CONTOH KASUS GROUPING

NON BEDAH

1. Diagnosa utama : A01.0 - Thypoid fever

Diagnosa Sekunder : J40 - Bronchitis, not specified as acute or chronic
Penunjang : 90.59 - Microscopic examination of blood, other microscopic
examination
Hasil Grouping : A-4-14-I PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN
(RINGAN)
Tarif INA-CBG : Rp. 2.181.200
Kelas :3

Diagnosa utama : J40 - Bronchitis, not specified as acute or chronic

Diagnosa Sekunder : A01.0 - Thypoid fever
Penunjang : 90.59 - Microscopic examination of blood, other microscopic
examination
Hasil Grouping : J-4-21-III - GEJALA, TANDA DAN DIAGNOSIS SISTEM PERNAFASAN
LAIN-LAIN (BERAT)
Tarif INA-CBG : Rp. 6.235.300
Kelas :3
Tarif RS : Rp. 1.548.575 (perawatan 3 Hari)

2. Diagnosa utama : K30 - Dyspepsia

Diagnosa Sekunder : E11.9 – Non-insulin-dependent diabetes mellitus without
complications
Penunjang :-
Hasil Grouping : K-4-18-I GANGGUAN SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
Tarif INA-CBG : Rp. 1,295,200
Kelas :3

Diagnosa utama : E11.9 – Non-insulin-dependent diabetes mellitus without

complications
Diagnosa Sekunder : K30 - Dyspepsia
Penunjang :-
Hasil Grouping : E-4-10-I 3 - PENYAKIT KENCING MANIS & GANGGUAN NUTRISI/
METABOLIK (RINGAN)
Tarif INA-CBG : Rp. 3,471,700
Kelas :3
Tarif RS : Rp. 756.100 ( Perawatan 2 hari)
 3. Diagnosa utama : A15.0 - Tb lung confirm sputum microscopy with or without culture
Diagnosa Sekunder : E11.9 – Non-insulin-dependent diabetes mellitus without
complications
Penunjang :
- 90.59 - Microscopic examination of blood, Other microscopic
examination
- 87.49 - Other chest x-ray
- 89.52 - Electrocardiogram
Hasil Grouping : J-4-15-I - PERADANGAN DAN INFEKSI PERNAFASAN (RINGAN)
Tarif INA-CBG : Rp. 4,169,100
Kelas :3

Diagnosa utama : E11.9 – Non-insulin-dependent diabetes mellitus without

complications
Diagnosa Sekunder : A15.0 - Tb lung confirm sputum microscopy with or without culture
Penunjang :
- 90.59 - Microscopic examination of blood, Other microscopic
examination
- 87.49 - Other chest x-ray
- 89.52 - Electrocardiogram
Hasil Grouping : E-4-10-II- PENYAKIT KENCING MANIS & GANGGUAN NUTRISI/
METABOLIK (SEDANG)
Tarif INA-CBG : Rp. 4,851,000
Kelas :3
Tarif RS : Rp. 2.198.195 (Perawatan 4 hari)

BEDAH

1. Diagnosa utama : I84.2 - Internal haemorrhoids without complication

Diagnosa Sekunder :-
Penunjang :
- 90.59 - Microscopic examination of blood, Other microscopic
examination
- 49.43 - Cauterization of hemorrhoids
Hasil Grouping : K-4-18-I - GANGGUAN SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
Tarif INA-CBG : Rp. 1,295,200
Kelas :3
Tarif RS : Rp. 13,143,925 (perawatan 7 hari)

2. Diagnosa utama : K35.8 - Acute appendicitis, other and unspecified

Diagnosa Sekunder :-
Penunjang :
- 90.59 - Microscopic examination of blood, Other microscopic
examination
- 47.09 - Other appendectomy
 Hasil Grouping : K-1-13-I- PROSEDUR APPENDIK (RINGAN)
Tarif INA-CBG : Rp. 2,909,000
Kelas :3
Tarif RS : Rp. 10,026,475 (perawatan 3 hari)
3. Diagnosa utama : J35.0 - Chronic tonsillitis
Diagnosa Sekunder :-
Penunjang :
- 90.59 - Microscopic examination of blood, Other microscopic
examination
- 28.2 - Tonsillectomy without adenoidectomy
- 87.49 - Other chest x-ray
Hasil Grouping : U-1-15-I - PROSEDUR TONSIL & ADENOID (RINGAN)
Tarif INA-CBG : Rp. 3,699,600
Kelas :3
Tarif RS : Rp. 10,432,225 (perawatan 3 hari)

4. Diagnosa utama : J32.9 - Chronic sinusitis, unspecified

Diagnosa Sekunder : J34.8 - Other specified disorders of nose and nasal sinuses
Penunjang / prosedur :
- 90.59 - Microscopic examination of blood, Other microscopic
examination
- 22.63 – Ethmoidectomy
- 87.49 - Other chest x-ray
Hasil Grouping : U-1-12-I - PROSEDUR MASTOID DAN SINUS (RINGAN)
Tarif INA-CBG : Rp. 5,090,600
Kelas :3
Tarif RS : Rp. 10,088,575 (perawatan 3 hari)
Diagnosa utama : O33.0 - Maternal care for disproportion due to deformity of
maternal pelvic bones
Diagnosa Sekunder : O82.9 - Delivery by caesarean section, unspecified
- O61.0 - Failed medical induction of labour
- Z37.0 - Single live birth
Penunjang / prosedur :90.59 - Microscopic examination of blood, Other microscopic
examination
- 74.0 – Classical cesarean section
Hasil Grouping : O-6-10-I - OPERASI PEMBEDAHAN CAESAR (RINGAN)
Tarif INA-CBG : Rp 5,034,900
Kelas :3
Tarif RS : Rp. 10,491,450 (perawatan 3 hari)