BEDAH DIGESTIF

No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Diagnosa
Cholelithiasis + Cholecystitis
Cholelithiasis + Cholecystitis
Cholelithiasis + Cholecystitis + Fatty Liver
Cholelithiasis + Cholecystitis + HHD w CHF

Level
R
R
S
B

Kode ICD 10
K80.8 + K81.9
K80.8 + K81.10
K80.8 + K81.9 + K76.0
K80.8 + K81.9 + I11.0

Tindakan
Cholecystectomy
Cholecystectomy
Cholecystectomy

Kode ICD 9
51.22
51.22
51.22

Kode
B-1-12-I
B-1-12-II
B-1-12-III

Kelas I
4.918.200
9.564.500
20.499.000
24.238.000

INA CBG
Kelas II
4.215.600
8.197.300
17.568.900
20.777.500

Kelas III
3.512.600
6.831.100
14.640.700
17.312.800

PEDIATRI
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

Diagnosa
Febris
Febris + Kejang Demam R
Febris + Epistaksis R
Kejang Demam
GE
GE + Kejang Demam R
GE + DBD R
Epilepsy
Bronchopneumonia
Pneumonia + Typhoid Fever B
ISPA
ISPA + DBD R
CHD
CHD + BP
Typhoid Fever
Typhoid Fever + Ggn Elektrolit
Typhoid Fever + DHF B
DHF
DHF + Ggn Elektrolit
Multiple Lymphadenopathy
Multiple Lymphadenopathy + ISK
Multiple Lymphadenopathy + BP R

Level
R
S
S
R
R
S
B
R
R
B
R
B
R
B
R
S
B
R
S
R
S
B

Kode ICD 10
R50.9
R50.9 + R56.0
R50.9 + R04.0
R56.0
A09
A09 + R56.0
A09 + A91
G40.9
J18.0
J18.9 + A01.0
J06.9
J06.9 + A91
Q24.9
Q24.9 + J18.0
A01.0
A01.0 + E87.8
A01.0 + A91
A91
A91 + E87.8
R59.1
R59.1 + N30.9
R59.1 + J18.0

Tindakan

Kode ICD 9

Kode
A-4-12-I
A-4-12-II
A-4-12-II
G-4-22-I
K-4-17-I
K-4-17-II
K-4-17-III
G-4-22-I
J-4-16-I
J-4-16-III
U-4-13-I
U-4-13-III
I-4-19-I
I-4-19-III
A-4-14-I
A-4-14-II
A-4-14-III
A-4-13-I
A-4-13-II
D-4-14-I
D-4-14-II
D-4-14-III

36
37
38
39
40
41
42
43
44

Kelas I
2.759.500
4.364.700
4.364.700
2.771.600
3.163.800
4.325.000
4.879.100
2.771.600
5.414.900
12.594.000
2.311.600
3.748.300
4.705.600
8.736.500
4.323.200
5.561.300
6.371.900
3.057.200
3.629.800
3.451.000
6.187.600
8.675.600

INA CBG
Kelas II
2.365.300
3.741.100
3.741.100
2.375.600
2.711.700
3.707.000
4.181.500
2.375.600
4.641.800
10.796.200
1.981.300
3.212.600
4.033.400
7.489.100
3.706.000
4.766.800
5.461.100
2.620.600
3.110.800
2.958.300
5.303.200
7.436.200

Kelas III
1.971.100
3.117.600
3.117.600
1.979.500
2.636.400
3.604.400
4.065.800
1.979.500
3.868.200
8.996.000
1.926.400
3.123.100
3.361.500
6.240.900
3.088.000
3.972.000
4.550.900
2.547.500
3.024.400
2.465.200
4.419.700
6.197.400

NEUROLOGI / BEDAH SARAF

No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

Diagnosa
Infark Cerebri
Infark Cerebri + TIA
Infark Cerebri + Hemoptisis
Infark Cerebri + Pneumonia
Dementia
Dementia + Atrofi Otak
Dementia + Atrofi Otak + Infark Cerebri S
Comotio Cerebri
Contusio Cerebri
Vertigo
Vertigo + ISK
Convulsion
Deep Vein Trombosis
Deep Vein Trombosis + ISK
Deep Vein Trombosis + Batu Ginjal
Low Back Pain / HNP
Low Back Pain L Region + Polineuropati DM
Spinal Instabilities + Degenerasi Spinal
Paraplegia
Spondilitis TB
Tension Headache
Headache

Level
R
S
S
B
R
S
B
R
R
R
S
R
R
S
S
R
S
B
R
R
R
R

Kode ICD 10
I63.9
I63.9 + G45.9
I63.9 + R04.2
I63.9 + J18.9
F03
F03 + G31.1
F03 + G31.1 + I63.9
S06.0
S06.2
H81.3
H81.3 + N30.9
R56.8
I80.2
I80.2 + N30.9
I80.2 + N20.0
M54.56 / M51.9
M54.56 + E11.4
M53.29 + G32.0
G82.2
A18.0
G44.2
R51

Tindakan

Fusi Tulang Belakang

Kode ICD 9

81.08

Kode
G-4-14-I
G-4-14-II
G-4-14-II
G-4-14-III
F-4-16-I
F-4-16-II
F-4-16-III
G-4-25-I
G-4-24-I
U-4-11-I
U-4-11-II
G-4-22-I
I-4-13-I
I-4-13-II
I-4-13-II
M-4-17-I
M-4-17-II
M-1-03-III
G-4-10-I
M-4-15-I
G-4-23-I
G-4-23-I

35
36
37
38
39
40

INA CBG
Kelas I
5.220.300
9.439.300
9.439.300
11.804.400

Kelas II
4.474.600
8.090.900
8.090.900
10.117.100

Kelas III
3.728.400
6.743.000
6.743.000
8.430.900

9.494.300
12.673.300
2.776.500
4.332.600
3.124.500
4.164.000
2.771.600
8.141.300
10.324.700
10.324.700
3.978.800
5.207.400
53.163.200
4.146.500
4.649.700
3.257.100
3.257.100

8.138.000
10.863.900
2.379.800
3.713.600
2.678.400
3.569.100
2.375.600
6.978.200
8.848.900
8.848.900
3.410.400
4.464.000
45.573.000
3.554.100
3.985.100
2.792.100
2.792.100

6.782.300
9.053.200
1.983.200
3.094.700
2.231.800
2.974.000
1.979.500
5.815.200
7.374.100
7.374.100
2.842.300
3.719.600
37.973.700
2.961.800
3.321.200
2.326.700
2.326.700

