKSISI KATARAK 13.59 2.
FLOATER H43.9 EKSISI PT 11.39 3.
FOREIGN BODY IN CORNEA T15.0 KONTROL MATA Z01.0
GLUCOMA CRONIS H40.8 FUNDUS PHOTOGRAPY 95.11
HORDIOLUM H00.0 RELASE SINBLIFARON 11.59
KALAZION H00.1 REMOVAL FOREIGN BODY CORNEA98.21
KATARAK H26.9 IRIGASI MATA 96.51
KERATITIS / SIKATRIK H16.9 ECCE + CIL 13.59
KERATOPATY H18.9 EXCICI KALAZION 08.21
KONJUNGTIVITIS H10.9 CURETTAGE CORNEA 11.29
KONTROL MATA Z01.0 INSISI KALAZION 8.09
MIOPY H52.1 REMOVAL SUTURE EXPOSURE 08.81
PRESBYOPIA/DRAY AYE H52.4
RETINO HYPERTENSI H35.0
SIKATRIK CORNEA H15.9
H17.9
TRAUMA KARUTA S05.9
TRAUMA OPTIC NEOPATI S00.2
UVITIS H20.9
TRAUMA OCCULI S05.9
EPICLERITIS H15.1
EKSOFTALMUS H05.2
pseudofakia Z96.1
EXOPHORIA H50.5
ABLASIO RETINA H33.2
PERDARAHAN PD MATA H57.8
ULKUS CORNEA H16.0
BLEPHARITIS H01.0
PDR H35.2
PALPEBRA D31.9
DACRIOSISTITISD H04.3
HIPEMA H21.0
 TARIF BPJS
TARIF
DX KODE TINDAKAN
KLS 1 KLS 2 KLS 3
KATARAK H26.9 13.59 8,935,000 7,658,600 6,382,200
PHETEREGIUM H11.0 11.39 5,872,100 5,032,700 4,193,900
CHALAZION H00.1 08.21 5,872,100 5,032,700 4,193,900
 THT
DIAGNOSA KODE TINDAKAN KODE
ANGIOFIBROMA D10.6
CA NASOPHARYNG C119 ASPIRASI DRAINASE ABSESS 28.O
BLEEDING POST OPS TE T81.0 BIOPSI NASOPHARYNG 29.12
CAULIFLOWER AD H61.9 BLEEDING CONTROL 28.7
CORPUS ALENUM/ CORPAL T16 EKSISI KISTA 86.3
CYSTA BRACHIALIS Q18.0 FARINGOSCOPY 29.11
DIPLOPIA H53.2 KAUTER PHARY 29.39
DYSPAGIA R13 KONKATOMY/TURBINECTOMY 21.69
FISTEL PHEARIAURIKULAR D03.2 LARYNGOSCOPY 31.42
FRAKTUR NASAL BONES S02.2 NEKROTOMY DEBRIDEMEN 86.22
GRANULASI TELINGA D03.2 OTOS COPY 18.11
GRANULOMATUS L92.9 POLYPECTOMY 21.31
HEARING LOSS H91.9 RHINOSCOPY 21.21
HIPERTROPY CONCHA J34.3 SPOOLING 96.52
HYPERTROPI ADENOID J35.2 TONSILEKTOMY 28.2
KONKA J34.2 TURBINECTOMY 21.69
KONTROL THT Z01.1 EXCICI CYST BRACHIALIS 29.2
LARYNGOPHARYNGITIS J06.0 ADENOIDECTOMY+TONSYLECTOMY 28.3
