KODE PENJELASAN KETERANGAN

DPM Daerah
bersifat lokal & rs boleh sepakat atau tidak sepakat & dpt mengajukan ke kemenkes ut dibahas dg dpjp pusat serta perwakilan
organisasi di pusat
OBGYN
SC kode untuk tindakan sc dx u : penyebab sc
dx u : O 65.4 - CPD (obstructed labour ec. CPD) dx s : tindakan sc
dx s : O 82.0 - delivery by elective sc (O 82.1 - emergency sc) jml bayi
Z 37.0 - single live birth prosedur (psd) : tindakan sc
psd : 74.4 - SC
spontan dx u : O 83.9 - assisted single delivery unspecified dx u : lahir spontan
dx s : Z 37.0 - single live birth dx s : single/kembar/lainnya
psd : 73.59 - other manually assisted delivery
spontan → rest placenta → kuret, bayi +
dx : O 72.0 - third stage placenta + Z 37.1 - single stillbirth kls I - 4.125.300, kls II - 3.536.000, kls III - 2.946.700
psd : 73.59 assited delivery + 69.02 d & c
ancaman pd kehamilan dimana akan timbul persalinan pd uk
PPI O 60 - preterm labour & delivery (uk ˂ 37 mgg) yg blm aterm
O 60.0 tdk melahirkan
O 60.1 lahir premature
O 60.2 lahir cukup bulan
O 60.3 lahir tanpa labour spontan (sc/induksi)
Aborsi < 20 mgg, jika > 20 & < 38 mg merup lahir prematur
O 20.0 threatened abortion/ ancaman aborsi
O 03-O 08 aborsi
Z 35.9 supervision of high pregnancy unspecified ut kontrol kehamilan
Z 37.2 twins, both liveborn
Z 39.2 kontrol post SC/post partum 93.57 - rawat luka
D 25.9 leimyoma of uterus unspecified ut mioma uteri, 68.29 - miomektomi
O 02.1 missed abortion/abortus imminen
spontaneous abortion complete or unspecified witout
O 03.9 ut Abortus komplit
complications
O 13 HDK/Ht dl kehamilan
O 23.5 infections of genital tract in pregnancy ut kasus gravida + vaginitis
O 30.0 twin pregnancy
O 32.1 maternal care of breech presentation/kontrol letak sungsang klo sc pake O 64.9
O 32.4 maternal care for high head at term ut floating head
O 32.9 maternal care for malpresentation of fetus, unspec
O 33.9 maternal care for CPD kontrol karena cpd, tp klo px sc pake O 65.4
O 34.2 maternal care due to uterine scar from previous surgery ut LMR
ut nst patologis, iugr (intrauterine growth restriction), gerak
O 36.9 maternal care for fetal problem janin menurun
O 41.0 oligohidramnion
O 42.0 KPD ˂24 jam, O 42.1 ˃24 jam, O 42.9 unspec
O 43.9 insufisiensi placenta, placenta disorder unspec
O 44.0 placenta previa
O 44.1 placenta previa + haemorrhage ut apb ec placenta previa
O 48 post date, prolonged placenta
O 61.0 gagal drip oxytocin
O 61.9 failed induction labour gagal konservatif
O 63... long labour
O 63.1 prolonged first stage (of labour)
O 64… partus macet pada…
O 64.1 breech presentation letsu
O 64.4 shoulder letli

O 64.9 obstructed labour due malposition & malpresentation, unspecified ut sc ec. letsu/letli, klo kontrolhamil pake O 32.1

O 65.4 obstructed labour ec.cpd klo kontrol hamil ec cpd pake O 33.9
O 71.9 ROB/BOH, obsteric trauma, BOH (bad obstetric history)
O 81.4 vacum extraction (persalinan dg vacum) psd : 72.79 - vacum extraction
O 99.0 kontrol hamil + anemia