Pulmologi
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Diagnosa

Level

Kode ICD 10

Tindakan

Kode ICD 9

CPC
CPC + PPOK

R
S

I27.9
I27.9 + J44.9

Kode
I-4-24-I
I-4-24-II

Dyspnoe + Asthma
Asthma

R
R

R06.0 + J45.9
J45.9

J-4-21-I
J-4-18-I

Ca Bronchus
Ca Bronchus + PPOK

R
S

C34.9
C34.9 + J44.9

J-4-14-I
J-4-14-II

TB tanpa BTA /+ DM tipe 2 /+ Pneumonia

TB tanpa BTA + ISK
TB dgn BTA(+) + Fatty Liver
TB dgn BTA(+) + Ggn Elektrolit
TB dgn BTA(+) + PPOK R
TB dgn BTA(+) + Spondilitis TB S
TB tanpa BTA + Oedema Paru
TB tanpa BTA + MCI S
TB Milier
TB tanpa BTA + Infark Cerebri S
TB Peritoneal + Effusi Pleura S
Respiratory Arrest + TB Milier B
Effusi Pleura + TB Paru tanpa BTA R
Effusi Pleura + CHF + HHD B
PPOK

R
S
S
S
S
S
B
B
R
B
B
B
S
B
R

A16.1 /+ E11.9 /+ J18.9

A16.1 + N30.9
A15.0 + K76.0
A15.0 + E87.8
A15.0 + J44.9
A15.0 + A18.0
A16.1 + J81
A16.1 + I21.9
A19.9
A19.9 + I63.9
A18.3 + J90
R09.2 + A19.9
J90 + A16.1
J90 + I11.0
J44.9

J-4-15-I
J-4-15-II
J-4-15-II
J-4-15-II
J-4-15-II
J-4-15-II
J-4-15-III
J-4-15-III
A-4-14-III
A-4-14-III
K-4-18-III
J-4-11-III
J-4-20-II
J-4-20-III
J-4-17-I

ISPA

J06.9

U-4-13-I

INA CBG
Kelas I
3.930.800
9.854.000

Kelas II
3.369.100
8.446.700

Kelas III
3.275.200
8.212.100

3.244.300
2.555.000

2.781.100
2.189.900

2.317.600
2.129.000

[Link]

8.599.000

7.165.100

6.499.500
7.764.300
7.764.300
7.764.300
7.764.300
7.764.300
10.317.300
10.317.300
4.323.200
7.183.000
7.969.500
7.183.000
7.951.200
12.930.300
4.144.800

5.570.400
6.655.100
6.655.100
6.655.100
6.655.100
6.655.100
8.843.400
8.843.400
3.706.000
5.461.100
6.831.700
6.156.900
6.814.600
11.084.200
3.553.000

4.642.000
5.545.900
5.545.900
5.545.900
5.545.900
5.545.900
7.369.500
7.369.500
3.088.000
4.550.900
5.692.500
5.130.700
5.678.800
9.236.800
2.960.900

2.311.600

1.981.300

1.926.400

THT
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Diagnosa

Level

Kode ICD 10

Tindakan

Kode ICD 9

Sinusitis Maxilaris Akut

J01.0

Antrotomy Maxilaris External

22.39

Kode
U-1-12-I

Septum Deviasi

J34.2

Septoplasty

21.88

U-1-20-I

Concha Hyperthrophy
Concha Hyperthrophy

R
R

J34.3
J34.3

Conchotomy
Turbinectomy

21.5
21.69

U-1-20-I

Mastoiditis

H70.9

Mastoidectomy + Tympanoplasty

20.49 + 19.6

U-1-20-I

SNNT

E04.1

Isthmus Lobectomy

ICD 06.2

E-1-20-I

INA CBG
Kelas I
6.848.400

Kelas II
5.869.500

Kelas III
4.891.200

8.431.100

7.227.300

6.022.200

8.431.100

7.227.300

6.022.200

8.277.500

7.095.700

5.912.500

BEDAH
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Diagnosa

Level

Kode ICD 10

Tindakan

Kode ICD 9

Tumor Parotis

D11.0

Parotidectomy

26.3

Branchial Cyst

Q18.0

Eksisi

29.2

Abses Psoas / Tendon

M65.05

Eksisi Biopsy

83.31

Wound Dehiscence
Wound Dehiscence
Wound Dehiscence + Anaemia

R
R
S

T81.3
T81.3
T81.3 + D64.9

Suture
Suture

54.63
54.63

ILO

T81.4

HIL Unilateral Reponible

K40.9

Hernioraphy

53.29

HIL Unilateral Incarserata + Ileus

K40.3 + K56.7

Laparatomy

54.19

Varicocele + Pimosis

I86.1 + N47

High Ligasi + Circumsisi

63.1 + 64.0

Hemoroid Externa

I84.5

Hemoroidectomy

49.46

Appendicitis Perforasi
Appendicitis + TB tanpa BTA
Appendicitis Perforasi + Peritonitis
Lipoma

R
S
S
R

K35.1
K35.1 + A16.1
K35.1 + A16.1
D17.9

Appendectomy
Appendectomy
Laparatomy + Appendectomy
Eksisi

47.09
47.09
54.19 + 47.09
86.4

34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57

Hemoroid Externa
Haemoroid Interna
Haemoroid Interna + Proctitis

R
R
S

I84.5
I84.2
I84.2 + K51.2

Hemoroidectomy

49.46

Post Ileostomy

Z93.2

Reanastomosis Ileus-Colon

45.93

Soft Tissue Tumor

D21.9

Wide Eksisi

86.4

Polydactyly

Q69.9

Eksisi

77.58

Haemoroid Interna
Haemoroid Interna + Proctitis

R
S

I84.2
I84.2 + K51.2

Abses Payudara

N61

Adeno Ca Colon
Adeno Ca Rectosigmoid + Anemia
Adeno Ca Colon + Sepsis

R
S
B

C18.9
C19 + D64.9
C18.9 + A41.9

Hemicolectomy Kanan + Ileostomy

Hemicolectomy Kanan + Ileostomy
Hemicolectomy Kanan + Ileostomy

45.73 + 46.19
45.73 + 46.20
45.73 + 46.20

INA CBG
Kode
U-1-13-I

Kelas I
7.341.900

Kelas II
6.293.700

Kelas III
5.244.700

U-1-20-I

8.431.100

7.227.300

6.022.200

M-1-50-I

7.590.500

6.506.800

5.422.300

S-4-13-I
K-1-40-I
K-1-40-I

3.311.400
9.810.500
12.030.900

2.838.000
8.409.000
10.313.300

2.365.300
7.007.500
8.594.400

A-4-11-I

7.756.100

6.648.700

5.540.600

K-1-14-I

6.909.600

5.922.500

4.935.900

K-1-40-II

12.030.900

10.313.300

8.594.400

V-1-12-I

6.781.200

5.812.500

4.843.700

K-1-50-I

7.524.600

6.449.700

5.375.300

K-1-13-I
K-1-13-II
K-1-40-II
M-1-50-I

5.282.800
8.857.800
12.030.900
7.590.500

4.528.100
7.593.100
10.313.300
6.506.800

3.773.400
6.327.000
8.594.400
5.422.300

K-1-50-I
K-4-18-I
K-4-18-II

7.524.600

6.449.700

5.375.300

6.496.700

5.569.100

4.460.900

K-1-20-I

16.535.400

14.173.200

11.811.000

M-1-50-I

7.590.500

6.506.800

5.422.300
6

M-1-30-I

12.545.900

10.753.600

8.960.500

K-4-18-I
K-4-18-II

6.496.700

5.569.100

4.460.900

K-1-20-I
K-1-20-II
K-1-20-III

16.535.400
23.130.500
38.588.100

14.173.200
19.828.100
33.075.500

11.811.000
16.523.400
27.560.200

NEFROLOGI
No
1
2
3
4
5
6
7
8
9
10

Diagnosa
CKD
CKD + DM Tipe 2
CKD + HN
CKD + Pneumonia
CKD
CKD + DM Tipe 2
CKD + CHF ec HHD
CKD
CKD + Anaemia
CKD + CHF ec HHD

