Kode Diagnosa ICD 10

No

Deskripsi

Ibu

Kode

Diagnosa

O14.0

PER/ Moderate Pre Eclamsia

O14.1

PEB/ Severe Pre Eclamsia

O42.0

KPD -24 Jam

O42.1

KPD +24 Jam

O63. 9

PFL

O63. 9

PFA

O34.2

SC Riwayat SC

O75.7

Spontan Riwayat SC

O30.0

Gemelly

O48

Post Date

O66.9

Gagal Drip

O43.2

Placenta Accreta

O43.8

Placenta Other Dissorder

O44.0

PP/ Placenta Previa Tak Berdarah

O44.1

PP/ Placenta Previa Berdarah

O33.8

CPD/ Chepalo Pelvis Disporposional

O85

Sepsis

O24.9

Diabetes Ibu Hamil

O36.8

Ibu Rawat Inap Hamil

O10.9

Hypertensi Ibu Persalinan

O12.2

Oedema Portio

N75.8

Bartholinitis

O36.4

IUFD Ibu

O60.1

Persalinan Prematur

O36.5

IUGR Ibu

O32.1

Letsu Ibu

O32.2

Letli Ibu

Q35.0

Anencepalus Ibu

O66.2

Bayi Besar Ibu

O03

Spontan Abortion

O04

Medical Abortion

O47.0

False Labour Before 37 Weeks

O47.1

False Labour After 37 Weeks

O32.0

Maternal Care For Unstable Lie

O99.0

Anemia Komplikasi Ibu Hamil

O33.8

Cephalopelvic Disproportion

O21.0

Hyperemesis Gravidarum

O70.1

Rupture Perineum

O86.8

Puerperal Infection

O41.0

Oligohidramnion

O68

Fetal Distress

O25

Malnutrusi Ibu Hamil

O00.8

Kehamilan Ektopik Terganggu

O43.8

Other Placental Disorders

Metode

S31.4

Open Wound Of Vagina & Vulva

O61.0

Failed Medical Forceps

O80.0

Spontaneous Vertex Delivery

O80.1

Spontaneous Brach Delivery

O81.4

Vacuum Extractor Delivery

O82.0

Delivery by Elective SC

O82.1

Delivery by Emergency SC

O84.0

Multiple Delivery, All Spontaneous

O84.1

Multiple Delivery, All Vacuum

O84.2

Multiple Delivery, All by SC

Outcome Delivery Z37.0

Single Live Birth

Z37.1

Single Still Birth

Z37.2

Twins, Both Live Born

Z37.3

Twins, One Live Born & One Still Born

Z37.4

Twins, Still Born

Z37.5

Other Multiple Birth, All Live Born

Z37.6

Other Multiple Birth, Some Live Born

Z37.7

Other Multiple Birth, All Still Born

Z37.9

Other Multiple Birth, Unspesified

O02.0

BO/ Blighded Ovum

O02.1

Missed Abortus/ Abortus Imminens

O02.8

Dead Conceptus

O20.8

Perdarahan Awal Kehamilan

O46.8

Perdarahan Sebelum Persalinan

O72.0

Perdarahan Akreta Plasenta

O72.2

Perdarahan Post Partum

O73.1

Sisa Placenta tanpa Perdarahan

O05.4

Abortus Incomplete

P21.0

Asphyxia Berat

P21.1

Asphyxia Sedang

P21.1

Asphyxia Ringan

P59.8

Ikterus

P24.8

Pneumonia Bayi/ Aspirasi

Q42

Atresia Ani

P07.3

Prematur

P05.9

IUGR Anak

P07.1

BBLR

P80

Hypotermi/ Cost Mahal RS Type B

P81.0

Hypertermi/ Cost Mahal RS Type B

P95

IUFD

K59.3

Megacolon

Q69.9

Polyductily

Curretage

Bayi

Q03.9

Hydrochepalus

P01.7

Letsu Bayi

P03.1

Letli Bayi

P02.4

Tali Pusat Menumbung

Q00.0

Anencepalus Bayi

P28.4

Apnea Bayi

P24.1

Aspirasi Pnemonia Bayi

Z33

Bayi Belum Lahir

P08.0

Bayi Besar

P92.2

Bayi Kurang Minum

P95

Bayi Mati

P03.3

Bayi Lahir Vakum

P03.4

Bayi Lahir SC

P12.0

Cepalhematoma Bayi

P91.5

Koma Bayi

P78.3

Diare Bayi Baru Lahir

P03.6

Drip Bayi Normal

P20.1

Fetal Bayi

P54.8

Hematoma Bayi

Q03.0

Hidrocepalus Bayi

P01.3

Hidrom Neos Bayi

P70.4

Hipoglikemia Bayi

P21.9

Hipoksia Bayi

P54.1

Melena Bayi

P37.5

Monoliasis Bayi

P94.0

Mysatenia Gravis Bayi

P03.1

Obstruksi Anus (Bawaan Lahir)

P51.9

Perdarahan Tali Pusat Bayi

P25.2

Pnemonia Deastinum Bayi

P55

Penyakit Hemolitik Janin/ Bayi

P02.0

Placenta Previa Bayi

P54.2

Rectal Bleeding Bayi

P22.9

Respiratory Distress Bayi

P28.5

Respiratory Failure Bayi

P36.8

Bacterial Sepsis of Newborn

R95

Sindrom Mendadak Bayi

P01.5

Gemelly Bayi

P01.1

Fetus & Newborn Affected Cervix

P36.1

Bayi Panas/ Febris

P00.0

Bayi Dipengaruhi Hipertensi Ibu

P02.0

Bayi Dipengaruhi Plasenta Previa

P08.2

Bayi Postdate

P03.8

Bayi Dipengaruhi Komplikasi Ibu

Q02

Microcephaly

Q43.1

Hirschsprung Disease

Live Born

Umum

Z38.0

Singleton, Born in Hospital

Z38.1

Singleton, Born Outside in Hospital

Z38.2

Singleton, Unspesific of Birth

Z38.3

Twin, Born in Hospital

Z38.4

Twin, Born Outside in Hospital

Z38.5

Twin, Unspesific of Birth

Z38.6

Other Multiple, Born in Hospital

Z38.7

Other Multiple, Born Outside Hospital

Z38.8

Other Multiple, Unspesific of Birth

A91

Demam Berdarah/ DHF

I84

Haemorrhoids

A90

Dengue Fever/ DF

A01.0

Thypoid Fever

R07.3

Chest Pain

G93.4

Encephalopathy

K65.0

Peritonitis Akut

M13.8

Other Specified Arthritis

R50.9

Demam/ Febris

D61.8

Pancytopenia

J06.9

ISPA

D56.8

Other Thalasemia

J00

Common Cold/ Nasofaringitis

K12.1

Stomatitis

J02.9

Faringitis

J03

Tonsilitis Akut

R05

Hiperaktif Bronkus/ Batuk

A15.8

TBC/ KP (Koch Pulmonal)

A18.3

Peritonial TB

K30

Dispepsia

K27.7

Ulkus Peptikum

R11

Mual/ Muntah/ Vomiting

R10.4

Nyeri Perut/ Abdomen

J46

Asma Akut

J45.9

Asma

R51

Headace/ Cephalgia

H52.1

Myopi

S50

Contusio Elbow (Siku Lecet)