O 99.2 kontrol hamil + DM ,+endocrine, nutritional & metabolic ds

ds of the digestive system complicating pregnancy, childbirth & the

O 99.6 puerperium

Page 1 sri_m
 other specified ds & conditions complicating pregnancy, childbirth ut kontrol ulang px hamil, ut miopi juga pake ini
O 99.8 & the puerperium
N 72 inflammatory ds of cervix uteri (ut cervicitis kronis)
N 73 other female pelvic inflammatory ds
N 73.9 PID unspecified psd : 96.44 - vaginal douche
N 76.0 acute vaginitis
N 80.0 endometriosis of uterus
N 80.1 endometriosis ovarii
N 80.9 endometriosis unspec
N 84.1 polip cervix
N 83.2 kista ovari (other & unspecified ovarian cyst) psd : 65.93 - ut kistektomi
67.32 - kauterisasi (destruction of lesion of cervix by
N 86 erosi portio luas (erosion & ectropion of cervix uteri) cauterization) kls I - 5.040.600
obs leukorrhea, other specified noninflammatory disorder of
N 89.8 vagina
N 91.1 secondary amenorrhea
N 91.2 amenorrhea, unspecified
N 92.0 menorrhagia
N 92.6 irregular menstruation
N 93.0 post coital & contact bleeding
N 93.9 AUB, disfungsional uterine bleeding 88.76 - USG abdomen
N 94.6 dysmenorrhoea 88.78 - USG gravida
T 83.3 mechanical complication of intrauterine contraceptive device ut benang iud tdk tampak

Page 2 sri_m
NEONATUS
post SC kode ut klaim bayi post sc, cth
dx u : P 03.4 - fetus & newborn affected by caesarean delivery
dx s : Z 38.0 - singleton, born in hospital
P 03.3 bayi, lahir dg vacum
P 07.1 BBLR (other low birth weight) liat icd, ada rangeberatnya
P 21.0 severe birth asphyxia liat icd, ada apgar score
P 59.9 neonatal jaundice psd : 99.83 - fototerapi
Q 21.0 vsd - ventricular septal defect
Q 22.9 congenital malformation of tricuspid valve, unpsec ut mild tricuspid & pulmonal regurgitation
Q 38.1 ankyloglossia 27.91 - labial frenotomy

PEDIATRI
B 05.9 morbilli/measles
B 08.4 HFMD
F 80.9 development disorder of speech & tongunge unspecified ut delay speech
K 59.0 konstipasi
L 04.9 acute limfadenitis unspec
R 62.0 delayed milestone

INTERNA
psd : 39.95. obat eritropeitin pd px HD, "Rinofer" 100mg Rp
HD dx u : Z 49.1 - extracorporial dyalsis 62.304, "Hemapo" 2000 IU JKN, Rp 92.400, "Eprek" 2000 IU
Rp 118.800
AVF stenosis (arteri-vena fistula stenosis, ut stenosis pd av shunt, px HD)
T 82.8 (dx u) arteri vena stenosis 39.50 - ut percutaneus transluminal angioplasty/PTA
N 18.5 (dx s) ckd st V kls I -16.101.800, kls II - 13.801.600, III - 11.501.300
88.48 - arteriography of femoral & lower ext arteries (ut
venography), kls I - 3.615.400
A 01.0 tifoid fever
A 06.9 amoebiasis, unspecified
A 09.9 gea (jika FL (+) entamoeba & tx (+) metronidazole)
A 15.9 TB paru unspec, confirmed bacteriologically & histologically
A 18.2 TB kelenjar, tuberculous peripheral limphadenopathy
A 41.9 sepsis
A 49.9 bacterial infection
A 90 dengue fever
A 91 DHF
B 01.9 varicella
D 50 anemia defisiensi besi
D 50.0 ADB to blood loss (chronic)
D 50.9 ADB unspecified
D 62 acute post haemorrhagic anemia
D 63.8 anemia in ckd st ≥3 kode degger esterix + N 18.3 - N 18.5
D 64.9 anemia unspecified 99.04 - transfusi PRC
D 69.3 ITP (idiopatic thrombocytopenic purpura) 99.05 - transfusi platelet
D 69.6 thrombocytopenia unspec
E 03.9 hipotiroid unspec
E 04.9 nontoxic goitre unspec struma thyroid
E 05.0 grave ds
E 05.9 hipertiroid, unspec
E 11.2 DKD (DM + CKD)
E 11.4 + G 63.2 diabetic polyneuropati
non insulin dependent DM with peripheral circulatory
E 11.5
complications
E 11.9 DM tanpa komplikasi
E 46 unspec protein - energy malnutrition/ malnutrisi berat
E 78.5 hyperlipidemia ut dislipidemia
E 79.0 hiperurikemia
E 87.6 hipokalemia
E 88.0 hipoalbumin 99.07 - transfusi albumin behring
jika px dg DM + Ht + dislipidemia (ato dg 3 peny metabolic
E 88.9 metabolic disorder, unspecified lainnya)
I 00 rheumatic fever without mention of heart involvement
I 10 hipertensi
Page 3 sri_m
K 21.0 gerd with oesophagitis dipake ut LPR/ laryngopharyngeal reflux
diagnosana gerd pada ritl harus disertai dg endoskopi, sama
K 21.9 gerd without esophagitis seperti dx gastritis
K 27.9 ulkus peptikum unspec
K 29.1 other acute gastritis
K 29.7 gastritis unspec
K 30 dyspepsia
K 73.9 chronic hepatitis unspec
K 76.9 liver ds unspec, ut CLD, hepatoma yg tdk jelas
K 80.5 calculus of bile duct
K 80.8 other cholelithiasis
K 81 cholecystitis
K 81.9 cholecystitis unspec
M 06.9 rheumatoid arthritis, unspec
M 06.99 rheumatoid arthritis, unspec site
M 17.9 gonarthrosis ut oa genu, psd : 81.92 - inj intra artikular
M 32.9 sle, unspecified
N 17.9 ACKD, acute renal failure unspec
N 18.5 ckd st V
T 78.2 anaphylactic shock