Level
R
S
S
B
R
S
B
R
S
B

Kode ICD 10
N18.9
N18.9 + E11.2
N18.9 + I12.0
N18.9 + J18.9
N18.9
N18.9 + E11.2
N18.9 + I11.0
N18.9
N18.9 + D64.9
N18.9 + I11.0

Tindakan

Kode ICD 9

Hemodialisis

39.95

Cimino
Cimino
Cimino
Dual Lumen
Dual Lumen
Dual Lumen

39.27
39.27
39.27
86.07
86.07
86.07

INA CBG
Kode
I-4-10-I
I-4-10-II
I-4-10-II
I-4-10-III
N-1-12-I
N-1-12-II
N-1-12-III
L-1-40-I
L-1-40-II
L-1-40-III

Kelas I
4.252.500
5.731.000
5.731.000
10.026.600
5.288.500
17.547.400
31.876.000
5.658.200
12.202.100
20.873.100

Kelas II
3.644.600
4.912.300
4.912.300
8.593.400
4.533.000
15.042.100
27.325.000
4.850.400
10.457.900
17.891.200

Kelas III
3.037.200
4.093.600
4.093.600
7.161.800
3.777.500
12.535.100
22.770.800
4.042.000
8.715.800
14.909.300

UROLOGI
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

Diagnosa
Vesikolithiasis
Retensi Urine + Vesikolithiasis
Retensi + Vesikolithiasis + Sepsis
Vesikolithiasis
Retensi Urine + Vesikolithiasis
Retensi + Vesikolithiasis + Sepsis
Ureterolithiasis
Ureterolithiasis + Hydronephrosis
Ureterolithiasis + Sepsis
Nefrolithiasis
Nefrolithiasis + Hydronephrosis
Nefrolithiasis + Sepsis
BPH
BPH + ISK
BPH + CHF ec HHD
BPH
BPH + ISK
BPH + Sepsis
BPH
BPH + ISK
BPH + Pneumonia
Ca Prostat
Ca Prostat + Metastasis Paru
Ca Prostat + Hydronephrosis
Ca Prostat + Pneumonia
Ca Testis
Ca Testis + Metastasis Hepar
Ca Testis + CHF ec HHD
Ca Penis
Ca Penis + Anaemia
Ca Penis + CHF ec HHD
Subpelvic Stenosis Ginjal
Subpelvic Stenosis Ginjal + Hydronephrosis
Kista Ginjal

Level
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
S
B
R
S
B
R
S
B
R
S
R

Kode ICD 10
N21.0
R33 + N21.0
R33 + N21.0 + A41.9
N21.0
R33 + N21.0
R33 + N21.0 + A41.9
N20.1
N20.1 + N13.2
N20.1 + A41.9
N20.0
N20.0 + N13.2
N20.0 + A41.9
N40
N40 + N30.9
N40 + I11.0
N40
N40 + N30.9
N40 + A41.9
N40
N40 + N30.9
N40 + J18.9
C61
C61 + C78.0
C61 + N13.0
C61 + J18.9
C62.9
C62.9 + C78.7
C62.9 + I11.0
C60.9
C60.9 + D64.9
C60.9 + I11.0
Q62.3
Q62.3 + N13.0
Q61.9

Tindakan

Kode ICD 9

Lithotripsi
Lithotripsi
Lithotripsi
Sectio Alta
Sectio Alta
Sectio Alta

ICD 57.0
ICD 57.0
ICD 57.0
57.19
57.19
57.19

Aff DJ Stent

97.62

URS + DJ Stent
URS + DJ Stent
URS + DJ Stent

56.0 + 59.8
56.0 + 59.8
56.0 + 59.9

TUR-P
TUR-P
TUR-P
Open Prostatectomy
Open Prostatectomy
Open Prostatectomy

60.29
60.29
60.29
60.5
60.5
60.5

Cystoscopy

57.32

Orchidectomy
Orchidectomy
Orchidectomy
Penectomy
Penectomy
Penectomy

62.3
62.3
62.3
64.3
64.3
64.3

35
36
37
38
39
40
41
42
43

Kista Ginjal + Electrolyte Imbalance

Kista Ginjal + CHF ec HHD
Batu Staghorn
Batu Staghorn + Pyonephrosis
Batu Staghorn + Sepsis
Batu Staghorn
Batu Staghorn + Pyonephrosis
Batu Staghorn + Sepsis
Meatal Stenosis

S
B
R
S
B
R
S
B
R

Q61.9 + E87.8
Q61.9 + I11.0
N20.0
N20.0 + N13.6
N20.0 + A41.9
N20.0
N20.0 + N13.6
N20.0 + A41.9
N35.9

44
45
46
47
48
49
50
51
52
53
54
55
56
57
58

Meatal Stenosis + Hydronephrosis

Meatal Stenosis + Pneumonia
Striktur Uretra
Striktur Uretra + Hydronephrosis
Striktur Uretra + Pneumonia
Female Genital Fistule + vesicovaginal Fist
Ureterolithiasis
Ureterolithiasis + Hydronephrosis
Ureterolithiasis + Sepsis
Orchitis + Epididimitis
Orchitis + Epididimitis + ISK
Orchitis + Epididimitis + Sepsis
Orchitis + Epididimitis
Orchitis + Epididimitis + ISK
Orchitis + Epididimitis + Sepsis

S
B
R
S
B
R
R
S
B
R
S
B
R
S
B

N35.9 + N13.0
N35.9 + J18.9
N35.9
N35.9 + N13.0
N35.9 + J18.9
N82.1 + N82.0
N20.1
N20.1 + N13.2
N20.1 + A41.9
N45.9
N45.9 + N30.9
N45.9 + A41.9
N45.9
N45.9 + N30.9
N45.9 + A41.9

Nefrectomy
Nefrectomy
Nefrectomy
Pyelolithotomy
Pyelolithotomy
Pyelolithotomy
Meatoplasty

55.4
55.4
55.4
55.11
55.11
55.11
58.47

Meatoplasty
Meatoplasty
Release Striktur
Release Striktur
Release Striktur
Ureteroneocystostomy
ESWL
ESWL
ESWL