S01.4

Luka Lecet Pipi

K36

Apendicities Kronis

K35.0

Apendicities Akut

K35.1

Apendicities Akut Perforasi

I10

Hypertensi/ HT Grade I/ Primer

I15.8

Hypertensi/ HT Grade II/ Sekunder

I20.9

Angina Pectoris

I50.9

Jantung

R00.1

Brachicardia

I21.9

Infark Myocard Akut

A37.0

Batuk

E88.0

Disorders Plasma Protein Metabolism

J11.1

Flu

J44.8

PPOK/ COPD

R58

Haemorrhage

G47.9

Insomnia

H26.8

Katarak

H26.2

Katarak Sekunder/ OD

H40.2

Glaucoma Acute

S06.0

COR/ COS/ CKR/ CKS

S09.8

COB

K59.0

Konstipasi

L02.8

Benjolan Ketiak

J18.8

Pneumonia

J18.0

Bronkopnemonia

J20.8

Bronkitis Akut

J40

Bronkitis

I63.8

CVA infark

I63.6

CVA Trombolik

F48.8

Neurosis Psikosa

I50.9

Decomp Cordis

K75.9

Hepatitis

E10.1

DM Insulin Ketoasidosi

E10.8

DM Insulin

E11.8

DM Non Insulin

E14.8

Unspesific Complication DM

K90.8

Malabsorbsi Usus

K62.5

Hemoroid

K56.7

Ileus Obstruksi

K56.1

Intussusception

S61.8

Open Wound Wrist & Hand

B34.8

Other Viral Infection

A09

Gastroenteritis Akut

K29.6

Gastritis Perdarahan

K29.1

Gastritis Akut

K29.5

Gastritis Krnonis

H81.4

Vertigo

L91.8

Keloid

D17.7

Lipoma

H44.0

Endopthalmitis

R56.0

Febris Convulsi

G03.8

Meningitis

K36

Apendik Kronis

D25

Myoma Uteri

N83.2

Cysta Ovarium

L03.8

Selulitis Unspesifik

L03.0

Selulitis Kaki

N40

BPH

N20.0

Calculus Of Kidney/ Nephrolithiasis

N20.1

Calculus Of Ureter

N21.0

Calculus In Bladder

N13.2

Hydronephrosis

N19

Kidney Failure

N11.8

Pyelonephritis

N30.1

Interstitial Cystisis

N35.8

Strikture Urethra

N39.8

Urinary Tract Infection

R33

Retensio Urine

N49.8

Inflammatory Male Genital

I25.8

Iskemik Kronis/ Jantung

I25.2

Old Myocard Acute

I95.8

Hipotensi

H16.0

Ulkus Kornea/ Keratitis

N13.2

Hidroneprosis

S02.4

Fraktur Maxilaris

S02.0

Fraktur Cranii

S06.2

Contusio Cerebri

K92.1

Melena

K40.3

Hernia

K40.9

HIL

H11.0

Pterygium

S51.8

Luka Terbuka Tangan

S93.3

Dislokasi Kaki

S91.3

Luka Terbuka Kaki

C67.9

Carcinoma Bladder/ Buli

T31.8

Terbakar 80%

A41.8

Sepsis

M70.5

Bursitis

S32.0

Fraktur Lumbar

S01.0

Luka Lecet Pelipis Kepala

L30.8

Dermatitis

R73.9

Hiperglikemia

E16.1

Hipoglikemia

J90

Efusi Pleura

R57.8

Shock

C50.9

Fibroadenomatosis

N90.8

Disorder Vulva & Perineum

D69.3

Ideopatic Trombocytopenia Purpuralis

M66.4

Rupture Tendon

L89.0

Ulkus Diabetikum

E04.8

Nontoxic Goitre

K80.8

Other Cholelithiasis

S98.4

Amputasi Kaki

T01.8

Vulnus Appertum

E86

Dehidrasi Berat

R57.1

Hypovolaemic Shock

R06.0

Dyspnea

S82.7

Fracture Tibia & Fibula

S62.7

Fracture Finger

S42.0

Fracture Clavicle

S52.4

Fracture Radius & Ulna

D50.8

Anemia

I25.1

Penyakit Jantung Koroner

G51.0

Bell Palsy

R04.2

Haemoptysis

J31.0

Chronic Rhinitis

M67.4

Ganglion

K76.0

Fatty Liver

E05.9

Thyrotoxicosis

R02

Gangren

M79.1

Myalgia

J01.8

Sinusitis

J33.9

Polip Nasal

S01.1

Laserasi Mata

S01.3

Laserasi Telinga

G83.0

Diplegia

D06.9

Carcinoma Cervix

M10.9

Gout

K91.8

Other Post Procedural Disorders Of Digestive

M96.8

Musculoskeletal Disorders

C22.7

Carcinomas Liver

G70.0

Myasthenia Gravis

Kontrol/ Periksa Z00.0

General Check Up

Z01.2

Periksa Gigi

Z01.3

Periksa Tekanan Darah

Z01.6

Periksa Radiologi

Z01.7

Periksa Laboratorium

Z02.0

Periksa Kesehatan untuk Pendidikan

Z02.1

Periksa Kesehatan untuk Kerja

Z03.0

Observasi Suspek TBC

Z03.1

Observasi Suspek Neoplasma

Z03.8

Observasi Suspek Penyakit Lainnya

Z04.0

Observasi Alkohol/ Narkoba

Z04.1

Periksa Akibat Kecelakaan di Jalan Raya

Z04.2

Periksa Akibat Kecelakaan Kerja

Z04.3

Periksa Akibat Kecelakaan Lainnya

Z08.0

Kontrol Setelah Operasi Neoplasma

Z08.2

Kontrol Setelah Kemoterapi

Z09.0

Kontrol Setelah Operasi

Z09.8

Kontrol Setelah Rawat Inap

Z09.4

Kontrol Setelah Patah Tulang

Z39.2

Kontrol Post Partum

Z87.6

Kontrol Bayi Post MRS

Z00.1

Kontrol Bayi Sehat

Z30.2

Sterilisasi (MOW)

Z03.1

Observasi Neoplasma

Z35.9

Periksa Sebelum Curettage

Z35.8

Primi Tua Primer

Z35.5

Primi Tua Sekunder

Z35.6

Primigravida < 17 th

Z34.8

Pemeriksaan Kehamilan

Z24

Imunisasi

Z01.0

Periksa Mata

Z30.0

Konsultasi Kontrasepsi

Z93

Colostomy Kontrol

Z23

Vaksinasi

F43.9
G52.6
E78.5
G62.9
K02.1
K04.0
I61.9
H52.0
H52.1
H93.1

Stres tidak diketahui penyebapnya

Tic Facial
Dyslipidemia
Neurophaty/Polyneurophaty
Carries of dentin
Pulpitis
ICH
Hypermetrophia
Myopia
Tinitus

J45.9
R50.9
K30
K29.1
K29.5
K29.7
I10
I25.1
I50.0
N40
I11.0
I11.9
M54.5
N18.0
J44.0

Asma
Fever / Febris ( Of )
Dyspepsia
Gastristis Akut
Gastristis Kronik
Gastritis
Hypertension ( Ht )
Atherosclerotic Heart Disease ( Pjk )
Congestive Heart Failure ( Chf )
Hyperplasia Of Prostate (Bph)
Hypertensive Heart Failure ( Hhf )
Hypertensive Heart Disease ( Hhd)
Low Back Pain ( Lbp )
Esrd, Ckd, Ggk
Ppok

A16.0
A01.0
M15.4
G20
F20.9
F48.9
H52.0
H52.1
H52.4
H52.6
K02.1
K04.0
K04.1
K05.0
K05.1
K05.2
K05.3

Tb Paru
Typhoid Fever ( Tf )
Erosive (Osteo)Arthrosis ( Oa )
Parkinson's Disease
Schizophrenia
Neurotic Disorder
Hypermetropia
Myopia
Presbyopia
Disorder Of Refraction/ Gangguan Mata
Carries Of Dentine
Pulpitis
Necrosis Of Pulp
Acute Gingivitis
Kronik Gingivitis
Acute Peridontitis
Kronik Peridontitis

Keterangan
Pre Eklamsi Sedang
Pre Eklamsi Berat
Ketuban Pecah Dini
Ketuban Pecah Dini
Pro-long Fase Laten
Pro-long Fase Aktif

Kembar
Lebih bulan
Gagal Rangsang
Plasenta Lengket di Rahim
Placenta Letak Rendah
Marginalis
Pinggul Sempit
Ibu Hamil