LASERASI TELINGA S01.3 EXTRAXSI 18.29
LYMPHADENOPATI I88.8 KURETAGE MEMBRAN TYMPANI 20.79
MANIERE H81.0 PHARENGEAL BIOPSY 29.12
OTITIS MEDIA H66.9 KURETAGE PERYCHONDRITIS 18.29
OTITIS MEDIA SUPURATIF CRONIS H66.3 NASOINDUSCOPY 21.21
PERFORASI MEMBRAN TYMPANI H72.9 RECONTRUCSI AURICLE 18.71
PERITONSILAR ABSEC J36 ANTERIOR NASAL PECING 21.01
PERTONSILLER ABCESS J36 EXICI KISTA PALATUM 27.31
PHARINGITIS ACUT J02.9 RECONTRUCSI CAE 18.6
PHARINGITIS ALERGI J30.4 TYMPANOPLASY 19.4
PHARINGITIS CRONIS J31.2 INCICI PERITONITIA ABSCES 20.79
PHERICHONDRITIS H61.0 IRRIATION SINUS 22.00
POLYP NASAL J33.9 REPOSISI FRACTUR NASAL 21.72
RHINOSINUSITIS J06.8 CWL 22.61
SERUMEN H61.2 NASAL SEPTUM 21.5
SINOSITIS KRONIS J32.9 ENDOSCOPY EAR 18.11
SUSP.NASOPHARYNG D10.6 INDUSCOPY
TONSILITIS ACUT J03.9 EVAKUASI CERUMEN 18.29
TONSILITIS CRONIS+ADENOID J35.9 FUNGSI 20.09
TONSILLITIS CRONIS J35.0 REMOVAL CORPAL 98.11
TONSILOPHARINGITIS J06.8
TUNUS PALATINUS K12.2
KISTA PALATUM K09.8
OTOMYCOSIS B36.9
STENOSIS CAE H61.3
WAGENERS GRANULOMATUS M31.3
SINEKIA CONCHA J34.2
TUBA CATARAL J00
FURUNKEL (BISUL) EAR H60.0
CYST DENTYGEROUS K09.8
NPC (NASOPHARYNG CANCER) C11
EPISTAXIS R04.0
TINNITUS H93.1
CORPUS ALENUM NASAL T17.0 EKSTRAKSI 98.12
LARYNGITIS J04.0
OTALGIA H92.0
PRESBYCUSIS H91.1
 TARIF
NO DX KODE TINDAKAN KODE
KLS 1
1. TONSILITIS KRONIS J35.0 TONSILEKTOMY 28.2 2,504,300
2. TONSILITIS KRONIS & ADENOID J35.9 TONSILOADENOIDECTOMY 28.3 2,504,300
RHINOSINOSITIS J06.8 IRRIGASI NASAL 22.00
3.
HYPERTROPI CONCHA J34.3 TURBINECTOMY 21.69 6,744,800
NASAL POLYP J33.9 POLYPECTOMY 21.31
4. RHINOSINOSITIS J06.8 IRRIGASI NASAL 22.00
HYPERTROPI CONCHA J34.3 TURBINECTOMY 21.69 6,744,800
5. HYPERTROPI CONCHA J34.3 CONCATOMY 21.1 2,205,000
6. SEPTUM DEVISIASI J34.2 SEPTOPLASTY 21.88 6,744,800
EPISTAKSIS R04.0
7. TAMPON ANTERIOR 21.01 2,200,900
HYPERTENSI I.10
 TARIF