58.47
58.47
58.5
58.5
58.5
56.74
98.51
98.51
98.51

Epididimectomy
Epididimectomy
Epididimectomy

63.4
63.4
63.4

INA CBG
Kode
N-1-40-I
N-1-40-II
N-1-40-III
N-1-30-I
N-1-30-II
N-1-30-III
N-4-13-I
N-4-13-II
N-4-13-III
N-4-10-I
N-4-10-II
N-4-10-III
V-4-11-I
V-4-11-II
V-4-11-III
V-1-14-I
V-1-14-II
V-1-14-III
V-1-10-I
V-1-10-II
V-1-10-III
V-4-10-I
V-4-10-II
V-4-10-II
V-4-10-III
V-1-13-I
V-1-13-II
V-1-13-III
V-1-11-I
V-1-11-II
V-1-11-III
N-4-16-I
N-4-16-II
N-4-16-I

Kelas I
10.929.400
14.828.500
17.220.200
10.470.900
15.649.200
16.433.900
4.044.800
4.840.600
11.888.800
10.929.400
14.823.500
17.220.200
3.825.100
5.370.900
9.411.000
10.959.800
14.637.500
19.900.600
9.225.200
10.401.600
13.386.100
9.909.600
9.909.600
9.909.600
18.936.900
10.296.800
14.648.200
18.159.200
9.295.900
10.438.600
15.356.900
4.695.200
5.642.900
4.695.200

Kelas II
9.368.100
12.708.900
14.760.200
8.975.100
13.414.900
14.087.600
3.466.600
4.149.500
10.190.400
9.368.100
12.708.900
14.760.200
3.278.700
4.603.200
8.066.500
9.395.000
12.546.400
17.057.700
7.907.300
8.915.600
11.472.700
8.493.900
8.493.900
8.493.900
16.231.600
8.825.800
12.554.300
15.566.500
7.967.900
8.948.200
13.163.000
4.024.100
4.836.300
4.024.100

Kelas III
7.806.700
10.591.800
12.301.400
7.478.500
11.178.000
11.738.500
2.888.900
3.457.900
8.492.800
7.806.700
10.591.800
12.301.400
2.732.500
3.836.300
9.411.000
7.829.200
10.456.400
14.214.700
6.588.800
7.428.900
9.561.500
7.079.000
7.079.000
7.079.000
13.525.000
7.354.900
10.463.000
12.970.800
6.639.900
7.456.100
10.970.300
3.353.400
4.030.700
3.353.400

N-4-16-II
N-4-16-III
N-1-20-I
N-1-20-II
N-1-20-III
N-1-20-I
N-1-20-II
N-1-20-III
N-1-40-I

5.642.900
10.045.200
15.883.600
20.225.100
23.076.000
15.883.600
20.225.100
23.076.000
10.929.400

4.836.300
8.609.300
13.614.500
17.335.800
19.781.300
13.614.500
17.335.800
19.781.300
9.368.100

4.030.700
7.174.400
11.345.400
14.445.100
16.484.500
11.345.400
14.445.100
16.484.500
7.806.700
9

N-1-40-II
N-1-40-III
N-1-40-I
N-1-40-II
N-1-40-III
N-1-20-I
N-1-20-I
N-1-20-II
N-1-20-III
V-4-11-I
V-4-11-II
V-4-11-III
V-1-12-I
V-1-12-II
V-1-12-III

14.828.500
17.220.200
10.929.400
14.828.500
17.220.200
15.883.600
15.883.600
20.225.100
23.076.000
3.825.100
5.370.900
9.411.000
6.781.200
16.912.900
17.511.000

12.708.900
14.760.200
9.368.100
12.708.900
14.760.200
13.614.500
13.614.500
17.335.800
19.781.300
3.278.700
4.603.200
8.066.500
5.812.500
14.495.300
15.008.000

10.591.800
12.301.400
7.806.700
10.591.800
12.301.400
11.345.400
11.345.400
14.445.100
16.484.500
2.732.500
3.836.300
6.722.800
4.843.700
12.079.400
12.507.900

10

OBGYN
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

Diagnosa
Pregnancy
Pregnancy + Anaemia
Pregnancy + Stillbirth
Pregnancy + Sepsis
Pre-Eclampsi + Pregnancy
Pre-Eclampsi + Anaemia
Pre-Eclampsi + Pneumonia
Ketuban Pecah Dini
Partus Tak Maju
Post Date
Letak Lintang
Prev SC
Prev SC + Anaemia
Prev SC + CHF ec HHD
Mioma Uteri
Mioma Uteri + Anaemia
Mioma Uteri + DHF
Mioma Uteri
Mioma Uteri + Anaemia
Mioma Uteri + Typhoid
Hiperemesis Gravidarum
Hiperemesis + Electrolyte Imbalance
Hiperemesis Gravidarum + Typhoid
Abortus Iminens
Abortus Iminens + Anaemia
Abortus Iminens + DHF
Abortus Insipiens
Abortus Incomplete
Missed Abortion + Anaemia
Blighted Ovum
Placenta Praevia Perdarahan
Placenta Praevia Perdarahan + Anaemia
Perdarahan Uterine Abnormal
Perdarahan Uterine Abnormal + Anemia
Perdarahan Uterine Abnormal

Level
R
S
S
B
R
S
B
R
R
R
R
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
R
S
R
R
S
R
S
B

Kode ICD 10
Z32.1
Z32.1 + D64.9
Z32.1 + Z37.1
Z32.1 + A41.9
O14.9 + Z32.1
O14.9 + D64.9
O14.9 + J18.9
O42.9
O66.4
O26.9
O26.9
O34.2
O34.2 + D64.9
O34.2 + I11.0
D25.9
D25.9 + D64.9
D25.9 + A91
D25.9
D25.9 + D64.9
D25.9 + A01.0
O21.1
O21.1 + E87.8
O21.1 + A01.0
O20.0
O20.0 + D64.9
O20.0 + A91
O05.1
O05.4
O02.1 + D64.9
O02.0
O44.1
O44.1 + D64.9
N93.9
N93.9 + D64.9
N93.9

Tindakan

Kode ICD 9

Partus Pervaginam
Partus Pervaginam
Partus Pervaginam
Partus Pervaginam
Partus Pervaginam
Partus Pervaginam
Partus Pervaginam
SC
SC
SC
SC
SC
SC
SC

73.59
73.59
73.59
73.59
73.59
73.59
73.59
ICD 74.0
ICD 74.0
ICD 74.0
ICD 74.0
ICD 74.0
ICD 74.0
ICD 74.0

Miomektomi
Miomektomi
Miomektomi

68.29
68.29
68.29

Dilatasi + Curetase
Dilatasi + Curetase
Dilatasi + Curetase
Dilatasi + Curetase

69.52
69.52
69.09
69.52

Kode
Z-4-12-I
Z-4-12-II
Z-4-12-II
Z-4-12-III
W-4-16-I
W-4-16-II
W-4-16-III
O-6-10-I
O-6-10-I
O-6-10-I
O-6-10-I
O-6-10-I
O-6-10-II
O-6-10-III
W-4-12-I
W-4-12-II
W-4-12-III
W-1-20-I
W-1-20-II
W-1-20-III
W-4-16-I
W-4-16-II
W-4-16-III
W-4-14-I
W-4-14-II
W-4-14-III
W-1-11-I
W-1-11-I
W-1-11-II
W-1-11-I
W-4-16-I
W-4-16-II
W-4-12-I
W-4-12-II
W-4-12-III