HT

Ibu kurang dari < 37 mgg

Intra Uterine Growth Retardation
Oblique

Aborsi Spontan
Aborsi
Medis
Persalinan
Palsu Kurang 37
Minggu
Persalinan Palsu Lebih 37 Minggu
Perawatan Ibu Persalinan Palsu
CPD
HEG
Robek/ Laserasi Perineum
Infeksi Pasca Persalinan

KEK/ Kekurangan Energi Kronis

KET/ HDK
Plasenta Letak Rendah

Robekan Jalan Lahir/ ROJ

Gagal Drip/ Induksi
Persalinan
Persalinan Normal
Letak Sungsang/
Lintang
Persalinan Vakum
Persalinan SC Terencana
Persalinan
Darurat
Persalinan SC
Multipel,
Spontan
Semua
Persalinan Multipel, Vakum
Semua
Persalinan Multipel, SC Semua
Lahir Satu Hidup
Lahir Satu Mati
Lahir Kembar Hidup Semua
Lahir Kembar, 1 Hidup 1 Mati
Lahir Kembar Mati
Lahir
Semua
Lahir Lebih
Lebih dari
dari 2,
2, Hidup
Beberapa
Hidup
Lahir Lebih dari 2, Hanya Lahir
Saja
Lahir Lebih dari 2, Tidak Spesifik

HPP
Retensio Plasenta

Bayi Kebiru"an Berat (AS 0-3)

Bayi Kebiru"an Sedang (AS 4-7)
Bayi Kebiru"an Ringan (AS 4-7)
Bayi Kuning
Tersedak
Tidak Punya Anus
Kelahiran bayi < 28 mg
Kelahiran bayi < 2500 gram
Suhu tubuh terlalu dingin
Suhu tubuh terlalu panas
bayi keluar mati apapun

Letak Sungsang
Letak Lintang
Tali Pusat Keluar Lebih Dulu

Inpartu

Sepsis/ Infeksi Bakteri

Bayi Dipengaruhi KPD

PER/ PEB

PFL/ PFA
Tidak Ada Batok Kepala
Megacolon Bayi

Lahir Satu diluar Rumah Sakit

Lahir Satu Tidak Spesifik
Lahir Kembar di Rumah Sakit
Lahir Kembar diluar Rumah Sakit
Lahir Kembar Tidak Spesifik
Lahir
Rumah
Sakit
Lahir Lebih
Lebih Dari
Dari 2
2 di
diluar
Rumah
Sakit
Lahir Lebih Dari 2 Tidak Spesifik

Wasir
Demam Tipes
Dada Sesak

Artritis
Panas

Masuk Angin

TB Paru
Gangguan Pernapasan

Cholic Abdomen
Bronchiale
Pusing
Rabun Jauh

Darah Tinggi

Brakikardi
OMI
Hypoalbumin
Paru Menahun
Perdarahan
Susah Tidur
Chatarac Secondary to Occular
Disorders
Glukoma
Cidera Otak Sedang/ Ringan
Cidera Otak Berat
Sembelit

Stroke
Gangguan Psikologi Syaraf
Gagal Jantung
KAD
Type I
Type II
Koma Asidosis Diabetik/ KAD
Wasir
Invaginasi
Luka Robek Pada Tangan
Mencret/Diare/ GEA/ GEADS

Benjolan
Mata Sakit
Kejang

Kista Ovarium

Prostat
Batu Ginjal
Batu Ureter
Batu
BBB Batu
GinjalKandung
Bengkak/Kemih/
HN/ Akibat
Ginjal
Gagal Ginjal
Kantong Kemih Sakit
Stenosis
ISK/ UTI

DM
Ulcer Cornea

Hernia Inguinalis

Combustio Degree 80%

Empisema
Kanker Payudara/ FAM

Tendon Putus

Struma/ Gondok

Sesak Nafas/ Nafas Pendek

Jari
Patah Tulang Belikat
Antebrachii
PJK
Batuk Darah

Sakit Hati
Hyperthyroidism

Luka Mata
Luka Telinga

Asam Urat
Post Kolostomi, Hernia, Ileus
Jaringan Lunak
Hepatoma

Rontgen/ Ronsen

Mabuk/ Mendem/ Oplosan

Tabrakan
Kejatuhan Genting

Jatuh di Toilet
Kista
SC/ BPH/ dll
Post DHF/ ISPA/ dll
Partus Normal
Ikterus/ Aspiksia

Usia Ibu > 35 th

KB
Operasi membuat saluran untuk
BAB

Kode Tindakan ICD 9 CM

NO

Kode

73.59

73.4

73.3

73.6

72.71

72.54

74.3

74.1

66.39

10

69.02

11

69.09

12

68.9

13

49.49

14

75.99

15

93.94

16

03.02

17

01.24

18

02.01

19

80.92

20

47.09

21

54.11

22

86.09

23

86.99

24

99.1

25

64

26

13.9

27

88.78

28

88.76

29

87.43

30

93.53

31

87.4

32

18.01

33

99.03

34

75.4

35

53.9

36

62.5

37

85.6

38

66.4

39

86.22

40

86.59

41

96.59

42

93.51

43

79.0

44

75.69

45

22.9

46

70.79

47

46.10

48

83.99

49

83.81

50

86.04

51

18.4

52

86.11

53

84.12

54

95.31

55

89.11

56

11.29

57

16.29

58

13.9

59

12.64

60

60.29

61

57.49

62

96.25

63

56.74

64

57.32

65

59.8

66

97.65

67

56.31

68

57.85

69

58.0

70

58.5

71

98.51

72

55.11

73

64.99

74

34.04

75

34.73

76

99.3

77

06.4

78

67.12

79

83.99

80

78

81

79

82

79.6

96.59

Kode Tindakan ICD 9 CM

Metode/ Tindakan
Other Manually Assisted Delivery/ Partus Normal
Medical Inducing/ Rangsang
Failed Forcep/ Gagal Drip
Episiotomy Vagina
Vakum & Episotomy
Brach Delivery
Operation Ectopic Pregnancy
Sectio Secarean
Oklusi Tuba Falopi/ Tutup Hamil
Curretage Following Delivery
Curretage Following Cysta
Hysterectomy
Haemorrhoids
Other Obstetric Operation
Nebulizer
Laminectomy
Other Craniotomy
Cranioplasty
Excision Elbow
Appendictomy
Exploratory Laparotomy
Other Incision Of Skin & Subcutaneous Tissue
Other Operations Of Skin & Subcutaneous Tissue
Injection
Circumcisi
Operasi Katarak
USG Ibu Hamil
USG Abdomen
Rontgen Clavicula
Application Of External Fixation Device
Rontgen Thorax
Tindik Bayi
Transfusi Darah
SC Other Spesific Type
Repair Hernia
Orciopexy
Mastectomy
Salpingectomy
Debridement Of Wound
Jahit Luka
Other Irrigation Wound
Pasang Jacket Plester
Close Fracture Fixation
Perineotomy

Operation Nasal Sinuses

Repair Vagina
Colostomy
Incisi Pada Kaki
Tendon Graft
Incisi & Drainase
Operasi Kecil Keloid di Telinga
Biopsy
Amputation Of Through Foot
Fitting & Dispensing of Spectales
Tonometry
Other Diagnostic Procedures Cornea
Other Diagnostic Procedures Orbit & Eyeball
Operation Of Lens
Trabeculectomy
Transurethral Prostate/ TURP
Transurethral Bladder/ TURB
Therapeutic Distention Of Bladder
Ureteroneocystostomy/ URS
Other Cystoscopy
Ureteral Catheterization/ Pasang DJ Stent
Removal Of Urethral Stent/ Lepas DJ Stent Ginjal
Uretroscopy
Urethroplasty
Urethrotomy/ Sachse
Urethral Stricture
Lithotripsi
Pyelotomy/ Menghancurkan Batu Ginjal
Operation Genital Organ
Insertion Of Intercostal Catheter For Drainage
Closure Of Thoracostomy
Vaccinatioin
Thyroidectomy
Biopsy Cervix
Other Operation Muscoloskeletal
Lepas Plate
Open Reduction & Internal Fixation
Debridement Ortho
rawat luka