Page 4 sri_m
PSIKIATRI
F 32.1 moderate depresive episode psd : 94.33 - behavior therapy
94.42 - family therapy (masukkan ke2 psd ini ke e-klaim
F 32.2 severe depresive (-) psychotic symptoms pd px psikiatri yg kontrol, pd billing tertulis psikoterapi oleh
spkj)
F 32.3 severe depresive (+) psychotic symptoms
F 32.9 depresi
F 34.0 cyclothemia ut bipolar ringan
F 41.9 generalized anxiety disorder
F 41.9 anxiety
F 45.9 somatoform disorder ut disfungsi otonomik somatoform
F 93.9 childhood emotional disorder unspec ggn emosional pd masa anak

CARDIO
R 00.2 palpitasi (rajal : 552.100)
E 05.9 + I 43.8 - thyrotoxic heart ds peny jantung tiroid
I 09.9 RHD/rheumatic heart ds, unspecified
I 10 ht
I 11.0 HHD + chf
I 11.9 hypertensive heart ds without congestive heart failure ut HHD
I 12.0 hypertensive renal ds with renal failure ut ckd + ht
I 13.2 HHD + CHF + CKD
I 20.0 uap
I 20.9 angina pectoris unspecified ut AP stable
I 21.3 stemi, subsequent st-elevation myocardial infarction
I 21.4 nstemi
I 25.1 atherosclerotic heart ds ut stable CAD
I 25.2 old myocardial infarction ut OMI
I 27.9 pulmonary heart failure ds, unspecified ut CPCD/ cor pulmonale chronicum ds
I 34.9 nonrheumatic mitral valve disorder, unspecified ut MR (mitral regurgitation)
I 42.0 DCM/ dilated cardiomyopathy
I 44 arterioventricular & left bundle branch block (lbbb)
I 44.2 total av block (tavb)
I 47.1 svt (rajal : 640.000)
I 48 AF, atrial fibrilation & flutter
I 49.3 VES/ ventricular premature depolarization
I 49.5 sick sinus syndrome tachycardia bradycardia syndrome
I 50.0 chf/ congestive heart ds
I 50.1 chf + odem paru
I 51.7 cardiomegaly, ut LVH 88.72 - echo
I 95.9 hipotensi

