Coding BPJS untuk CAPD
KALBE - BAXTER
TARIF INA CBGs
1. Pasang Catheter Tenchoff
SEVERITY 1 SEVERITY 2
KODE DX N18.5
KODE DX N18.5 D63,8
KODE TINDAKAN 54.93 KODE TINDAKAN 54.93
KELAS 1 8,344,200 99.04
KELAS 1 9,199,800
KELAS 2 7,152,200 KELAS 2 7,885,500
KELAS 3 5,960,100 KELAS 3 6,571,300
Berikut contoh untuk RS type C
BHP PASANG KATETER CAPD
PAKET OPERASI
NAMA HARGA
NO BARANG JM L SATUAN TOTAL
1 Pull Apart Introducer 1
2 Sarung tangan steril 4
3 Lidocain inj 15
4 Jrm & bng vicril 2.0 1 109,200 109,200
5 Bisturi 1
6 Heparin vial 1
7 Spuit 1 cc 1
8 Spuit 10 cc 1
9 Spuit 20 cc 1
10 Spuit 50 cc 1
11 Transfusi set 1
12 Nacl 0,9% 500 cc 3
13 Condom usg 1
14 Kasa lipat 50
15 Betadin 30 cc
16 Alkohol 70% 30 cc
17 Hepafix 20 cm
18 Masker 5
19 Topi 5
Total 1,980,300
Pe mbulatan 2,000,000
Berikut contoh bhp jika pemasangan dilakukan oleh nefro
Paket Awal
HARGA
NO PRODUK CAPD KALBE - BAXTER JUMLAH
HNA + PPN Ket
1 PAKET AWAL
2 Tenckoff kateter Lurus 1 Rp 830.500 Non e - katalog
3 Titanium adaptor 1 Rp 981.454 e-katalog
4 Transfer Set 1 Rp 283.951 e-katalog
5 Ultraclamp (1 Unit ) 1 Rp 104.000 e-katalog
TOTAL Rp 2.199.905
Dianeal Twinbag 120 bag 2 Rp 54.000
Minicap 120 unit 2 Rp 7.400
Paket Pelayanan
NO RINCIAN KELAS 1 KELAS 2 KELAS 3 KETERANGAN
1 Pendaftaran IGD
2 Pendaftaran Ranap
4 Pemeriksaan IGD
5 EKG
6 Laboratorium hema rtn, pt,aptt,gds, kalium, hb
7 Tarif Kamar (3 hari)
8 Visite Dokter (3 hari) konsultan
9 Obat fleet enema, lactulosa, ceftriaxon amp, genta salp, pct, dll
10 HD (OT) jika perlu ( overtime/ bukan jadwal rutin)
11 Transfusi jika perlu
12 BHP operasi 2,000,000 2,000,000 2,000,000
13 Jasmed operator tarif Op CAPD
14 Sewa OK
15 Paket Awal CAPD 2,472,912 2,472,912 2,472,912 harga bpjs + ppn + margin rs
16 Dianeal(2 bag) + minicap flushing post op
17 USG Guiding
18 Dressing Exit Site post op
19 BNO/Thorax Foto pre op
20 Tindakan Infus/Inj (ranap)
21 BHP ranap
Total 11,651,250 11,001,250 10,126,250
TARIF INA CBGs
• 2. Training • 3. Pergantian Transferset & PET
SEVERITY 1
KODE DX N18.5 KODE DX T85.5
KODE TINDAKAN 54.98 TARIF 190,400
KELAS 1
KELAS 2
KELAS 3
Paket Pelayanan
• Ganti Transferset
HARGA
NO RINCIAN JML
SATUAN TOTAL
1 Ganti Cairan 1 40,000
2 Ganti Verban 1 55,000
3 Ganti Transfer Set 1 70,000
165,000
Paket Pelayanan
• PET • KT/V
HARGA HARGA
NO RINCIAN JML NO RINCIAN JML
SATUAN TOTAL SATUAN TOTAL
1 PET 1 120,000 1 KT/V 1 70,000
2 Urea N 4 40,000 160,000 2 Urea N 3 40,000 120,000
3 Creatinin 4 40,000 160,000
3 Creatinin 3 40,000 120,000
4 Glukosa 4 30,000 120,000
560,000 310,000
Tindakan CAPD
KODING
NO JENIS TINDAKAN KET
DX TINDAKAN
1 Pasang Kateter N18.5 54.93 Craetion
2 Training CAPD N18.5 54.98 Peritoneal Dialisis
3 Ganti Transfer Set T85.5 Mechanical Complication
4 Kontrol Z99.2
Diagnosa CAPD
NO DIAGNOSA KODE KET
1 Chronic kidney disease, stage 5 N18.5 CKD STAGE V
2 Anaemia in other chronic diseases classified elsewhere D63.8 ANEMIA (TRANSFUSI)
3 Haemorrhage and haematoma complicating a procedure, not elsewhere classified
T81.0 PENDARAHAN CATETER CAPD
4 Mechanical complication of gastrointestinal prosthetic devices, implants and grafts T85.5 GANTI TRANSFERSET/INFLOW ATAU OUTFLOW TIDAK LANCAR
5 Mechanical complication of vascular dialysis catheter T82.4 AFF THANEL
Infection and inflammatory reaction due to other internal prosthetic devices, implants and
6 grafts T85.7 KALO INFECTION EXIT SITE (PASIEN CAPD)
7 Fitti ng and adjustment of unspecified external prosthetic device Z44.9 KONTROL CAPD
8 Coagulation defect, unspecified D68.9 UNTUK DIAGNOSA CAPD APABILA PTAPTNYA MEMANJANG
9 Dependence on renal dialysis Z99.2 PENANDA PASIEN KONTROL PASIEN CKD
10 Peritonitis,unspecified k65.9 PASIEN PERITONITIS
11 other Peritonitis k65.8 PASIEN PERITONITIS
12 Acute Peritonitis k65.0 PASIEN PERITONITIS
Kode Tindakan
NO UNTUK KODE TINDAKAN KODE KET
1 Peritoneal lavage 54.25 PENDARAHAN CAPD
2 Removal of other therapeutic device 97.89 AFF
3 Peritoneal dyalisis 54.98 TRAINING CAPD
4 Creation of cutaneoperitoneal fistula 54.93 OPERASI CAPD
5 Transfusion of packed cells 99.04 TRANSFUSI DARAH
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