36
37
38
39
40
41
42
43
44
45

Perdarahan Uterine Abnormal

Perdarahan Uterine Abnormal + Anemia
Uterine Bleeding + CHF ec HHD
Proplaps Uteri
Proplaps Uteri + Electrolyte Imbalance
Proplaps Uteri + Typhoid
Endometriosis + Adenomiosis
Endometriosis + Adenomiosis + Anaemia
Endometriosis + Adenomiosis + Sepsis

R
S
B
R
S
B
R
S
B

N93.9
N93.9 + D64.9
N93.9 + I11.0
N81.4
N81.4 + E87.8
N81.4 + A01.0
N80.9 + N85.1
N80.9 + N85.1 + D64.9
N80.9 + N85.1 + A41.9

Vaginal Hysterectomy
Vaginal Hysterectomy
Vaginal Hysterectomy
Vaginal Hysterectomy
Vaginal Hysterectomy
Vaginal Hysterectomy
Laparoskopi Lysis Periuretered
Laparoskopi Lysis Periuretered
Laparoskopi Lysis Periuretered

68.7
68.7
68.7
68.7
68.7
68.7
59.03
59.03
59.03

W-1-01-I
W-1-01-II
W-1-01-III
W-1-01-I
W-1-01-II
W-1-01-III
W-1-20-I
W-1-20-II
W-1-20-III

INA CBG
Kelas I
2.212.600
4.642.900
4.642.900
7.147.000
3.249.700
4.345.800
5.890.000
6.267.300
6.267.300
6.267.300
6.267.300
6.267.300
6.916.000
7.254.500
2.775.700
4.491.500
5.711.800
9.768.700
12.150.500
13.272.800
3.249.700
4.345.800
5.890.000
2.072.400
2.723.800
3.356.400
4.258.400
4.258.400
7.485.900
4.258.400
3.249.700
4.345.800
2.775.700
4.491.500
5.711.800

Kelas II
1.896.400
3.979.000
3.979.000
6.125.000
2.785.200
3.724.600
5.048.000
5.372.500
5.372.500
5.372.500
5.372.500
5.372.500
5.928.600
6.217.500
2.379.200
3.849.900
4.896.300
8.373.200
10.414.700
11.376.700
2.785.200
3.724.600
5.048.000
1.776.600
2.334.700
2.877.200
3.649.700
3.649.700
6.416.500
3.649.700
2.785.200
3.724.600
2.379.200
3.849.900
4.896.300

Kelas III
1.843.700
3.868.900
3.868.900
5.955.600
2.321.000
3.103.800
4.207.100
4.476.700
4.476.700
4.476.700
4.476.700
4.476.700
4.940.500
5.181.800
1.982.600
3.207.900
4.079.800
9.768.700
8.679.800
9.480.600
2.321.000
3.103.800
4.207.100
1.480.500
1.945.600
2.397.400
3.041.700
3.041.700
5.347.600
3.041.700
2.321.000
3.103.800
1.982.600
3.207.900
4.079.800

14.024.500
15.728.300
24.900.800
14.024.500
15.728.300
24.900.800
9.768.700
12.150.500
13.272.800

12.019.800
13.481.400
21.343.600
12.019.800
13.481.400
21.343.600
8.373.200
10.414.700
11.376.700

10.017.500
11.234.500
17.788.100
10.017.500
11.234.500
17.788.100
6.978.400
8.679.800
9.480.600
11

INTERNA
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Diagnosa
DM Tipe 2
DM Tipe 2 + ISK
DM Tipe 2 + Fatty Liver
DM Tipe 2 + CHF
DM Tipe 2 + PPOK
DM Tipe 2 + Ggn Elektrolit
DM Tipe 2 + DHF R
DM Tipe 2 + Effusi Pleura
DM Tipe 2 + HHD w CHF R
DM Tipe 2 + MCI R
Gangrene + DM
Gangrene + DM + Pneumonia
Gangrene + DM
Gangrene + DM + Pneumonia
Hypoglycaemia + Coma Diabetik
Hypoglycaemia + Coma Diabetik+ Ggn Elektrolit
Hyperglycaemia + Coma Diabetik
Spondilitis TB
TB tanpa BTA /+ DM tipe 2 /+ Pneumonia
TB tanpa BTA + ISK
TB dgn BTA(+) + Fatty Liver
TB dgn BTA(+) + Ggn Elektrolit
TB dgn BTA(+) + Spondilitis TB S
TB tanpa BTA + Oedema Paru
TB tanpa BTA + MCI S
TB tanpa BTA + Infark Cerebri S
Respiratory Arrest + TB Milier B
HHD /+ CAD /+ DM Tipe 2
HHD + CHF
HHD + TB Tanpa BTA
HHD + Ggn Elektrolit
CHF ec HHD

Level
R
S
S
S
S
S
B
B
B
B
S
B
S
B
R
S
B
R
R
S
S
S
S
B
B
B
B
R
S
S
S
R

Kode ICD 10
E11.9
E11.9 + N30.9
E11.9 + K76.0
E11.9 + I50.0
E11.9 + J44.9
E11.9 + E87.8
E11.9 + A91
E11.9 + J90
E11.9 + I11.0
E11.9 + I21.9
R02 + E11.5
R02 + E11.5 + J18.9
R02 + E11.5
R02 + E11.5 + J18.9
E16.2 + E11.0
E16.2 + E11.0 + E87.8
R73.9 + E11.0
A18.0
A16.1 /+ E11.9 /+ J18.9
A16.1 + N30.9
A15.0 + K76.0
A15.0 + E87.8
A15.0 + A18.0
A16.1 + J81
A16.1 + I21.9
A16.1 + I63.9
R09.2 + A19.9
I11.9 /+ I25.1 /+ E11.9
I11.9 + I50.0
I11.9 + A16.1
I11.9 + E87.8
I11.0

Tindakan

Amputasi Jari Kaki

Amputasi Jari Kaki

Kode ICD 9

84.11
84.11

33
34
35
36
37
38
39
40
41

CHF ec HHD + PPOK

CHF ec HHD + Atrial Fibrilasi
CHF ec HHD + Oedem Paru
CHF
CHF + TB tanpa BTA S
CHF + ISK
CHF + Ggn Elektrolit
CHF + CKD S
CHF + Pneumonia

S
S
B
R
S
S
S
S
B

I11.0 + J44.9
I11.0 + I48
I11.0 + J81
I50.0
I50.0 + A16.1
I50.0 + N30.9
I50.0 + E87.8
I50.0 + N18.9
I50.0 + J18.9

42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65

CHF + MCI S
CHF + Effusi Pleura
CAD
CAD + ISK /+ AF R
CAD + Pneumonia R
CAD + SVT R
MCI
MCI + ISK
MCI + Fatty Liver
MCI + HHD w CHF B
CKD
CKD + DM Tipe 2
CKD + Pneumonia
CKD + MCI S
Penyakit Jantung Rematik
Penyakit Jantung Rematik + AF
Penyakit Jantung Rematik + Effusi Pleura
Angina Pectoris
Angina Pectoris + PPOK
Angina Pectoris + CHF ec HHD R
Hipertensi
Hipertensi + Anaemia / CKD
Hipertensi + PPOK
Hipertensi + Typhoid Fever R