KLS 2 KLS 3
2,146,500 1,788,800
2,146,500 1,788,800

5,781,900 4,818,200

5,781,900 4,818,200
1,889,800 1,575,000
5,781,900 4,818,200
1,886,700 1,572,300
 OBGINE
DIAGNOSA KODE TINDAKAN KODE
ABORTUS INKOMPLET O05.4 EKLAMSIA 15.9
ABORTUS INSIPEN O26.2 LAHIR SC 74.4
ABOSTUS IMINEN O26.2/O02.1 INDUKSI 73.4
ADENOMYOSIS N85.1 SAH+SOB 66.4
ADNEXITIS/SALPINGITIS N70.9 KURETAGE 69.02
ANCAMAN PARTUS PREMATUR ATAS 3 O74.1 SALPINGECTOMY 66.69
ANCAMAN PARTUS PREMATUR BAWAHO47.0 MOW 66.39
ATONIA UTERI/B.LYENCH O72.2 MARSUPIALISAN 71.23
AMENORHEA N91.2
BAYI LAHIR Z37.0 TRANSFUSI 99.03
BBLR P07.0 CONTRACTID PELVIC O6.5O
BEKAS SC Z92.4 HYSTERECTOMY 68.9
BLIGHTED OVUM O02.0 BISALPINGO OOFOROSTOMY 66.72
BOH Z35.2 MYRINGOTOMI 20.09
CA CERVIX C53.9 MANUAL PLASENTA 75.4
CERVISITIS N72 SOS 65.49
CONTRACTID PELVIC O65.0 EXTERPASI POLYP 70.33
CPD O65.0 INSPEKULO 96.44
CPD (RJ) O34.9
CYST BARTHOLINI N75.0
CYST OVARIUM N83.2
CONDYLOMA A51.3
PID N73.9
DUB N93.9
DUP N93.9
DYSMENORHE N94.6
ELECTIVE SC O82.0
EMERJENSI SC O82.1
ENDOMETRIUM HYPERPLASIA N85.0
ENDOMETRIOSIS N80.9
FALSE LABOUR O47.9
GAGAL INDUKSI O61.9
GAMILY O30.0
GAMILY (BAYI) Z37.2
GAMILY MENINGGAL 1 O31.2
GAWAT JANIN(FETAL STRESS) O68.9
GRANDEMULTIPARA Z35.4
HAEMAPTU R04.2
HAMIL Z34.9
HAMIL DNGN HEPATITIS O98.4
HAMIL KEMBAR SC O84.2
HIPERTENSI ESSENSIAL O10.0
HPP O72.1
HSVB(BAYI MAHAL) Z35.0
HYDATIDIFORM MOLLE O01.9
HYDRAMNION O40
HYPERENIMIS GRAVIDA(HEG) O21.0
HYSTEREKTOMI O82.8
IBU DNGN BAYI BESAR O33.5
IBU HAMIL DNGN ANEMIA O99.0
IBU HAMIL DNGN ASMA O99.4+J45.9
IBU HAMIL DNGN DM O24.9
IBU HAMIL DNGN HEMOROID O22.4
IBU HAMIL DNGN HT O10.0
IBU HAMIL DNGN ISPA O99.5
IBU HAMIL DNGN KPD Z03.9
IBU HAMIL DNGN RIW BEKAS SC Z35.2
IBU HAMIL DNGN SUNGSANG O32.9
INERTIA UTERINE O62.2
INFERTILITY N97.9
IUFD (INTRA UTERIN FITAL DEAT) O36.4
IUGR O36.5
KALLA 1 O63.0
KALLA 2 O63.1
KEMBAR/GAMILY Z37.2
KET O00.9
KONDISI YG BERHUB KEHAMILAN O26.9
KPD (KETUBAN PECAH DINI) O42.9
LAHIR KEMBAR DNGN FORCEF DAN F O84.1
LAHIR KEMBAR SPONTAN O84.0
LETAK LINTANG O32.2
LETAK SUNGSANG O64.8
MENOMETORAGIA N92.1
MENORAGIA N92.0
MENSTRUASI N94.8
MISSED ABORTION O02.1
MOLA HIDATIDOSA O01.9
MYOMA UTERI D25.9
OLIGOHYDRAMNIOS O41.0
PARAMETRITIS N73.0
PARTUS PERVAGINAM O80.9
PARTUS TAK MAJU O63.9
PCOS E28.2
PEB (PREEKLAMSI BERAT) O14.1
PELVIC PAIN R10.2
PER (PREEKLAMSI RINGAN ) O14.0
PERDARAHAN PADA VAGINA O46.9
PID N73.9
PLASENTA PREVIA O44.0
POLYHIDRAMION O40
PREBILITIS O26.9
PREMATURE CONTRACSI O62.0
PRIMITUA Z35.5
PROLAP UTERI N81.4
PTM (PART TAK MAJU) O63.9
RAWAT KONSERVATIF Z51.5
RETENSIO PLASENTA O73
RIWAYAT LAPARATOMY Z92.4
SC ( SCTV ) O82.9
SEROTINUS O48
SYOCK DLM KEHAMILAN O75.1
TORSI CYST N83.5
VAGINITIS N76.0
VESIKOVAGINAL FISTULA N82.0
IBU HAMIL DNGN BAYI BESAR O33.5
HAP O46.9
SEPSIS ABORSI O08.0
IBU HAMIL+GASTRITIS 098.9
SYMPHISIS
INFECTION NIFAS O86.0
PRO MOW O99.8
IBU HAMIL + HYPERCHOLESTEROL
KELAINAN LETAK O32.2
HAMIL + GEA O98.9
HAMIL + TRAUMA TUMP ABD O71.9
HAMIL + ABSES PERI O23.5
EROSI PARTIO N86/S37.6
MYOM INTRA MURAL D25.1
EROSI VAGINA N86
PLASENTA RESTORI O43.9
LEUKORHE N89.8
OCLUSI H21.4
CANDIDIASIS B37.3+N77.1
HAMIL + DYSPEPSIA O26.9
STGV D25.9
HAMIL+VARICELA O98.5
CYST NABOTHIAN N88.8
IREGULAR MENSTRUASI N92.6
 TARIF
NO DX KODE TINDAKAN KODE
KLS 1 KLS 2
1. KISTA OVARIUM N83.2 CYSTECTOMY 57.79 8,235,800 7,059,200
2. KISTA BARTHOLIN N75.0 EXCISI BARTHOLIN 71.24
3.
4.
5.
6.
7.
8.