CM
Keterangan
Persalinan Normal
Pemberian Rangsangan Persalinan
Gagal Dirangsang
Persalinan Vakum/ VE
Persalinan Sungsang
KET
Operasi Sesar/ SC
MOW
Kiret Kehamilan
Kiret Kista
Wasir
Operasi Lain Selain Persalinan
Pengasapan
Bedah Syaraf Spinal
Trepanasi
Bedah Syaraf Kepala
Eksisi Siku Tangan
Usus Buntu
Insisi Jaringan Lunak
Operasi Jaringan Lunak
Injeksi/ Suntik
Sunat
Ultrasonografi
Ronsen Tulang Belikat
Pasang Ransel, Gipsum
Ronsen Dada
Whole Blood
Hernioplasthy/ Herniotomy
Angkat Payudara
Pengangkatan Tuba Falopi
Heacting
Kontrol Jahitan Post Bedah/ SC

Sinusitis/ Polip/ Nasal

Menyambung Tendon
I&D
PA
Amputasi Sekitar Kaki

Tindakan Mata

Tindakan Urologi

Water Selaed Drainage/ WSD

Menusuk Jarum di Dada
Vaksinasi/ Imunisasi
Tiroid/ Struma

Pasang/ Angkat Pen/ Orthopedi

Top Up Specia
No

List Item Special CMG

Tipe Special CMG

Koefisien Top Up

Tumor Pineal - Endoskopy

Special Procedure

0.5

Hip Replacement/ Knee Replacement

Special Procedure

0.5

PCI

Special Procedure

Keratoplasty

Special Procedure

Pancreatectomy

Special Procedure

Repair Of Septal Defect Of Heart

Renal Transplantation

Special Procedure

Special Procedure

Stereotactic Surgery & Radiotheraphy Special Procedure

Torakotomi

Special Procedure

10

Lobektomi/ Bilobektomi

Special Procedure

11

Air Plumbage

Special Procedure

12

Timektomi

Special Procedure

13

Vitrectomy

Special Procedure

14

Phacoemulsification

Special Procedure

15

Microlaringoscopy

Special Procedure

16

Cholangiograph

Special Procedure

Top Up Special Procedure

Kode INA CBG's

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Jalan

Prosedur Rawat Jalan

Prosedur Rawat Jalan

ocedure
Kode ICD 9 CM
0713 Biopsy of pituitary gland, transfrontal approach Class I
0715 Biopsy of pituitary gland, unspecified approach Class I
0717 Biopsy of pineal gland Class I
0751 Exploration of pineal field Class I
0752 Incision of pineal gland Class I
0753 Partial excision of pineal gland Class I
0754 Total excision of pineal gland Class I
0759 Other operations on pineal gland Class I
0761 Partial excision of pituitary gland, transfrontal approach Class I
0762 Partial excision of pituitary gland, transsphenoidal approach Class I
0763 Partial excision of pituitary gland, unspecified approach Class I
0764 Total excision of pituitary gland, transfrontal approach Class I
0765 Total excision of pituitary gland, transsphenoidal approach Class I
0768 Total excision of pituitary gland, other specified approach Class I
0769 Total excision of pituitary gland, unspecified approach Class I
0771 Exploration of pituitary fossa Class I
0772 Incision of pituitary gland Class I
0779 Other operations on hypophysis Class I
8151 Total hip replacement Class I
8152 Partial hip replacement Class I
8153 Revision of hip replacement, NEC Class I
8154 Total knee replacement Class I
8155 Revision of knee replacement, NEC Class I
8156 Total ankle replacement Class I
8162 Fusion or refusion of 2-3 vertebrae Class I
8163 Fusion or refusion of 4-8 vertebrae Class I
8164 Fusion or refusion of 9 or more vertebrae Class I
8426 Foot reattachment Class I
8427 Lower leg or ankle reattachment
3541 Enlargement of existing atrial septal defect Class II
3596 Percutaneous valvuloplasty Class II
3604 Intracoronary artery thrombolytic infusion Class II
3605 Multiple vessel (percutaneous) transluminal coronary angioplasty (pt Class II
3606 Insertion of non-drug -eluting coronary artery stent(s) Class II
3607 Insertion of drug-eluting coronary artery stent(s) Class II
3609 Other specified removal of coronary artery obstruction Class II
3726 Catheter based invasive electrophysiologic testing Class II
3727 Cardiac mapping Class II
3734 Excision or destruction of lesion or tissue of heart, other approach Class
111 Incision of cornea Class II

1151 Suture of corneal laceration Class II

1152 Repair of postoperative wound dehiscence of cornea Class II
1153 Repair of corneal laceration or wound with conjunctival flap Class II
1159 Other repair of cornea Class II
1160 Corneal transplant, not otherwise specified Class II
1161 Lamellar keratoplasty with autograft Class II
1162 Other lamellar keratoplasty Class II
1163 Penetrating keratoplasty with autograft Class II
1164 Other penetrating keratoplasty Class II
1169 Other corneal transplant Class II
1171 Keratomeleusis Class II
1172 Keratophakia Class II
1173 Keratoprosthesis Class II
1174 Thermokeratoplasty Class II
1175 Radial keratotomy Class II
1176 Epikeratophakia Class II
1179 Other reconstructive surgery on cornea Class II
1192 Removal of artificial implant from cornea Class II
1199 Other operations on cornea Class II
1200 Removal of intraocular foreign body from anterior segment of eye, no Class II
1201 Removal of intraocular foreign body from anterior segment of eye wit Class II
1202 Removal of intraocular foreign body from anterior segment of eye wit Class II
1211 Iridotomy with transfixion Class II
1212 Other iridotomy Class II
1213 Excision of prolapsed iris Class II
1214 Other iridectomy Class II
1221 Diagnostic aspiration of anterior chamber of eye Class II
1222 Biopsy of iris Class II
1229 Other diagnostic procedures on iris, ciliary body, sclera, and anter Class II
1231 Lysis of goniosynechiae Class II
1232 Lysis of other anterior synechiae Class II
1233 Lysis of posterior synechiae Class II
1234 Lysis of corneovitreal adhesions Class II
1235 Coreoplasty Class II
1239 Other iridoplasty Class II
1240 Removal of lesion of anterior segment of eye, not otherwise specifie Class II
1241 Destruction of lesion of iris, nonexcisional Class II
1242 Excision of lesion of iris Class II
1243 Destruction of lesion of ciliary body, nonexcisional Class II
1244 Excision of lesion of ciliary body Class II
1251 Goniopuncture without goniotomy Class II
1252 Goniotomy without goniopuncture Class II