NEURO
R 42 dizziness & giddiness
B 02.2 + G 63.0 - post herpes neuralgia merup.kode degger asterix
F 03 unspecified dementia
F 95.9 tic disorder, unspecified
G 20 parkinson
G 25.8 other specified extrapyramidal & movement disorders ut rest less leg
G 31.9 degenerative ds of nervous system, unspecified ut mci/mild cognitive impairment
G 40.9 epilepsi
G 44.2 TTH/tension type headache
G 45.9 TIA
G 51.0 bell,s palsy
G 56.0 CTS (carpal tunnel's syndrome)
G 56.2 neuropati N.ulnaris
G 62.9 polineuropati
G 54.2 CRS (cervical roots syndrome)
G 70.0 myastenia gravis
G 83.9 paralytic syndrome, unspec
H 81.1 BPPV/benign paroxysmal vertigo
I 60.9 SAH unpsec
I 62.0 sdh, acute, nontraumatic
I 62.9 ich, nontraumatic, unspec SH pd rajal
Page 5 sri_m
I 63… cerebral infarc
I 63.9 snh
I 64 stroke not spec. as haemorrhage or infarction
M 13.9 arthritis unspec
M 13.1 monoarthritis
M 13.95 arthritis unspecified pelvic & tigh ut coxitis
M 47.99 spondylosis
M 51.9 HNP
M 54.39 sciatica, sindrom piriformis/ ischialgia
M 54.59 lbp
M 65.39 trigger finger unspec
M 65.4 de quarvain
M 65.9 synovitis & tenosynovitis unspec
M 75.0 adhesive capsulitis of shoulder ut frozen shoulder
M 75.4 impingement syndrome of shoulder
M 79.10 myalgia, mutiple sites
M 79.19 myalgia unspecified ut myofacial pain
N 64.4 mastodynia ut mastalgia

Page 6 sri_m
MATA
Z 96.1 presence intra ocular lens ut kontrol post phaco
secondary tindakan secondary implant pd billing psd 13.72- secondary insertion of intraocular lens prosthesy
implant H 27.0 - aphakia ( klaim : Rp 3.671.000)

H 25.9 pas op katarak terjadi komplikasi vitreous prolaps (H59.0)

KSI shg dilakukan SICS bukan phaco (small incision cataract sustruction klaim : 3.671.000 top up (-)
(13.71) & vitrektomi anterior (14.71)

10.99 - other operations on conjungtiva (pd billing : prosedur

Lithiasis H 11.1 - conjugtival degenerations & deposits lithiasis670.175), rajal -533.700
PDR E 11.3 + H 36.0 = penyakit diabetic retinopathy
neoplasm of uncertain or unknown behaviour of connective &
D 48.1 ut tumor pd eye & eyelid
other soft tissue
H 00.0 hordeolum & other deep inflammation of eyelid 10.1 - other incision of conjungtiva (Rp 533.700)
H 00.1 chalazion 08.21 - excision of chalazion
H 04.1 dry eye, other disorders of lacrimal gland
H 10.9 konjungtivitis
11.39 - other excision of pterygium, gr IV bisa ranap, selain
H 11.0 pterigium itu harus rajal
H 25.9 KSI psd : 13.41 - phaco
13.71 - IOL (tdk diinput pd phaco, hanya pada operasi katarak
yg konvensional ?)
H 26.0 juvenile cataract
13.64 - dicission of secondary membrane (after cataract), ut
H 26.4 after cataract (ut PCO/posterior capsular opacification) tindakan yag laser
psd : 14.75 - injecton of vitreous substitute, klaim
H 34.8 CRVO/ central retina vein oclusion Rp1.562.600, billing Rp 4.699.709

H 35.7 CSR/ central serous retinopathy (separation of retinal layers)

H 40.9 glaucoma psd : 89.11 - tonometry

95.26 - anel test (tonography, provocative test & other
glaucoma testing) rj-252.200
H 43.3 other vitreous opacities, ut houters
H 43.9 disorder of vitreous body, unspec
H 52… disorder of refraction 95.01 - pemeriksaan visus (rj- 192.100)
H 52.0 hypermetropia 95.02 - px mata menyeluruh (rj - 223.800, ↑31.700)
H 52.1 myopia
H 52.2 astigmatism
H 52.4 presbyopia
H 52.7 disorder of refraction unspec
H 53.1 subjective visual disturbance ut asthenopia
T 15.9 foreign body on external eye, part unspecified ut corpus alienum pd mata
psd : 98.21 - removal of superficial foreign body from eye
without incision