9.
10.
TARIF
KLS 3
5,883,300
 P.DALAM
DIAGNOSA KODE TINDAKAN KODE
ABCES BUCCALIS K12.2 RAWAT LUKA 93.57
ABCES LIVER A06.4 INSISI ABSCESS 86.05
ABCES PEDIA L02.8 DEBREDEMEN EXCICIONAL 86.22
ABCES PEDIS M71.07 EKSISI PAYUDARAH 85.21
ABCES SUBMANDIBULA K12.2 EKSISI 86.3
ABDOMEN PAIN R10.4 INSISI SKIN 86.09
ABORTUS SPONTAN O03 OMENTECTOMY 54.74
ABORTUS SUNGSANG O64.8 HERNEATOMY + MES 53.05
ACITES R18 ORCTHIEDHETONY TOTAL 62.3
ACS I25.4 VASICOSTOMY 57.21
ADENO CA RECTI C26 LAPARATOMI 54.11
AFASIA/APHAKIA H27.0 APPENDYCTOMY 47.09
AKNE L70 EXCICI VARICOCEL 63.1
ALERGI J30 PASANG NGT 96.07
AMENORE N94.9 EXSICI VARICOCELLE 63.1
AMINORHE N94.8 EXCICI BATU DILIDAH 26.29
AMNESIA D50 INJ. INTRA AURIKULAR 83.97
ANEMIA D64.9 EXCISI HEMOROID 49.46
ANEMIA CRONIS D63 EXICI HEMOROID+TROMBECTOMY 49.47
ANEMIA HEMOLITIC D59.8 DEBREDEMEN NECROTIC 86.22
ANEMIA MEGALOBLASTIC D53.1 INSISI ANAL 49.01
ANGINA PEKTORIS I20.9 evakuasi haemartrisis 83.94
ANGIONEUROTIC UDEMA T78.3 GV 97.16
ANOREXIA R63.0 REMOVAL NAIL 86.23
ANXIETY F41.9 CROSS INCISI 86.04
APP INFILTRAD K36
ARTRITIS (AR) M06
ASMA BRONKIALE J45.9
ASTIGMAT N52.2
ATRALGIA M25.9
ATRIAL FIBRE (AF) I48
ASITES R18
ALBUMIN ABNORMAL R77.0
ACKD N28.1
AKI N28.9
AIHA D59.1
ANEMIA TANPA TRANFUSI D53.9
ATRIOVENTIKULAR BLOCK /AV BLOCK I44.3
ATHEROM L72.9
ABSCESS DIGITY MANUS 94+
ANGIODEMA D84.1
BSK N21.9
BATU EMPEDU(CHOLELITHIASIS) K80.8
BACTERIAL INFECTION A49.9
BATU (CALCULUS) BULI N21.0
BATU GINJAL (UROLITHIASIS) N20.0
BATU URETER N20.1
BE (BRONCHIECTASIS) J47
BELLS PLAY G51.0
BP(BRONCO PLEMONI) J18.0
BPH N40
BRONCHITIS J40
BRONCHITIS ACUTE J20.9
BRONCHITIS CRONIC J42
BURCHITIS M70.11
BPPV H81.1
BATU (CALCULUS) LINGUAL (LIDAH) K11.5
BRONCHIESTAXIS(BE) J47
BATUK DARAH R04.2
BSK N21.9

CTS G56.0
CVA I64
CA HEPAR/LIVER C22.9
CA MAMAE D05
CACAR AIR (VARICELA) B01
CAD (CORONARY ARTHERY DEASIS) I25.0
CALLUS L84
CAMPAK B05
CANDILOMA AKUMINATA A63.0
CANDIDIASIS B37.9
CARDYOMYOPATHY I42.9
CELULITIS L03.9
CEPALGIA /HEADACHE R51
CHEST PAIN R07.4
CHF I50.0
CIKUNGUNYA A92
CKD N28.9
CLAVUS L84
CML C92.9
CMV B25
COCHONIA R64
COLELITIASIS(BATU EMPEDU)+CHOLESISTITIS K80.8/K81.9
COLIC ABDOMEN R10.4
COLIC URETER/RENAL N23
CPC (I26.0) i27.9
CRS
CYSTITIS (ISK) N30.9
CHOLELISTITIS K81.9
CTEV M21.5
COLIC RENAL N23
CP (CEREBRAL PALSY) G80.9
CKR S06.0
CUTANEUS LARVA MIGRAIN B76.9
COMMON WART B07
CYST SEBACEA AURICULAR D23.2
CUSHING'S SYNDROM E24.9

DM HONK E11.7
DM RETINOPATY H36.0
DEFISIENSI VOTAMEN E50
DEHIDRASI E86
DEMEMTIA F01
DENGUE FEVER A90
DERMATITIS L30.9
DHF A91
DIARE A09
DIPSNOE R06
DISFAGIA R13
DISLIPIDEMIA E78.5
DISLOKASI S43
DM E14.9
DM TYPE II NEROPATY E11.4
DORSALGIO M54.9
DUB N93.9
DYSPEPSIA K30
DELLAYED SPEED R47.8
DERMOID
DVT I80.2
DOA R96,0
DOWN SYNDROM Q90