1253 Goniotomy with goniopuncture Class II

1254 Trabeculotomy ab externo Class II
1255 Cyclodialysis Class II
1259 Other facilitation of intraocular circulation Class II
1261 Trephination of sclera with iridectomy Class II
1262 Thermocauterization of sclera with iridectomy Class II
1263 Iridencleisis and iridotasis Class II
1264 Trabeculectomy ab externo Class II
1265 Other scleral fistulization with iridectomy Class II
1266 Postoperative revision of scleral fistulization procedure Class II
1269 Other scleral fistulizing procedure Class II
1271 Cyclodiathermy Class II
1272 Cyclocryotherapy Class II
1273 Cyclophotocoagulation Class II
1274 Diminution of ciliary body, not otherwise specified Class II
1279 Other glaucoma procedures Class II
1281 Suture of laceration of sclera Class II
1282 Repair of scleral fistula Class II
1283 Revision of operative wound of anterior segment, not elsewhere class Class II
1285 Repair of scleral staphyloma with graft Class II
1286 Other repair of scleral staphyloma Class II
1291 Therapeutic evacuation of anterior chamber Class II
1292 Injection into anterior chamber Class II
1293 Removal or destruction of epithelial downgrowth from anterior chambe Class II
1297 Other operations on iris Class II
1298 Other operations on ciliary body Class II
1299 Other operations on anterior chamber Class II
1300 Removal of foreign body from lens, not otherwise specified Class II
1301 Removal of foreign body from lens with use of magnet Class II
1302 Removal of foreign body from lens without use of magnet Class II
1311 Intracapsular extraction of lens by temporal inferior route Class II
1319 Other intracapsular extraction of lens Class II
132 Extracapsular extraction of lens by linear extraction technique Class II
133 Extracapsular extraction of lens by simple aspiration (and irrigatio Class II
1341 Phacoemulsification and aspiration of cataract Class II
1342 Mechanical phacofragmentation and aspiration of cataract by posterio Class II
1343 Mechanical phacofragmentation and other aspiration of cataract Class II
1351 Extracapsular extraction of lens by temporal inferior route Class II
1359 Other extracapsular extraction of lens Class II
1364 Discission of secondary membrane (after cataract) Class II
1365 Excision of secondary membrane (after cataract) Class II
1366 Mechanical fragmentation of secondary membrane (after cataract) Class II

1369 Other cataract extraction Class II

1370 Insertion of pseudophakos, not otherwise specified Class II
1371 Insertion of intraocular lens prosthesis at time of cataract extract Class II
1372 Secondary insertion of intraocular lens prosthesis Class II
138 Removal of implanted lens Class II
139 Other operations on lens Class II
1400 Removal of foreign body from posterior segment of eye, not otherwise Class II
1401 Removal of foreign body from posterior segment of eye with use of ma Class II
1402 Removal of foreign body from posterior segment of eye without use of Class II
1421 Destruction of chorioretinal lesion by diathermy Class II
1422 Destruction of chorioretinal lesion by cryotherapy Class II
1426 Destruction of chorioretinal lesion by radiation therapy Class II
1427 Destruction of chorioretinal lesion by implantation of radiation sou Class II
1429 Other destruction of chorioretinal lesion Class II
1431 Repair of retinal tear by diathermy Class II
1432 Repair of retinal tear by cryotherapy Class II
1433 Repair of retinal tear by xenon arc photocoagulation Class II
1434 Repair of retinal tear by laser photocoagulation Class II
1435 Repair of retinal tear by photocoagulation of unspecified type Class II
1439 Other repair of retinal tear Class II
1441 Scleral buckling with implant Class II
1449 Other scleral buckling Class II
1451 Repair of retinal detachment with diathermy Class II
1452 Repair of retinal detachment with cryotherapy Class II
1453 Repair of retinal detachment with xenon arc photocoagulation Class II
1454 Repair of retinal detachment with laser photocoagulation Class II
1455 Repair of retinal detachment with photocoagulation of unspecified ty Class II
1459 Other repair of retinal detachment Class II
1471 Removal of vitreous, anterior approach Class II
1472 Other removal of vitreous Class II
1473 Mechanical vitrectomy by anterior approach Class II
1474 Other mechanical vitrectomy Class II
1475 Injection of vitreous substitute Class II
1479 Other operations on vitreous Class II
149 Other operations on retina, choroid, and posterior chamber Class II
161 Removal of penetrating foreign body from eye, not otherwise specifie Class II
1623 Biopsy of eyeball and orbit Class II
1629 Other diagnostic procedures on orbit and eyeball Class II
500 Hepatotomy Class II
5021 Marsupialization of lesion of liver Class II
5022 Partial hepatectomy Class I
5029 Other destruction of lesion of liver Class II

503 Lobectomy of liver Class I

504 Total hepatectomy Class I
5061 Closure of laceration of liver Class II
5069 Other repair of liver Class II
5092 Extracorporeal hepatic assistance Class I
5182 Pancreatic sphincterotomy Class II
5183 Pancreatic sphincteroplasty Class II
5201 Drainage of pancreatic cyst by catheter Class II
5209 Other pancreatotomy Class II
5222 Other excision or destruction of lesion or tissue of pancreas or pancreatic duct Class II
523 Marsupialization of pancreatic cyst Class II
524 Internal drainage of pancreatic cyst Class II
5251 Proximal pancreatectomy Class I
5252 Distal pancreatectomy Class I
5253 Radical subtotal pancreatectomy Class I
5259 Other partial pancreatectomy Class I
526 Total pancreatectomy Class I
527 Radical pancreaticoduodenectomy Class I
5280 Pancreatic transplant, not otherwise specified Class I
5281 Reimplantation of pancreatic tissue Class I
5282 Homotransplant of pancreas Class I
5283 Heterotransplant of pancreas Class I
5292 Cannulation of pancreatic duct Class II
5295 Other repair of pancreas Class I
5296 Anastomosis of pancreas Class I
5299 Other operations on pancreas Class II
3500 Closed heart valvotomy, unspecified valve Class I
3501 Closed heart valvotomy, aortic valve Class I
3502 Closed heart valvotomy, mitral valve Class I
3503 Closed heart valvotomy, pulmonary valve Class I
3504 Closed heart valvotomy, tricuspid valve Class I
3531 Operations on papillary muscle Class I
3532 Operations on chordae tendineae Class I
3533 Annuloplasty Class I
3534 Infundibulectomy Class I
3535 Operations on trabeculae carneae cordis Class I
3539 Operations on other structures adjacent to valves of heart Class I
3542 Creation of septal defect in heart Class I
3550 Repair of unspecified septal defect of heart with prosthesis Class I
3551 Repair of atrial septal defect with prosthesis, open technique Class I
3552 Repair of atrial septal defect with prosthesis, closed technique Class I
3553 Repair of ventricular septal defect with prosthesis, open technique Class I
3560 Repair of unspecified septal defect of heart with tissue graft Class I
3561 Repair of atrial septal defect with tissue graft Class I
3562 Repair of ventricular septal defect with tissue graft Class I

3570 Other and unspecified repair of unspecified septal defect of heart Class I
3571 Other and unspecified repair of atrial septal defect Class I
3572 Other and unspecified repair of ventricular septal defect Class I
3595 Revision of corrective procedure on heart Class I
3598 Other operations on septa of heart Class I
3599 Other operations on valves of heart Class I
3603 Open chest coronary artery angioplasty Class I
362 Heart revascularization by arterial implant Class I
3631 Open chest transmyocardial revascularization Class I
3632 Other transmyocardial revascularization Class I
3639 Other heart revascularization Class I
363 Other heart revascularization Class I
3691 Repair of aneurysm of coronary vessel Class I
3699 Other operations on vessels of heart Class I
3710 Incision of heart, not otherwise specified Class I
3711 Cardiotomy Class I
3712 Pericardiotomy Class I
3724 Biopsy of pericardium Class I
3731 Pericardiectomy Class I
3732 Excision of aneurysm of heart Class I
3733 Excision or destruction of other lesion or tissue of heart, open approach Class I
3735 Partial ventriculectomy Class I
374 Repair of heart and pericardium Class I
3761 Implant of pulsation balloon Class I
3791 Open chest cardiac massage Class I
3799 Other operations on heart and pericardium Class I
3964 Intraoperative cardiac pacemaker Class I
3966 Percutaneous cardiopulmonary bypass Class I
5569 Other kidney transplantation Class I
Z510 Radiotherapy session (C-4-12,Q-5-42) Severity 1
3195 Tracheoesophageal fistulization Class II
3209 Other local excision or destruction of lesion or tissue of bronchus Class II
3221 Plication of emphysematous bleb Class II
3229 Other local excision or destruction of lesion or tissue of lung Class II
329 Other excision of lung Class II
330 Incision of bronchus Class II
331 Incision of lung Class II
3325 Open biopsy of bronchus Class II
3328 Open biopsy of lung Class II
3329 Other diagnostic procedures on lung or bronchus Class II
3339 Other surgical collapse of lung Class II
3393 Puncture of lung Class II
3399 Other operations on lung Class II