B
B
R
S
B
B
R
S
S
B
R
S
B
B
R
S
B
R
S
B
R
S
S
B

I50.0 + I21.9
I50.0 + J90
I25.1
I25.1 + N30.9 /+ I48
I25.1 + J18.9
I25.1 + I47.2
I21.9
I21.9 + N30.9
I21.9 + K76.0
I21.9 + I11.0
N18.9
N18.9 + E11.2
N18.9 + J18.9
N18.9 + I21.9
I09.9
I09.9 + I48
I09.9 + J90
I20.9
I20.9 + J44.9
I20.9 + I11.0
I10
I10 + D64.9 / N18.9
I10 + J44.9
I10 + A01.0

Hemodialisis

39.95

66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85

Typhoid Fever
Typhoid Fever + Ggn Elektrolit
Typhoid Fever + DHF B
DHF
DHF + Ggn Elektrolit
DHF + Hypovolemic shock
ISK
ISK + PPOK
ISK + Typhoid Fever S
ISK + DHF S
Nausea + Vomiting
Dyspepsia
Dyspepsia + Anemia
GERD
GERD + Anaemia
Gastritis
Gastritis + ISK R
Gastritis + Bulbitis R
Febris
ISPA

R
S
B
R
S
B
R
S
B
B
R
R
S
R
S
R
S
S
R
R

A01.0
A01.0 + E87.8
A01.0 + A91
A91
A91 + E87.8
A91 + R57.1
N30.9
N30.9 + J44.9
N30.9 + A01.0
N30.9 + A91
R11
K30
K30 + D64.9
K21.9
K21.9 + D64.9
K29.7
K29.7 + N30.9
K29.7 + K29.8
R50.9
J06.9

86
87
88
89
90
91
92
93
94
95
96
97
98

GE Akut
GE Akut + KDR
GE + DBD R
Sirosis Hepatis
Sirosis Hepatis + Ascites / CKD
SH + Varices Esofagus Non-Bleeding
SH + Varices Esofagus Bleeding R
Varices Esofagus
Perdarahan Varices Esofagus + Anaemia
Deep Vein Trombosis
Deep Vein Trombosis + ISK
Deep Vein Trombosis + Batu Ginjal
Colitis Ulcerative + Ggn Elektrolit

R
S
B
R
S
S
B
R
S
R
S
S
S

A09
A09 + O00.0
A09 + A91
K74.6
K74.6 + R18 / N18.9
K74.6 + I85.9
K74.6 + I85.0
I85.9 / I85.0
I85.0 + D64.9
I80.2
I80.2 + N30.9
I80.2 + N20.0
K51.9 + E87.8

99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115

PSMBA / PSMBB
PSMBA / PSMBB + Anaemia
PSMBA / PSMBB + Hypovolemic shock
PSMBA / PSMBB
PSMBA / PSMBB + Anaemia
PSMBA / PSMBB + Hypovolemic shock
PSMBA / PSMBB + CHF ec HHD
MDS + Trombositopenia
Measles / Campak
Hemorrhoid Interna
Pneumonia
Pneumonia + PPOK
Pneumonia + Typhoid Fever B
Cellulitis
Cellulitis + Pneumonia

R
S
B
R
S
B
B
S
R
R
R
S
B
R
B

K92.2
K92.2 + D64.9
K92.2 + R57.1
K92.2
K92.2 + D64.9
K92.2 + R57.1
K92.2 + I11.0
D46.9 +D69.6
B05.9
I84.2
J18.9
J18.9 + J44.9
J18.9 + A01.0
L03.9
L03.9 + J18.9

Gastroscopy + Ligasi
Gastroscopy + Ligasi
Gastroscopy + Ligasi
Gastroscopy + Ligasi

44.13 + 44.91
44.13 + 44.91
44.13 + 44.91
44.13 + 44.91

INA CBG
Kode
E-4-10-I
E-4-10-II
E-4-10-II
E-4-10-II
E-4-10-II
E-4-10-II
E-4-10-III
E-4-10-III
E-4-10-III
E-4-10-III
I-4-15-II
I-4-15-III
M-1-30-II
M-1-30-III
E-4-10-I
E-4-10-II
E-4-10-III
M-4-15-I
J-4-15-I
J-4-15-II
J-4-15-II
J-4-15-II
J-4-15-II
J-4-15-III
J-4-15-III
J-4-15-III
J-4-11-III
I-4-17-I
I-4-17-II
I-4-17-II
I-4-17-II
I-4-12-I

Kelas I
4.334.300
5.999.400
5.999.400
5.999.400
5.999.400
5.999.400
9.153.900
9.153.900
9.153.900
9.153.900
7.968.200
9.081.000
26.023.100
38.821.000
4.334.300
5.999.400
9.153.900
4.649.700
6.499.500
7.764.300
7.764.300
7.764.300
7.764.300
10.317.300
10.317.300
10.317.300
7.183.000
4.961.300
6.725.100
6.725.100
6.725.100
5.448.900

Kelas II
3.715.100
5.142.900
5.142.900
5.142.900
5.142.900
5.142.900
7.845.500
7.845.500
7.845.500
7.845.500
6.829.200
7.784.500
22.303.300
33.271.800
3.715.100
5.142.900
7.845.500
3.985.100
5.570.400
6.655.100
6.655.100
6.655.100
6.655.100
8.843.400
8.843.400
8.843.400
6.156.900
4.252.100
5.764.300
5.764.300
5.764.300
4.670.200

Kelas III
3.095.600
4.285.700
4.285.700
4.285.700
4.285.700
4.285.700
6.538.500
6.538.500
6.538.500
6.538.500
5.691.000
6.487.000
18.587.900
27.726.500
3.095.600
4.285.700
6.538.500
3.321.200
4.642.000
5.545.900
5.545.900
5.545.900
5.545.900
7.369.500
7.369.500
7.369.500
5.130.700
3.543.800
4.803.600
4.803.600
4.803.600
4.540.600

I-4-12-II
I-4-12-II
I-4-12-III
I-4-12-I
I-4-12-II
I-4-12-II
I-4-12-II
I-4-12-II
I-4-12-III

9.335.400
9.335.400
11.244.500
5.448.900
9.335.400
9.335.400
9.335.400
9.335.400
11.244.500

8.001.400
8.001.400
9.637.700
4.670.200
8.001.400
8.001.400
8.001.400
8.001.400
9.637.700

7.779.200
7.779.200
9.371.000
4.540.600
7.779.200
7.779.200
7.779.200
7.779.200
9.371.000
12

I-4-12-III
I-4-12-III
I-4-16-I
I-4-16-II
I-4-16-III
I-4-16-III
I-4-10-I
I-4-10-II
I-4-10-II
I-4-10-III
I-4-10-I
I-4-10-II
I-4-10-III
I-4-10-III
I-4-24-I
I-4-24-II
I-4-24-III
I-4-20-I
I-4-20-II
I-4-20-III
I-4-17-I
I-4-17-II
I-4-17-II
I-4-17-III