ENSELOPATI K72.9
EDEMA PARU J81
EFUSI FLURA J90
ENDOKOMITIS H44
ENDOMETRIOSIS N80
ENSEPALITIS A85.0
ENTERITIS K50
EPILEPSI G40
EPISTAKSIS R04/L04.0
ENTHESOPATHY M77.9
EPIDIDYMIS N51.1

FRANK PAIN M25.59

FURONKEL AXILLA L02.9
FAM (FIBROADENOSIS) N60.2
FEBRIS R50.9
FILARIASIS B74
FISTULA ANAL K60.2
FIBROTIS N50.8
FIBROTIS LUKA OPRSI D23.9

GAE/GASTRITIS K29.7
GANGGUAN JARINGAN M60
GANGLION M67.4
GANGREN R02
GARIATRI R41.0
GASTROPATI DIABETIK E11.2
GATAL2 L50.9
GERD K21.9
GGA(GAGAL GINJAL AKUT) N17
GGK(GAGAL GINJAL KRONIS) N18.9
GLUKOMA H40
GOUT (ASAM URAT) M10
GRD K21
GASTRITIS ACUTE K29.1

HERPES ZOSTER B02.9

HAEMARTROSIS M25.0
HAEMOPTYSIS/HEMAPTOE/MUNTAH DARAH R04.2
HBV B16.9
HEMATURIA R31
HEMIPARASIS G81.9
HEMOROID I84.9
HEPAGLIKEMI E16.2
HEPATITIS A AKUT B15
HEPATITIS B AKUT B16
HEPATOMA C22.2
HERPES B00
HHD I11.9
HIDROCELE N43.3
HIDROSEPALUS G91
HIL K40.9 HIL + OMENTAL= K46.9
HILLP D71
HIPERALBUMIN R77.0
HIPERPIREXIA R50.9
HIPERTIROID E07.9
HIPERURICEMIA E79.0
HIPOALBUMIN R77.0
HIPOGLIKEMI E16.2
HIPOKALEMIA E87.6
HIPOTIROID E07.9
HIV B20R7
HNP LUMBAL M51.2
HODGKIN LYMPOMA C83.8
HPB J40
HT I10
HT STRAGE II I15.9
HYDROPS GALL BLADER K82.1
HENOCH SCHONLEIN PULPURA D69.0
HYDRONEPROSIS N13.3
HEMATOCHEZIA K92.2

INFEKSI H.PYLORI/HELICOBACTER N39.0

INFEKSI LUKA OPS T81.4
ISPA J06.9
ISK N39.0
ILIUS K56.7
INTUSSUSCEPTION K56.1
ITP D69.3
INSAEC BITE(GIGITAN SERANGGA) T63.9
ISHIALGIA M54.3
IHD I24.9
IRRITABLE BOWEL SYNDROM K58,9

KETOASIDOSIS DIABETIC/KAD E11.1

KONSTIPASI K59.0
KONTROL Z71.9
KERACUNAN OBAT L23.5
KDK R56.0
KEP E44.1
KEJENGKOLAN T62.8
KONSUL OBAT Z76.0
KELOID L91,0

LEUKOCYTOSIS D72.8
LYMPADHENITIS I88.9
LEPTOSPIROSIS A27.9
LUKA BAKAR T30.0
LYMPADENOPATI TB A18.2
LYMPHOEDEMA E89.0
LYPOMA L92
LETHARGY R53

METEORISMUS R14
MASTITIS TB
MALNUTRISION / gizi T73.0
MYALGIA M79.1
MANIEARE'S DIESIASE H81.0
MALIGNANT C76.1
MDS D46.9
MAMMAE ABESANT N61
MORBILI B05.9
MORBUS HANSEN A30.5
MELAENA K92.1

NEFROLITIASIS N20.9
NEKROSIS M72.69
NEUROPATI M14.6

ODEM PARU / ALO J81

OSTEO ARTHROSIS M15.0
OMI I25.2
OMSK H66.3
ORCHITIS N45.9
OSTEOMEYLITIS M86.9
OSTEOPOROSIS M81.9
OEDEMA R60.9

PNA N11.1
PANKREAS ABSES K85
POST OPERASI Z48.9
PPOK EKSERBASI ACUTE J44.1
PNEUMONIA J18.9
PAPILOEDEMA H47.1
PANCREATITIS ACUT K85
PAPILOMA/GRANULOMA L92.2
PARONIKIA L03.0
PHYMOSIS N47
PID(PELVIC IMFLAMMATORY DISEASE) N73.9
PSIKOSOMATIG F32.3
PARESE NERVUS FASIALIS
PITYRIASIS VERSICOLOR B36.0
PYLONEFRITIS ACUT N10
PAD I73.9
PANSITOPENIA PERIPER D61.9
POLYCYTHEMIA VERA D45
PLANTAR FASCITIS M72.28
PAROTITIS K11.2
PEPTIC ULCER K27.3