THT
R 49.0 disphonia (hoarseness) ut suara serak
B 36.9 + H 62.2 (otomikosis) kode degger asterix
H 60.0 abcess of external external ear
H 60.5 acute otitis externa, noninfective
H 60.9 otitis externa unspec 18.19 - endoskopi telinga
H 61.1 efusi kondrium 18.21 - aspirasi abses, rj- 412.800
H 61.2 impacted cerumen psd : 96.52 - irigasi telinga/ ekstraksi serumen
H 61.9 disorder of external ear unspec ut jaringan granulasi KAE
H 62.0 otitis externa in bacterial ds classified elsewhere
H 62.4 OE in other ds classified elsewhere, ut ranap
H 66.3 omsk
H 66.9 otitis media, unspecified
H 91.9 prebycusis penurunan pendengaran pd lansia
H 92.0 otalgia
H 93.1 tinnitus
J 00 acute nasofaringitis (common cold)
22.02 - irigasi sinus (aspiration or lavage of nasal sinus
J 01.0 acute maxillary sinusitis through nasal ostium)
J 01.9 acute sinusitis
Page 7 sri_m
J 02.9 acute pharyngitis
penambahan dx s "disfagia" (R 13), akan meningkatkan klaim,
J 03.9 acute tonsilitis dg/tanpa tindakan tonsilektomi (28.2), tp hanya berlaku ut px
anak2
J 06.0 acute laryngopharyngitis
J 06.9 URTI/ ISPA
J 31.0 chronic rhinitis
J 34.2 deviated nasal septum
J 35.0 chronic tonsillitis
J 35.9 chronic ds of tonsilitis & adenoids, unspecified
S 09.2 traumatic rupture of ear drum
T 16 foreign body of ear psd : 98.11 - removal foreign body from ear

Page 8 sri_m
PULMO
R 06.0 dyspneu
J 05.0 croup, acute obstructive laryngitis
J 18.0 bronchopneumonia, unspec
J 18.9 pneumonia, unspecified
J 20.9 acute bronchitis, unspec
J 21.9 acute bronchiolitis, unspec
J 40 bronchitis, not specified as acute or chronic
J 44.9 copd ut PPOK
J 45.9 asma attack psd : 93.94 - nebulizer
J 47 bronchiectasis
J 90 efusi pleura 34.01 - drainage cairan pleura (incision of chest wall)