3402 Exploratory thoracotomy Class II

3403 Reopening of recent thoracotomy site Class II
341 Incision of mediastinum Class II
3421 Transpleural thoracoscopy Class II
3422 Mediastinoscopy Class II
3426 Open mediastinum biopsy Class II
3427 Biopsy of diaphragm Class II
3428 Other diagnostic procedures on chest wall, pleura, and diaphragm Class II
3429 Other diagnostic procedures on mediastinum Class II
343 Excision or destruction of lesion or tissue of mediastinum Class II
3459 Other excision of pleura Class II
346 Scarification of pleura Class II
3473 Closure of other fistula of thorax Class II
3479 Other repair of chest wall Class II
3481 Excision of lesion or tissue of diaphragm Class II
3482 Suture of laceration of diaphragm Class II
3483 Closure of fistula of diaphragm Class II
3484 Other repair of diaphragm Class II
3485 Implantation of diaphragmatic pacemaker Class II
3489 Other operations on diaphragm Class II
3493 Repair of pleura Class II
3499 Other operations on thorax Class II
4061 Cannulation of thoracic duct Class II
4062 Fistulization of thoracic duct Class II
4063 Closure of fistula of thoracic duct Class II
4064 Ligation of thoracic duct Class II
4069 Other operations on thoracic duct Class II
537 Repair of diaphragmatic hernia, abdominal approach Class II
5380 Repair of diaphragmatic hernia with thoracic approach, not otherwise specified Class II
5381 Plication of the diaphragm Class II
5382 Repair of parasternal hernia Class II
7701 Sequestrectomy of scapula, clavicle, and thorax (ribs and sternum) Class II
7711 Other incision of bone without division, scapula, clavicle, and thorax (ribs and sternum) Class II
7721 Wedge osteotomy of scapula, clavicle, and thorax (ribs and sternum) Class II
7731 Other division of scapula, clavicle, and thorax (ribs and sternum) Class II
7761 Local excision of lesion or tissue of scapula, clavicle, and thorax (ribs and sternum) Class II
7771 Excision of bone for graft, scapula, clavicle, and thorax (ribs and sternum) Class II
7781 Other partial ostectomy of scapula, clavicle, and thorax (ribs and sternum) Class II
7791 Total ostectomy of scapula, clavicle, and thorax (ribs and sternum) Class II

7801 Bone graft of scapula, clavicle, and thorax (ribs and sternum) Class II
7811 Application of external fixation device, scapula, clavicle, and thorax (ribs and sternum) Class II
7841 Other repair or plastic operations on scapula, clavicle, and thorax (ribs and sternum) Class II
7851 Internal fixation of bone without fracture reduction on scapula, clavicle, and thorax (ribs and
sternum) Class II
7861 Removal of implanted device from scapula, clavicle, and thorax (ribs and sternum) Class II
7871 Osteoclasis of scapula, clavicle, and thorax (ribs and sternum) Class II
7881 Diagnostic procedures on scapula, clavicle, and thorax (ribs and sternum) Class II
7891 Insertion of bone growth stimulator into scapula, clavicle, and thorax (ribs and sternum) Class II
3173 Closure of other fistula of trachea Class II
3175 Reconstruction of trachea and construction of artificial larynx Class II
3179 Other repair and plastic operations on trachea Class II
321 Other excision of bronchus Class II
3222 Lung volume reduction surgery Class II
323 Segmental resection of lung Class I
3241 Thoracoscopic lobectomy of lung Class I
3249 Other lobectomy of lung Class I
324 Lobectomy of lung Class I
325 Pneumonectomy Class I
326 Radical dissection of thoracic structures Class I
3334 Thoracoplasty Class I
3341 Suture of laceration of bronchus Class II
3342 Closure of bronchial fistula Class II
3343 Closure of laceration of lung Class I
3348 Other repair and plastic operations on bronchus Class II
3349 Other repair and plastic operations on lung Class I
3392 Ligation of bronchus Class II
3398 Other operations on bronchus Class II
3451 Decortication of lung Class I
3474 Repair of pectus deformity Class II
9397 Decompression chamber Class I
J90 Pleural effusion, not elsewhere classified (J-4-20,Q-5-38) Severity 3
J91 Pleural effusion in conditions classified elsewhere (J-4-20,Q-5-38) Severity 3
J930 Spontaneous tension pneumothorax (J-4-20,Q-5-38) Severity 3
J931 Other spontaneous pneumothorax (J-4-20,Q-5-38) Severity 2
J938 Other pneumothorax (J-4-20,Q-5-38) Severity 2
J939 Pneumothorax, unspecified (J-4-20,Q-5-38) Severity 2
J940 Chylous effusion (J-4-20,Q-5-38) Severity 3
J942 Haemothorax (J-4-20,Q-5-38) Severity 3
J982 Interstitial emphysema (J-4-20,Q-5-44) Severity 2
P251 Pneumothorax originating in the perinatal period (J-4-20,P-8-08,P-9-17,Q-5-42) Severity 3

P252 Pneumomediastinum originating in the perinatal period (J-4-20,P-8-08,P-9-17,Q-5-42) Severity 3

P253 Pneumopericardium originating in the perinatal period (J-4-20,P-8-08,P-9-17,Q-5-42) Severity 3
P258 Oth conds rel interstit emphysema orig in perinatal period (J-4-20,P-8-08,P-9-17,Q-5-42)
Severity 3
S270 Traumatic pneumothorax (J-4-20,Q-5-41) Severity 2
S2700 Traumatic pneumothorax, without open wound into thoracic cavity (J-4-20,Q-5-41) Severity 2
S2701 Traumatic pneumothorax, with open wound into thoracic cavity (J-4-20,Q-5-41) Severity 2
S271 Traumatic haemothorax (J-4-20,Q-5-41) Severity 2
S2710 Traumatic haemothorax, without open wound into thoracic cavity (J-4-20,Q-5-41) Severity 2
S2711 Traumatic haemothorax, with open wound into thoracic cavity (J-4-20,Q-5-41) Severity 2
S272 Traumatic haemopneumothorax (J-4-20,Q-5-41) Severity 2
S2720 Traumatic haemopneumothorax, without open wound into thoracic cavity (J-4-20,Q-5-41)
Severity 2
S2721 Traumatic haemopneumothorax, with open wound into thoracic cavity (J-4-20,Q-5-41) Severity
2
T797 Traumatic subcutaneous emphysema (J-4-20,Q-5-42) Severity 2
0716 Biopsy of thymus Class II
0780 Thymectomy, not otherwise specified Class II
0781 Partial excision of thymus Class II
0782 Total excision of thymus Class II
0791 Exploration of thymus field Class II
0792 Incision of thymus Class II
0793 Repair of thymus Class II
0794 Transplantation of thymus Class II
0799 Other and unspecified operations on thymus Class II
400 Incision of lymphatic structures Class II
4011 Biopsy of lymphatic structure Class II
4019 Other diagnostic procedures on lymphatic structures Class II
4021 Excision of deep cervical lymph node Class II
4022 Excision of internal mammary lymph node Class II
4023 Excision of axillary lymph node Class II
4024 Excision of inguinal lymph node Class II
4029 Simple excision of other lymphatic structure Class II
403 Regional lymph node excision Class II
4050 Radical excision of lymph nodes, not otherwise specified Class II
4051 Radical excision of axillary lymph nodes Class II
4052 Radical excision of periaortic lymph nodes Class II
4053 Radical excision of iliac lymph nodes Class II
4054 Radical groin dissection Class II
4059 Radical excision of other lymph nodes Class II
409 Other operations on lymphatic structures Class II
111 Incision of cornea Class II
1151 Suture of corneal laceration Class II