11.244.500
11.244.500
3.558.000
5.107.300
6.089.300
6.089.300
6.263.400
9.364.600
9.364.600
13.478.600
4.252.500
5.731.000
10.026.600
10.026.600
3.930.800
9.854.000
10.247.000
5.703.600
6.554.800
8.710.100
4.961.300
6.725.100
6.725.100
8.162.900

9.637.700
9.637.700
3.049.600
4.377.500
5.219.100
5.219.100
5.368.900
8.027.200
8.027.200
11.552.500
3.644.600
4.912.300
8.593.400
8.593.400
3.369.100
8.446.700
8.782.700
4.888.400
5.617.800
7.465.000
4.252.100
5.764.300
5.764.300
6.996.100

9.371.000
9.371.000
2.964.900
4.256.300
5.074.200
5.074.200
4.624.100
7.804.300
7.804.300
11.230.600
3.037.200
4.093.600
7.161.800
7.161.800
3.275.200
8.212.100
8.538.800
4.074.000
4.681.500
6.220.900
3.543.800
4.803.600
4.803.600
5.830.000

A-4-14-I
A-4-14-II
A-4-14-III
A-4-13-I
A-4-13-II
A-4-13-III
N-4-12-I
N-4-12-II
N-4-12-III
N-4-12-III
K-4-17-I
K-4-18-I
K-4-18-II
K-4-12-I
K-4-12-II
K-4-11-I
K-4-11-II
K-4-11-II
A-4-12-I
U-4-13-I

4.323.200
5.561.300
6.371.900
3.057.200
3.629.800
4.537.400
3.268.000
4.562.200
6.209.600
6.209.600
3.163.800
4.331.200
6.496.700
3.192.300
5.562.400
3.099.200
4.470.300
4.470.300
2.759.500
2.311.600

3.706.000
4.766.800
5.461.100
2.620.600
3.110.800
3.889.400
2.801.100
3.910.500
5.332.500
5.332.500
2.711.700
3.712.500
5.569.100
2.736.000
4.768.200
2.656.700
3.831.700
3.831.700
2.365.300
1.981.300

3.088.000
3.972.000
4.550.900
2.547.500
3.024.400
3.781.000
2.334.300
3.259.000
4.435.400
4.435.400
2.636.400
3.094.000
4.640.900
2.280.200
3.973.500
2.214.000
3.193.000
3.193.000
1.971.100
1.926.400

K-4-17-I
K-4-17-II
K-4-17-III
B-4-13-I
B-4-13-II
B-4-13-II
B-4-13-III
K-4-12-I
K-4-12-II
I-4-13-I
I-4-13-II
I-4-13-II
K-4-13-II

3.163.800
4.325.000
4.879.100
4.166.600
6.061.800
6.061.800
7.589.400
3.192.300
5.562.400
8.141.300
10.324.700
10.324.700
5.628.600

2.711.700
3.707.000
4.181.500
3.571.000
5.195.800
5.195.800
6.504.500
2.736.000
4.768.200
6.978.200
8.848.900
8.848.900
4.824.500

2.636.400
3.604.400
4.065.800
2.976.100
4.329.800
4.329.800
5.421.000
2.280.200
3.973.500
5.815.200
7.374.100
7.374.100
4.020.800

13

K-4-18-I
K-4-18-II
K-4-18-III
K-1-20-I
K-1-20-II
K-1-20-III
K-1-20-III
C-4-14-II
A-4-13-I
K-4-18-I
J-4-16-I
J-4-16-II
J-4-16-III
L-4-12-I
L-4-12-III

4.331.200
6.496.700
7.969.500
16.535.400
23.130.500
38.588.100
38.588.100
7.053.100
3.057.200
4.331.200
5.414.900
7.609.300
12.594.000
4.531.700
11.965.800

3.712.500
5.569.100
6.831.700
14.173.200
19.828.100
33.075.500
33.075.500
6.044.900
2.620.600
3.712.500
4.641.800
6.522.300
10.796.200
3.884.300
10.257.400

3.094.000
4.640.900
5.692.500
11.181.100
16.523.400
27.560.200
27.560.200
5.037.400
2.547.500
3.094.000
3.868.200
5.435.800
8.996.000
3.236.600
8.547.800

14

ONKOLOGI
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

Diagnosa
Post Kemoterapi
Post Kemoterapi + Anemia
Post Kemoterapi + Pneumonia
NPC
NPC + Metastasis Paru
NPC + Sepsis
Ca Mamae
Ca Mamae + Metastasis Hati
Ca Mamae + Sepsis
Ca Mamae
Ca Mamae + Anemia
Ca Mamae + Sepsis
Non-Hodgkin's Limfoma
Non-Hodgkin's Limfoma + Anemia
NHL + Sepsis
Ca Thyroid
Ca Thyroid + Metastasis Hepar
Ca Thyroid + Sepsis
Ca Gaster
Ca Gaster + Electrolyte Imbalance
Ca Gaster + Pneumonia
Adeno Ca Colon
Adeno Ca Rectosigmoid + Anemia
Adeno Ca Colon + Sepsis
Adeno Ca Recti
Adeno Ca Recti + Metastasis Hepar
Ca Prostat
Ca Prostat + Metastasis Paru
Ca Prostat + Hydronephrosis
Ca Prostat + Sepsis
Ca Pankreas
Ca Pankreas + Trombositopenia
Ca Pankreas + Sepsis
Ca Bronchus
Ca Bronchus + PPOK

Level
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
B
R
S
R
S
S
B
R
S
B
R
S

Kode ICD 10
Z51.1
Z51.1 + D64.9
Z51.1 + J18.9
C11.9
C11.9 + C78.0
C11.9 + A41.9
C50.9
C50.9 + C78.7
C50.9 + A41.9
C50.9
C50.9 + D64.9
C50.9 + A41.9
C85.9
C85.9 + D64.9
C85.9 + A41.9
C73
C73 + C78.7
C73 + A41.9
C16.9
C16.9 + E87.8
C16.9 + J18.9
C18.9
C19 + D64.9
C18.9 + A41.9
C20
C20 + C78.7
C61
C61 + C78.0
C61 + N13.0
C61 + A41.9
C25.9
C25.9 + D69.6
C25.9 + A41.9
C34.9
C34.9 + J44.9

Tindakan

Kode ICD 9

Eksisi
Unilateral Radical Mastectomy
Unilateral Radical Mastectomy

85.2
85.45
85.45

Transfusi WB

99.03

Hemicolectomy Kanan + Ileostomy

Hemicolectomy Kanan + Ileostomy
Hemicolectomy Kanan + Ileostomy

45.73 + 46.19
45.73 + 46.19
45.73 + 46.19

Cystoscopy

57.32

36
37
38
39
40
41
42
43
44
45

Ca Bronchus + Pneumonia
Olfactory Neuroblastoma
Olf. Neuroblastoma + Metastase Paru
Olfactory Neuroblastoma + Pneumonia
Ca Testis
Ca Testis + Metastasis Hepar
Ca Testis + CHF ec HHD
Ca Penis
Ca Penis + Anaemia
Ca Penis + CHF ec HHD