RENAL STONE N20.0

RBBB INKOMPLET I45.1
RHEMATOID ARTITIS M06.9
RA (RHINITIS ALERGIC) J30.4
RECTAL BLEEDING K62.5
RADICULOPATHY M54.19
RIKETSITOSIS A79.9

SIROSIS HEPATIS K74.6

SINDROM PERIFORNIS G55.8
SEPTICAMIA/SEPSIS A41.9
SH (SYROSIS HEPATIS ) K74.6
SINDROM NEPHROTIC N04.9
SLE M32.9
SNNT E04.1
STOMATITIS K12.1
STROKE ISKEMIK I63.8
STROKE NO HEMOROGIK I63.9
SEQUELAE STROKE I69.4
SPINAL CORD INJURY T09.3
SPLENOMEGALI R16.1
SPONDYLOSIS M47.9
SPONDILITIS TB A18.0
SPORIASIS L40.9
SOL R90.0
SVES I49.3
SVT I47.1
SKIN TEG L91.8
SNH I63.8
SKIN TAG LABIA MAYORA N90.6
STEMI I21.9
SPASM OTOT M62.9
SCYBALA K56.7
SOPT B90.9

TIA G45.9
TINNITUS H93.1
TB MYELITIS A17.8+G05.0
TB PARU A16.2
TENSION HEADECHE G44.2
TFA J11.8
TROMBOSITOPENIA D69.6
TYPOID FEVER A01.0
TUMOR CAECUM D12.0
TUMOR COLI D23.6
TB ABDOMEN A18.8
TUMOR PARU D14.3
TONSION TYPE HEADACHE G44.2
TUMOR KULIT CRURIS D23.9
TAKICHARDI R00.0
TRAUMA MUSKULOSKELETAL T14
TETRAPARASE G82.5
TROMBUS I80.2
TRAUMA ABDOMEN S30.1
TUMOR DIGITY MANUS D63.9
TOFUS ASAM URAT M10.9
THOCHILOSIS G72.3
TENNIS ELBOW M77.1
TERSENGAT LISTRIK T75.4

UAP I20.0
ULKUS DIABETIK(GANGGREN) R02
UNDESCENDEN TESTIS Q53.1
ULKUS GASTRIC K28.9
ULKUS DECUBITUS L89
ULCER/ULKUS DM L97 / E 11.5
URTICARIA L50.9

VE
VERUKA VULGA B07
VES (CARTLIAC ARRLAYTMIA) I49.9
VIRAL INFECTION B34.9
VULNUS LASERATUM T14.1
VULNUS PULTUM S91.3
VARICOCELLE I86.1
VASICOLITIASIS N20.9
VARICELLA B01.9
VOMITIN/VOMITUS R11
VERTIGO H81.4
VARISES I83.9
# BRONCOPLENONIA + SEPSIS=BRONCO
# ABSES+ SEPSIS=ABSES
#OBSERVASI : Z03.8
#BATU URETER+HN(HYDRONEPHROSIS)=N13.2
#CHF+CPC+PPOK=I27.9
#BP+PPOK+HT=PPOK TDK MASUK SUDAH GABUNG DNGN BP
#KONTROL OBAT = Z76.0
#RUJUK