1152 Repair of postoperative wound dehiscence of cornea Class II

1153 Repair of corneal laceration or wound with conjunctival flap Class II
1159 Other repair of cornea Class II
1160 Corneal transplant, not otherwise specified Class II
1161 Lamellar keratoplasty with autograft Class II
1162 Other lamellar keratoplasty Class II
1163 Penetrating keratoplasty with autograft Class II
1164 Other penetrating keratoplasty Class II
1169 Other corneal transplant Class II
1171 Keratomeleusis Class II
1172 Keratophakia Class II
1173 Keratoprosthesis Class II
1174 Thermokeratoplasty Class II
1175 Radial keratotomy Class II
1176 Epikeratophakia Class II
1179 Other reconstructive surgery on cornea Class II
1192 Removal of artificial implant from cornea Class II
1199 Other operations on cornea Class II
1200 Removal of intraocular foreign body from anterior segment of eye, no Class II
1201 Removal of intraocular foreign body from anterior segment of eye wit Class II
1202 Removal of intraocular foreign body from anterior segment of eye wit Class II
1211 Iridotomy with transfixion Class II
1212 Other iridotomy Class II
1213 Excision of prolapsed iris Class II
1214 Other iridectomy Class II
1221 Diagnostic aspiration of anterior chamber of eye Class II
1222 Biopsy of iris Class II
1229 Other diagnostic procedures on iris, ciliary body, sclera, and anter Class II
1231 Lysis of goniosynechiae Class II
1232 Lysis of other anterior synechiae Class II
1233 Lysis of posterior synechiae Class II
1234 Lysis of corneovitreal adhesions Class II
1235 Coreoplasty Class II
1239 Other iridoplasty Class II
1240 Removal of lesion of anterior segment of eye, not otherwise specifie Class II
1241 Destruction of lesion of iris, nonexcisional Class II
1242 Excision of lesion of iris Class II
1243 Destruction of lesion of ciliary body, nonexcisional Class II
1244 Excision of lesion of ciliary body Class II
1251 Goniopuncture without goniotomy Class II
1252 Goniotomy without goniopuncture Class II
1253 Goniotomy with goniopuncture Class II
1254 Trabeculotomy ab externo Class II

1255 Cyclodialysis Class II

1259 Other facilitation of intraocular circulation Class II
1261 Trephination of sclera with iridectomy Class II
1262 Thermocauterization of sclera with iridectomy Class II
1263 Iridencleisis and iridotasis Class II
1264 Trabeculectomy ab externo Class II
1265 Other scleral fistulization with iridectomy Class II
1266 Postoperative revision of scleral fistulization procedure Class II
1269 Other scleral fistulizing procedure Class II
1271 Cyclodiathermy Class II
1272 Cyclocryotherapy Class II
1273 Cyclophotocoagulation Class II
1274 Diminution of ciliary body, not otherwise specified Class II
1279 Other glaucoma procedures Class II
1281 Suture of laceration of sclera Class II
1282 Repair of scleral fistula Class II
1283 Revision of operative wound of anterior segment, not elsewhere class Class II
1285 Repair of scleral staphyloma with graft Class II
1286 Other repair of scleral staphyloma Class II
1291 Therapeutic evacuation of anterior chamber Class II
1292 Injection into anterior chamber Class II
1293 Removal or destruction of epithelial downgrowth from anterior chambe Class II
1297 Other operations on iris Class II
1298 Other operations on ciliary body Class II
1299 Other operations on anterior chamber Class II
1300 Removal of foreign body from lens, not otherwise specified Class II
1301 Removal of foreign body from lens with use of magnet Class II
1302 Removal of foreign body from lens without use of magnet Class II
1311 Intracapsular extraction of lens by temporal inferior route Class II
1319 Other intracapsular extraction of lens Class II
132 Extracapsular extraction of lens by linear extraction technique Class II
133 Extracapsular extraction of lens by simple aspiration (and irrigatio Class II
1341 Phacoemulsification and aspiration of cataract Class II
1342 Mechanical phacofragmentation and aspiration of cataract by posterio Class II
1343 Mechanical phacofragmentation and other aspiration of cataract Class II
1351 Extracapsular extraction of lens by temporal inferior route Class II
1359 Other extracapsular extraction of lens Class II
1364 Discission of secondary membrane (after cataract) Class II
1365 Excision of secondary membrane (after cataract) Class II
1366 Mechanical fragmentation of secondary membrane (after cataract) Class II
1369 Other cataract extraction Class II
1370 Insertion of pseudophakos, not otherwise specified Class II

1371 Insertion of intraocular lens prosthesis at time of cataract extract Class II

1372 Secondary insertion of intraocular lens prosthesis Class II
138 Removal of implanted lens Class II
139 Other operations on lens Class II
1400 Removal of foreign body from posterior segment of eye, not otherwise Class II
1401 Removal of foreign body from posterior segment of eye with use of ma Class II
1402 Removal of foreign body from posterior segment of eye without use of Class II
1421 Destruction of chorioretinal lesion by diathermy Class II
1422 Destruction of chorioretinal lesion by cryotherapy Class II
1426 Destruction of chorioretinal lesion by radiation therapy Class II
1427 Destruction of chorioretinal lesion by implantation of radiation sou Class II
1429 Other destruction of chorioretinal lesion Class II
1431 Repair of retinal tear by diathermy Class II
1432 Repair of retinal tear by cryotherapy Class II
1433 Repair of retinal tear by xenon arc photocoagulation Class II
1434 Repair of retinal tear by laser photocoagulation Class II
1435 Repair of retinal tear by photocoagulation of unspecified type Class II
1439 Other repair of retinal tear Class II
1441 Scleral buckling with implant Class II
1449 Other scleral buckling Class II
1451 Repair of retinal detachment with diathermy Class II
1452 Repair of retinal detachment with cryotherapy Class II
1453 Repair of retinal detachment with xenon arc photocoagulation Class II
1454 Repair of retinal detachment with laser photocoagulation Class II
1455 Repair of retinal detachment with photocoagulation of unspecified ty Class II
1459 Other repair of retinal detachment Class II
1471 Removal of vitreous, anterior approach Class II
1472 Other removal of vitreous Class II
1473 Mechanical vitrectomy by anterior approach Class II
1474 Other mechanical vitrectomy Class II
1475 Injection of vitreous substitute Class II
1479 Other operations on vitreous Class II
149 Other operations on retina, choroid, and posterior chamber Class II
161 Removal of penetrating foreign body from eye, not otherwise specifie Class II
1623 Biopsy of eyeball and orbit Class II
1629 Other diagnostic procedures on orbit and eyeball Class II
1311 Intracapsular extraction of lens by temporal inferior route Class II
1319 Other intracapsular extraction of lens Class II
132 Extracapsular extraction of lens by linear extraction technique Class II
133 Extracapsular extraction of lens by simple aspiration (and irrigatio Class II