B
R
S
B
R
S
B
R
S
B

C34.9 + J18.9
C72.2 + C78.0
C72.2 + J18.9
C62.9
C62.9 + C78.7
C62.9 + I11.0
C60.9
C60.9 + D64.9
C60.9 + I11.0

Orchidectomy
Orchidectomy
Orchidectomy
Penectomy
Penectomy
Penectomy

62.3
62.3
62.3
64.3
64.3
64.3

Kode
C-4-13-I
C-4-13-II
C-4-13-III
U-4-10-I
U-4-10-II
U-4-10-III
L-4-11-I
L-4-11-II
L-4-11-III
L-1-50-I
L-1-50-II
L-1-50-III
C-4-11-I
C-4-11-II
C-4-11-III
E-4-13-I
E-4-13-II
E-4-13-III
K-4-10-I
K-4-10-II
K-4-10-III
K-1-20-I
K-1-20-II
K-1-20-III
K-4-10-I
K-4-10-II
V-4-10-I
V-4-10-II
V-4-10-II
V-4-10-III
B-4-11-I
B-4-11-II
B-4-11-III
J-4-14-I
J-4-14-II

Kelas I
2.482.900
4.670.100
6.461.600
6.243.800
9.591.000
14.726.600
4.283.000
5.927.700
16.015.500
7.627.200
13.690.100
16.495.500
5.490.100
6.289.100
12.647.600
4.201.900
7.102.400
12.111.400
5.679.400
9.028.100
17.583.600
16.535.400
23.130.500
38.588.100
5.679.400
9.028.100
7.665.100
9.909.600
9.909.600
18.936.900
5.714.900
8.711.400
9.398.000
5.974.000
10.031.200

INA CBG
Kelas II
2.128.100
4.002.800
5.538.800
5.352.100
8.221.200
12.622.200
3.671.200
5.080.900
13.727.600
6.538.300
11.735.600
14.139.000
4.706.200
5.390.700
10.839.700
3.601.900
6.088.400
10.382.200
4.868.500
7.739.200
15.072.400
14.173.200
19.828.100
33.075.500
4.868.500
7.739.200
6.570.700
8.493.900
8.493.900
16.231.600
4.898.000
7.466.900
8.054.700
5.121.100
8.599.000

Kelas III
2.068.800
3.891.600
5.384.500
4.369.200
7.992.200
12.270.500
3.059.300
4.234.100
11.440.800
5.448.000
9.778.700
11.782.500
3.921.500
4.491.800
9.033.100
3.001.600
5.073.200
8.651.900
4.057.100
6.448.700
14.652.400
11.811.000
16.523.400
27.560.200
4.057.100
6.448.700
5.475.600
7.079.000
7.079.000
13.525.000
4.082.100
6.222.400
6.712.900
4.267.600
7.165.100

J-4-14-III
G-4-11-I
G-4-11-II
G-4-11-III
V-1-13-I
V-1-13-II
V-1-13-III
V-1-11-I
V-1-11-II
V-1-11-III

11.876.900
5.615.800
7.609.400
10.579.100
10.296.800
14.648.200
18.159.200
9.295.900
10.438.600
15.356.900

10.180.200
4.812.800
6.521.400
9.068.200
8.825.800
12.554.300
15.566.500
7.967.900
8.948.200
13.163.000

8.482.700
4.679.600
6.340.900
8.816.400
7.354.900
10.463.000
12.970.800
6.639.900
7.456.100
10.970.300
15

KULIT
No
1
2
3
4
5
6
7
8
9
10

Diagnosa
SJS
SJS + CKD
SJS + Sepsis / Pneumonia

Level
R
S
B

Kode ICD 10
L51.2
L51.2 + N18.9
L51.2 + A41.9 / J18.9

Tindakan

Kode ICD 9

Kode
L-4-10-I
L-4-10-II
L-4-10-III

INA CBG
Kelas I

Kelas II

Kelas III

6.389.200
13.149.700

5.476.500
11.272.300

4.564.200
9.392.700

16

MATA
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Diagnosa

Level

Kode ICD 10

Tindakan

Kode ICD 9

Katarak Traumatica

H26.1

Phaco + Iol

13.41

Kode
H-1-30-I

Diabetic Retinopathy
Retinal Disorder
Retinal Disorder
Retinal Disorder
Retinal Disorder + Luka Robek Periocular

R
R
R
R
S

E11.3 + H36.0
H35.9
H35.9
H35.9
H35.9 + S01.1

Laser Photocoagulation
Retina Diathermy
Retina Cryotherapy
Mechanical Vitrectomy Anterior
Xenon Arc Photocoagulation

14.54
14.31
14.52
14.73
14.53

H-1-30-I
H-1-30-I
H-1-30-I
H-1-30-I
H-1-30-II

Congenital Entropion
Pterygium

R
R

Q10.2
H11.0

Repair of Entropion / Ectropion

Eksisi Pterygium

ICD 08.49
11.39

H-1-20-I
H-1-20-I

INA CBG
Kelas I
10.051.900

Kelas II
8.615.100

Kelas III
7.179.900

10.051.900
10.051.900
10.051.900
10.051.900
12.488.500

8.615.100
8.615.100
8.615.100
8.615.100
10.703.400

7.179.900
7.179.900
7.179.900
7.179.900
8.920.300

13.730.300
13.730.300

11.767.700
11.767.700

9.807.400
9.807.400

17

ORTHOPEDI
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Diagnosa

Level

Kode ICD 10

Tindakan

Kode ICD 9

Fx Femur Tertutup

S72.90

ORIF

79.35

Kode
M-1-20-I

Fx Tibia Terbuka

S82.31

External Fixation Tibia

78.17

M-1-70-I

Fx Radius Terbuka

S52.51

External Fixation Radius

78.13

M-1-80-I

Post ORIF

Z47.0

Remove Inplant

78.69

M-1-40-I

Fx Humerus Tertutup

S42.40

Reposisi + Gips

79.01 + 93.53

M-4-12-I

INA CBG
Kelas I
15.514.800

Kelas II
13.298.400

Kelas III
11.083.100

31.112.600

26.667.900

22.225.500

17.688.000

15.161.100

12.633.000

5.335.000

4.572.400

3.810.700

2.759.900

2.365.600

1.971.600

18

No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Diagnosa
NPC

Level
R

ONKOLOGI
Kode ICD 10
C11.9

Tindakan
Kemoterapi

OGI
Kode ICD 9
99.25

INA CBG
Kode
U-4-10-I

Kelas I
6.243.800

Kelas II
5.352.100

Kelas III
4.369.200

No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Diagnosa
NPC

Level
R

ONKOLOGI
Kode ICD 10
C11.9

Tindakan
Kemoterapi

OGI
Kode ICD 9
99.25

INA CBG
Kode
U-4-10-I

Kelas I
6.243.800

Kelas II
5.352.100

Kelas III
4.369.200