BEDAH
luka cth : dx u : S 61.0 - v app. R. manus dx u : dx luka
dx s : W 25.0 - contact with sharp glass, home dx s: moi
atheroma perianal
D 48.7 - neoplasm of uncertain or unknown behaviour of other psd : 86.3 - other local excision or destruction of lesion or
specified sites tissue of skin
86.09 - other incision of skin & subcutaneous tissue (kls I - Rp
5.379.000)
tumor colli D 48.9 - neoplasm of uncertain or unknown behaviour, unspec 86.04 - other incision with drainage of skin & subcutaneous
tissue (kls I - Rp 3.978.900)
kemoterapi pd Ca
99.25 - injection or infusion of cancer chemotherapeutic
C 85.9 + non hodgkin's lymphoma, unspecified type subastance
Z 51.1 - chemotherapy session for neoplasm
CVI I 87.2 chronic venous insufficiency 38.59 - ligasi & stripping of varicose veins
I 83.9 varises kaki (pake ke2 kode jika di resume ditulis ke2 nya, ato I 83.9 + 38.59, kls I - 14.285.200, II - 12.244.400, III -
salah satu saja jika dx nya 1 saja) 10.203.700
85.4 - mastectomy, 85.71 - LD flap (latissimus dorsi
C 50.9 ca mammae myocutaneous flap), tdk meningkatkan klaim
C 71.9 malignant neoplasm, brain unspec 01.24 - craniotomy
C 73 malignant neoplasma of thyroid gland
D 11.0 benign neoplasma ut tumor parotis
D 18.0 haemangioma any site
atheroma femur (benign neoplasm, connective & other soft tissue
D 21.2 of lower limb)
D 37 - 48 neoplasm of uncertain or unknown behaviour
neoplasm of uncertain or unknown behaviour of lip,oral cavity &
D 37.0 pharynx
D 48.6 neoplasm of uncertain or unknown behaviour of breast
E 04.1 nontoxic single thyroid nodule SNT/ single nodul tiroid
I 83… varicose veins of lower ext…
I 84.9 haemmorrhoids without complicating, unspec
I 86.8 varicose veins of other specified sites
26.29 - other excision of salivary gland lesion (kls I - Rp
K 11.6 mucocele of salivary gland 7.110.600)
K 35.8 acute appendicitis, other & unspec
K 37 unspecified appendicitis ( K 35- K 36 ut other appendicitis) 47.09 - other appendictomy
K 40.9 HIL
L 02.1 abses colli (cutaneous abscess, furuncle & carbuncle of neck)
L 72.0 epidermal cyst
M 85.66 other cyst of bone, lower leg (ut traumatic cyst pd malleolus) 86.3
N 61 mastitis (inflammatory disorder of breast)
N 64.4 mastodynia/mastalgia
N 64.8 fam psd : 85.21 - ut excisional biopsi fam
Q 89.2 thyroglossal cyst
R 59.9 limfadenopati (enlarged lymph nodes, unspec)
S 01.9 open wound of head, part unspec
S 06.0 CKR (concussion)
S 49.9 unspecified injury of shoulder & upper arm ut v.app r.humerus
S 53.4 sprain & strain of elbow
S 81.9 open wound of lower leg, unspec
Page 9 sri_m
S 91.2 open wound of toe(s) with damage to nail (ut avulsi kuku tangan) psd : 86.23 - ekstraksi kuku
S 93.4 sprain & strain of ankle
T 00.9 multiple supeficial injuries, unspec/ ut multiple v.excoriatum rajal : 193.500
T 01.9 multiple open wound, unspec/ ut multiple v.appertum rajal : 136.500
ut abrasion, bruise, contusion, haematoma, insect bite
T 14.0 superficial injury of unspec body region (nonvenomous)
T 63.4 toxic effect venom of other arthropods ut insect bite
T 81.4 ILO
V ... transport accident
V 01.0 jatuh naik sepeda gayung
W… MOI/ mekanisme terluka
W 01 jatuh dari….
W 11.0 jatuh dari tangga di rumah
W 19.0 unspec fall home
W 19.2 unspec fall, school other institution & public administration area
contact with other powered hand tools & household
W 29.0 ct ut px terbentur mesin cuci di rumah
macinery,home

ORTHO
S 52 fracture of humerus 93.53 - pasang gips
S 52.50 CF distal radius
S 86.0 injury of achilles tendon
S 93.4 sprain & strain of ankle
Z 47.9 orthopaedic f.up care, unspecified

Page 10 sri_m
KULIT
ut veruka simplex/vulgaris
86.4 - radical excision of skin lesion, ut tindakan
B 07 viral warts elektrocauter (billing eletrokauter, tarif 2- 520.129), klaim :
585.100
B 35.3 tinea pedis (athelete's foot)
B 35.4 tinea corporis
B 35.6 tinea cruris
L 02.9 cutaneous abscess, furuncle & carbuncle unpsec
L 03.9 cellulitis unspec
L 20.9 atopic dermatitis, unspec
L 21.8 seborrhoeic dermatitis
L 23.9 DKA/ allergic contact dermatitis, unspecified cause
L 28.0 lichen simplex chronicus ut neurodermatitis
L 28.1 prurigo nodularis
L 40.9 psoriasis unspec sebopsoraisis
L 50.9 urtikaria unspec
L 84 corns & collasites ut clavus
L 85.1 keratoderma palmaris et plantaris
T 78.4 allergy unspec