NO DX KODE TINDAKAN KODE

1. FAM N60.2 EXCISI FAM 85.21

2. SNT E04.1 THYROIDECTOMY 06.4
3. HIL K40.9 HERNEATOMY 53.05
4. BPH N40 PROSTATECTOMY 60.69
5. PYMOSIS N47 SIRKUMSISI 64.0
6. APP K35.9 APPENDYCTOMY 47.09
7. LIPOM L92.9 EXCISI LIPOM 86.3
8. HYDROKEL N43.3 EXCISI HYDROKEL 63.1
9. HEMOROID I84.9 HEMOROIDECTOMY 49.46
10. VARICOCEL I86.1 EXCISI VARICOCEL 63.1
11. APP PERPORASI K35.1 LAPARATOMY&APPENDECTOMY 54.11 & 47.09
12. CHOLELITIASIS K80.8 CHOLECISTECTOMY 51.22
13. FISTULA ANAL K60.3 FISTULECTOMY 49.12
14. BIBIR SUMBING Q36.9 REPAR CLEFT LIP 27.54
15 STT HEAD D21.0 EKSISI 86.3
 TARIF
KLS 1 KLS 2 KLS 3
7,222,300 6,191,100 5,158,800
6,785,200 5,816,400 4,846,500
5,057,000 4,335,000 3,612,500
7,891,800 6,764,400 5,637,000
1,718,000 1,472,600 1,227,100
4,032,900 5 2,880,400
4,638,100 3,975,900 3,313,300
5,425,500 4,650,000 3,875,400
6,168,000 5,286,900 4,405,700
5,425,500 4,650,000 3,875,400
8,041,700 6,893,600 5,744,100
7,650,800 6,558,500 5,465,400
6,168,000 5,286,900 4,405,700
4,440,600 3,806,300 3,171,900
5,774,700 4,949,700 4,124,800
 P.BEDAH
DIAGNOSA KODE TINDAKAN KODE
VARICOCELLE I86.1 HIL.OMENTECTOMY 54.74
KISTA ATHEROMA L92.9 HIL. HERNEATOMY + MESS 53.05
HIL K40.9
LIPOMA E88.2
KELOID SCAR ( FLANK PAIN ) L91.0
APP ( APPENDICSITIS ) K37
DIAGNOSA KODE
UNION RADIUS ULNA POST ORIF M84,22
FLEXION CONTRACTIONE DIGITY 3 MANUS T23.1
INSTABILITY ELBOW M25.39
OPEN COMMINUTIVA FRACTURE PHALANG PROXIMAL DIGITI II MANUS S62.8
OPEN SEGMENTAD FRACTURE METACARPAL MANUS S61.8
BURN GRAD II T302
TRINGGER FINGER M65.3
ABSCESS PEDIS M71.07
SKIN DEFCET CRURIS T79.3
GOUT ARTHRITIS M10.9
ANKILOSING SPONDYLITIS M08.1
FR.CALCANEUS S92.01
IMPLANT FAILURE FEMUR T84.9
BILATERAL NEGKGTED CTEV M21.5/Q66.0
TENOSINOFITIS M65.9
MALUNION FR. HUMERUS M84.02
REVISI INPLAT T84.9
Spontaneous rupture of extensor tendons, hand M66.24
PENGANGKATAN IMPLAT Z47.0
HAEMATRASIS KNEE S83.6
NON UNION FEMUR M84.16
DEQUERVEIN SYNDROM M65.4
MUSCLE CONTUSIO PARALUMBAL S30.0
CERVICAL NEUROPATHY M54.1
SEPTIC ARTHRITIS M00.9
CONTRACTURE ELBOW M62.44
TENDISITIS M77.9
FRACTUR CASTA T14.2
MEDIAL MENISCUS TEAR KNEE JOINT M23.83
MUSCLE SPRAIN PARACENTEBRA R25.2
INTOING GAIT M20.5
RUPTUR ACL S83.5
DRUJ DESCRUPTION S52.5
DEEP VAIN THROMBOSIS I80.2
MUSCLE CONTUSIO PROXIMAL TIBIA S90.3
SCATER DESEASE KNEE JOINT M92.5
ULKUS PLANTAR PEDIS L97
FRACTURE COMPRESI VL S32.0
AC JOINT DISRUPTION S43.1
BILATERAL BLANT DISEASE T70.8
myopati G72.9
MUSCLE SPASM LUMBAL M62.9
FRACTUR MALEUS S82.8
 TINDAKAN KODE
NO
RO.ANTEBRATI 88.24
REMOVE OF INPLAND 78.63 1.
EXSISI SOFT TISSUE OF THE HAND 82.39 2.
INTERNAL FIXASI WITHAOUT REDUCTION CARPAL 78.54 3.
CLOSED REDUCTIN UNDER ANALGESIA 79.72 4.
APPLICATION EXTERNAL FIXATION DEVICE AT THE ELBOW 78.1 5.
ORIF 79.35 6.
REMOVE GRAF 78.65 7.
SKINT TRAKSI 93.46 8.
RECONTRUCSI CLAVIKULA 78.51 9.