UROLOGY
N 10 PNA / acute tubulo-interstittial nephritis 88.75 - USG urology
N 13.2 hidronefrosis with renal & uretera calculus obstruction (HN+batu) 56.0 - ut urs
N 13.3 other & unspecified hidronefrosis (ut HN)
N 20.0 batu ginjal 55.4 - ut bivalve nephrectomy
N 20.1 batu ureter
N 20.9 urinary calculus unspec
N 21.0 batu buli2 57.0 - litotripsi (bukan eswl)
N 21.1 batu urethra
N 31.9 neuromuscular dysfunction of bladder, unspec ut neurogenic bladder
N 39 ISK/ urinary tract infection, site not specified UL, leukosit ≥ 10/lpb (SE dx no 60)
N 40 bph 60.29 - ut turp
N 41.9 inflammatory ds of protate unspec
N 43.3 hydrocele 63.1 - ut hidrocelectomy
N 44 torsio testis
N 45 ortchitis (epididymitis & epididymo-orchitis)
..0 with abcess ..9 without abcess
N 47 redundant prepuce, phimosis & paraphimosis 57.94 - pasang D&C
R 33 retention urine psd : 97.64 - aff dc

KODE Z
Z 03.9 observation for suspected ds or condition, unspecified ut dx susp
Z 09.0 kontrol post op for other conditions
Z 09.8 px kontrol ke poliklinik
Z 35.9 supervision of high pregnancy unspecified ut kontrol kehamilan
Z 39.1 care & examination of lactating mother
Z 39.2 kontrol post sc
Z 09.4 f.up fracture
Z 47.9 orthopaedic f.up care, unspecified
Z 49.1 extracorporial dyalisis ut dx u hd reguler

ut px batal op atas alasan medis namun dpt dilakukan tx

Z 53.0 procedure not carried out because of contraindication rawat jln/pulang maka dpt ditagihkan ranap dg kode Z 53.0
(pmk 76 th 2016 hal 57)

Z 54.8 convalescence px mrs dg perbaikan ku saja, kls I 1.696.800

Z 96.1 presence intraocular lens ut kontrol post phaco + iol

RAJAL (tdk bisa ut ranap)

R 00.2 palpitasi
R 04.0 epistaxis
R 04.2 hemoptoe
R 06.0 dyspneu
R 07.4 chest pain

Page 11 sri_m
R 09.0 asphyxia (ut hipoksia)
R 10.4 abd.pain
R 11 nausea & vomiting
R 18 ascites
R 25.2 cramp & spasm
R 25.8 involuntary movement
R 30.0 dysuria
R 31 hematuri
R 33 retensio urine
R 42 dizziness & giddiness
R 49.0 disphonia (hoarseness) ut suara serak
R50.9 fever
R 51 headache
R 53 malaise & fatigue
R 55 syncope & colapse
R 63.8 other symptoms & sign concerning food & fluid intake ut low intake