REVISI IMPLAT 81.59 10.
SELIAL CIRCULAR CASTING 93.53
OSTEOTOMY FEMUR 77.35
M21.5/Q66.0
APPLY SKELETAL TRAKSI FEMUR 78.15
RELEASE CONTRACTUR UNDER ANASTESI 80.40
RECONTRUCSI FOOT 81.57
ROTASIONAL FLAP 86.59
ROM 93.05
EVAKUASI HAEMATROSIS 83.94
SKLETAL TRAKSI 93.44
RELEASE CONTRACTURE ELBOW 93.05
SEQURECTOMY FEMUR 77.05
PASANG GIP 93.53
INJEKSI ARTICHULAR 81.92
LEPAS GIP 97.88
seques tibia 77.07
79.36
 TARIF
DX KODE TINDAKAN KODE
KLS 1 KLS 2
BUKA PEN FEMUR Z47.0 REMOVAL FEMUR 78.65 4,188,700 3,590,300
TARIF
KLS 3
2,991,900
DIAGNOSA KODE
CORVULSION(KEJANG) R56.8
SCARLET FEVER A38
BBLR DNGN SC P03.4
KONJUNGTIFITIS H10.9
KEJANG DEMAM R56.0
ISPA J06.9
CHIKUNGUNYA A92.0
TROMBOCYTOPENIA D69.6
PERIODONTITIS APICAL CRONIS K40.5
MORBILI B05.9
KDS R56.0
DYSENTRY A06.0
HEMOFILIA A D66
MECONIUM STAINING P24.0
BAYI BESAR P08.0
BBLR P07.1
HFMD B08.4
thelarche e30.8
SIANOSIS P28.2
SNA N00.9
ADHD F90
TONGUE TIE D10.1
INFEKSI H.PYLORI/HELICOBACTER N39.0
DOWN SYNDROM Q90,9
POST ASPIKSIA P21.9
INTERTIGO L30.4
DELAYED MOTORIC R62.0
MUMPS B26.9
IMPETIGO L01.0
NEC P77
KONSUL POST P96.8
 PEMERIKSAAN
PEMERIKSAAN KODE
EKG 89.52
FISIOTHERAPY 93.35
FISIOTHERAPY DX Z09.8/Z50.9
INFEKSI LUKA OPS T88.8
KONTROL Z71.9
LAB 90.59
POST OPS Z48.9
RAWAT LUKA(ORTHO) 93.57
RAWAT LUKA(ORTHO) 86.28
RO ABDOMEND 88.19
RO BNO 87.79
RO CERVICAL 87.43
RO CRANIUM 88.27
RO CRURIS 88.28
RO FEMUR 88.26
RO GENU 88.33
RO MANUS 88.23
RO PEDIS 88.28
RO THORAX 87.49
RO WATER 87.17
USG 88.78
USG ABDOMEND 88.76
NGT 96.07
RO PELVIS 88.26
RO SPINE 87.22
RO ANTEBRACI 88.23
INFUS PUMP 99.18
RO HUMERUS 88.21
PASANG KATETER/DC 57.94 96.48
DREN 97.16
HEACTING 86.59
PUNGSI 54.91
NEBULIZEL 93.94
RECTAL TOUCHE 89.34
RUJUK Z51.4
OXYGEN 93.96
AFF KATETER 97.64
ASPIRASI HEMATOM 86.01
EXC 93.12
IR 93.34
AFF HEATING 97.89
INJ INTRALESI 99.23
SKIZOPHENIA F20.0
LBP M54.5
CEPALGIA R51
BPPV H81.1
PARKINSON G20
CEREBRAL PALSY G80.9
EPILEPSI G40.9
DEMENSIA VARKULER F01.9
CERVICAL SYNDROM M53.02
PARASTESI R20.2
DIZZENESS R42
ISCHIALGIA M54.3
HNP M54.5
COMMON COLD J00
CARPAL TUNNEL SYNDROM G56.0
INSOMNIA G47.0
TRIGEMINAL NEURALGIA G50.0
TETRAPLEGIA G82.5
EXTRAPYRAMIDAL G25.9
PERIFORMIS SINDROM G57.0/G04.1
SOL R90.0
PARAPARASE INFERIOR G11.4
TTH G44.2
GDD F80.9
HYPERKINETIC F90.9
FSS M75.0
ATRALGIA M25.5
ICHIALGIA M79.6
FROZEN SHOULDER M75.0
TSS A48.3
NERVUS III G99.8
GANGGUAN COGNITIV F06.7
CRS G54.2
HEMIPARESA G81.9
DORSAL PEDIS M54.9
MIGRAIN G43.9
BP G51.0
TIC FASCIAL F95.9
MIASTHENIA GRAVIS G70.0
MOVEMENT DISORDER G25.9 EXTRAPYRAMIDAL
CERVICAL DISC SYNDROM M50.9
DIAGNOSA KODE TINDAKAN KODE
SCIZOPENIA F20.0 HYPNOTERAPI RELAKSASI 94.32
PSYCHOSOMATIC F32.3 TERAPI EDUKATIF 93.82
PANIK CEMAS F32.9 TERAPI KELURGA 94.42
GG.KEPRIBADIAN F60.9 PSIKOTERAPI 94.39
GG.EKTRAPYRAMYDAL G25.9 TERAPI SUPPORTIVE 94.38
PSYCO+DYSPEPSIA F45.3 BEHAVIOUR THERAPY (CBT) 94.33