Page 12 sri_m
PROSEDUR (ICD 9)
01.24 other craniotomy
01.28 placement of intracerebelar catheter (s) via burr hole (s)
08.21 excision of chalazion
10.99 other operations on conjungtiva (billing : lithiasis)
11.39 other excision of pterygium
13.41 phacoemulsification & aspiration of cataract top up +
13.64 dicission of secondary mambrane (after cataract) ut tindakan yag laser
13.71 IOL (tdk diinput pd phaco, hanya pd op katarak konvensional)
13.72 secondary insertion of intraocular lens prosthesy ut tindakan secondary implant
14.34 repair of retinal tear by laser phtocoagulation/ laser retina barrage
repair of retinal detachment with laser photocoagulation/ laser
14.54 ut laser retina di billingan (klaim : 811.800)
retina PRP
14.75 inj of vitreous substitute
18.19 endoskopi telinga
18.21 aspirasi abses pd efusi kondrium, rj - 412.800
irigasi sinus (aspiration or lavage of nasal sinus through nasal
22.02 ostium)
26.29 other excision of salivary gland lesion (kls I - Rp 7.110.600)
28.2 tonsilektomi without adenoidektomi
33.23 other bronchoscopy
34.91 thoracentesis (tindakan ut efusi pleura)
38.95 double lumen ut HD
39.27 av shunt (arteriovenostomy for renal dialysis)
39.42 revision of arteriovenous shunt for renal dialysis revisi av-shunt
39.43 removal av-shunt for renal dyalisis
39.50 ut percutaneus transluminal angioplasty/PTA
39.95 prosedur HD
47.09 other appendictomy
55.4 partial nephrectomy ut bivalve nefrectomy
56.0 transurethral removal of obstruction from ureter & renal pelvis ut URS
56.2 ureterotomy → tindakan ureterolitotomi pd batu ureter
57 litotripsi (bukan eswl)
57.94 pasang D & C
60.29 other transurethral prostatectomy ut turp
63.1 excision of varicocele & hydrocele of spermatic cord ut hidrocelectomy
65.93 manual rupture of ovarian cyst ut kistektomi
65.99 drilling ovarian biasanya tindakan dilakukan sekaligus pd saat sc
66.39 other bilateral destruction or occlusion of fallopian tubes ut steril/mow
67.32 kauterisasi/destruction of lesion of cervix by cauterization (I-5.040.600)
68.29 miomektomi (other excision or destruction of lesion of uterus) 68.29 = 68.49 tanggungan klaimnya, kls I 8.929.000
68.49 TAH/BSO (other & unspec total abdominal hysterectomy) kls II 7.653.400, kls III 6.377.900
72.79 vacuum extraction
73.59 other manually assisted delivery ut lahir spontan
81.92 inj of therapeutic substance into joint or ligament inj intra artikular
85.21 local excision of breast ut excisional biopsi mammae
85.4 mastectomy + 85.71-LD flap (latissimus dorsi myocutaneous flap) tdk meningkatkan klaim
86.04 other incision with drainage of skin & subcutaneous tissue kls I - 3.978.900
explorasi v.ictum (incision with removal of foreign body from skin
86.05 & subcutaneous tissue)
86.09 other incision of skin & subcutaneous tissue kls I - 5.379.000
explorasi v.ictum (excisional debridement of wound, infection or
86.22 burn)
86.23 ekstraksi kuku
86.3 other local excision or destruction of lesion or tissue of skin ut excisional biopsi (biopsi tdk dikoding/di klaim kan)
86.4 radical excision of skin lesion tindakan electrocauter veruka simplex/vulgaris
86.59 suture ut hecting
87.44 routine chest x-ray so described
88.19 BOF, other x-ray of abdomen
88.23 x ray wrist & hand
88.27 x ray thigh, knee & lower leg
88.48 arteriography of femoral & lower ext arteries (ut venography)
88.71 usg of head & neck, termasuk usg colli
88.72 ultrasound of heart ut echo
Page 13 sri_m
88.73 usg thorax ut usg mammae
88.75 usg urology
88.76 usg abdomen & retroperitoneum
88.78 usg of gravid uterus
88.79 other usg : musculoskeletal, usg transvagina, nongravid uterus
89.11 tonometry
89.37 spirometri/ vital capacity determinator
89.41 treadmill test
89.52 ECG
93.57 aplication of other wound dressing ut rawat luka
93.90 cpap
93.94 nebulizer
93.96 O2
95.01 pemeriksaan visus mata (rj-192.100, sama spt tanpa prosedur)
95.02 pemeriksaan mata menyeluruh (rj - 223.800, ↑31.700)

ut funduskopi (klo ada tonometry/89.11 & funduskopi/95.11,

95.11 fundus photography pakai 95.11 →252.200. klo pake 89.11 →223.800)

95.12 fluorescein angiography or angioscopy of eye ut fluorescein tes (top up + 378.300 →630.500)
95.26 anel test (tonography, provocative test & other glaucoma testing)
96.33 gastric lavage/ kumbah lambung
96.44 vaginal douche
96.52 irigasi telinga
96.71 ventilator < 96 jam
96.72 ventilator > 96 jam
97.38 aff hecting from head & neck
97.43 removal suture from thorax
97.64 aff dc
97.83 removal abdominal wall suture
97.84 removal suture from trunk, not elsewhere classified
97.88 removal of external immobilization device/ buka cast
93.94 nebulizer
98.11 removal foreign body from ear
98.21 removal of superficial foreign body from eye without incision
99.04 transfusi PRC
99.05 transfusi platelet
99.07 transfusi albumin behring
99.25 injection or infusion of cancer chemotherapeutic subastance
99.6 cpr, nos ut rjp
99.83 fototerapi

Page 14 sri_m