1341 Phacoemulsification and aspiration of cataract Class II

1342 Mechanical phacofragmentation and aspiration of cataract by posterio Class II
1343 Mechanical phacofragmentation and other aspiration of cataract Class II
1351 Extracapsular extraction of lens by temporal inferior route Class II
1359 Other extracapsular extraction of lens Class II
1364 Discission of secondary membrane (after cataract) Class II
1365 Excision of secondary membrane (after cataract) Class II
1369 Other cataract extraction Class II
1370 Insertion of pseudophakos, not otherwise specified Class II
1371 Insertion of intraocular lens prosthesis at time of cataract extract Class II
1372 Secondary insertion of intraocular lens prosthesis Class II
3141 Tracheoscopy through artificial stoma Class III
3142 Laryngoscopy and other tracheoscopy Class III
3144 Closed (endoscopic) biopsy of trachea Class III
3193 Replacement of laryngeal or tracheal stent Class III
3201 Endoscopic excision or destruction of lesion or tissue of bronchus Class III
3228 Endoscopic excision or destruction of lesion or tissue of lung Class III
3321 Bronchoscopy through artificial stoma Class III
3322 Fiber-optic bronchoscopy Class III
3323 Other bronchoscopy Class III
3324 Closed (endoscopic) biopsy of bronchus Class III
3327 Endoscopic biopsy of lung (closed) Class III
3391 Bronchial dilation Class III
5110 Endoscopic retrograde cholangiopancreatography (ERCP) Class III
5111 Endoscopic retrograde cholangiography (ERC) Class III
5114 Other closed (endoscopic) biopsy of biliary duct or sphincter of Oddi Class III
5115 Pressure measurement of sphincter of Oddi Class III
5164 Endoscopic excision or destruction of lesion of biliary ducts or sphincter of Oddi Class III
5184 Endoscopic dilation of ampulla and biliary duct Class III
5185 Endoscopic sphincterotomy and papillotomy Class III
5186 Endoscopic insertion of nasobiliary drainage tube Class III
5187 Endoscopic insertion of stent (tube) into bile duct Class III
5188 Endoscopic removal of stone(s) from biliary tract Class III
5213 Endoscopic retrograde pancreatography (ERP) Class III
5214 Closed [endoscopic] biopsy of pancreatic duct Class III
5221 Endoscopic excision or destruction of lesion or tissue of pancreatic Class III
5293 Endoscopic insertion of stent (tube) into pancreatic duct Class III
5294 Endoscopic removal of stone(s) from pancreatic duct Class III
5297 Endoscopic insertion of nasopancreatic drainage tube Class III
5298 Endoscopic dilation of pancreatic duct Class III
9705 Replacement of stent (tube) in biliary or pancreatic duct Class III

Top Up Speci
No

List Item Special CMG

Tipe Special CMG

Koefisien Top Up

Subdural Grid Electrode

Special Prosthesis

0.5

Cote Graft

Special Prosthesis

0.5

Cote Graft

Special Prosthesis

0.5

TMJ Prothesis

Special Prosthesis

Liquid Embolic For AVM

Special Prosthesis

Hip Implant/ Knee Implant

Special Prosthesis

Hip Implant/ Knee Implant

Special Prosthesis

Top Up Special Prothesis

Kode INA CBG's

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Prosedur Rawat Inap

Up Special Prothesis
Kode ICD 9 CM
0112 Open biopsy of cerebral meninges Class I
0113 Closed (percutaneous) (needle) biopsy of brain Class II
0114 Open biopsy of brain Class I
0118 Other diagnostic procedures on brain and cerebral meninges Class II
0121 Incision and drainage of cranial sinus Class II
0122 Removal of intracranial neurostimulator Class II
0123 Reopening of craniotomy site Class II
0124 Other craniotomy Class II
0125 Other craniectomy Class II
0131 Incision of cerebral meninges Class II
0132 Lobotomy and tractotomy Class I
0139 Other incision of brain Class II
0141 Operations on thalamus Class I
0142 Operations on globus pallidus Class I
0151 Excision of lesion or tissue of cerebral meninges Class I
0152 Hemispherectomy Class I
0153 Lobectomy of brain Class I
0159 Other excision or destruction of lesion or tissue of brain Class I
016 Excision of lesion of skull Class II
0201 Opening of cranial suture Class II
0202 Elevation of skull fracture fragments Class II
0203 Formation of cranial bone flap Class I
0204 Bone graft to skull Class II
0205 Insertion of skull plate Class I
0206 Other cranial osteoplasty Class I
0207 Removal of skull plate Class II
0211 Simple suture of dura mater of brain Class I
0212 Other repair of cerebral meninges Class I
0214 Choroid plexectomy Class I
022 Ventriculostomy Class II
0291 Lysis of cortical adhesions Class I
0292 Repair of brain Class I
0293 Implantation of intracranial neurostimulator Class II
0299 Other operations on skull, brain, and cerebral meninges Class II
0401 Excision of acoustic neuroma Class II
0441 Decompression of trigeminal nerve root Class II
3554 Repair of endocardial cushion defect with prosthesis Class I
3563 Repair of endocardial cushion defect with tissue graft Class I
3573 Other and unspecified repair of endocardial cushion defect Class I
3581 Total repair of tetralogy of fallot Class I

3582 Total repair of total anomalous pulmonary venous connection Class I

3583 Total repair of truncus arteriosus Class I
3584 Total correction of transposition of great vessels, not elsewhere classified Class I
3591 Interatrial transposition of venous return Class I
3592 Creation of conduit between right ventricle and pulmonary artery Class I
3593 Creation of conduit between left ventricle and aorta Class I
3594 Creation of conduit between atrium and pulmonary artery Class I
0115 Biopsy of skull Class II
0119 Other diagnostic procedures on skull Class II
0353 Repair of vertebral fracture Class II
7601 Sequestrectomy of facial bone Class II
7609 Other incision of facial bone Class II
7611 Biopsy of facial bone Class II
7619 Other diagnostic procedures on facial bones and joints Class II
762 Local excision or destruction of lesion of facial bone Class II
7631 Partial mandibulectomy Class II
7642 Other total mandibulectomy Class II
765 Temporomandibular arthroplasty Class II
7669 Other facial bone repair Class II
7670 Reduction of facial fracture, not otherwise specified Class II
7672 Open reduction of malar and zygomatic fracture Class II
7674 Open reduction of maxillary fracture Class II
7676 Open reduction of mandibular fracture Class II
7677 Open reduction of alveolar fracture Class II
7679 Other open reduction of facial fracture Class II
7691 Bone graft to facial bone Class II
7692 Insertion of synthetic implant in facial bone Class II
7694 Open reduction of temporomandibular dislocation Class II
7697 Removal of internal fixation device from facial bone Class II
7699 Other operations on facial bones and joints Class II
3802 Incision of other vessels of head and neck Class II
3812 Endarterectomy of other vessels of head and neck Class II
3832 Resection of other vessels of head and neck with anastomosis Class II
3842 Resection of vessel with replacement, other vessels of head and neck Class II
3852 Ligation and stripping of varicose veins, other vessels of head an Class II
3862 Other excision of vessels, other vessels of head and neck Class II
3882 Other surgical occlusion of vessels, other vessels of head and neck Class II
3972 Endovascular repair or occlusion of head and neck vessels Class II
3974 Endovascular removal of obstruction from head and neck vessel
8151 Total hip replacement Class I
8152 Partial hip replacement Class I
8153 Revision of hip replacement, NEC Class I

8154 Total knee replacement Class I

8155 Revision of knee replacement, NEC Class I
8156 Total ankle replacement Class I
8162 Fusion or refusion of 2-3 vertebrae Class I
8163 Fusion or refusion of 4-8 vertebrae Class I
8164 Fusion or refusion of 9 or more vertebrae Class I
8426 Foot reattachment Class I
8427 Lower leg or ankle reattachment Class I
8428 Thigh reattachment Class I

No

List Item Special CMG

Tipe Special CMG

Koefisien Top Up

Streptokinase

Special Drug

0.25

Deferiprone

Special Drug

0.5

Deferoksamin

Special Drug

0.5

Deferasirox

Special Drug

0.5

Human Albumin

Special Drug

0.5

Kode INA CBG's

Diagnosis Rawat Inap

Diagnosis Rawat Inap

Diagnosis Rawat Inap

Diagnosis Rawat Inap

Diagnosis Rawat Inap

Kode ICD 10
I210 Acute transmural myocardial infarction of anterior wall (I-4-10,Q-5-30) Severity 3
I211 Acute transmural myocardial infarction of inferior wall (I-4-10,Q-5-30) Severity 3
I212 Acute transmural myocardial infarction of other sites (I-4-10,Q-5-30) Severity 3
I213 Acute transmural myocardial infarction of unspecified site (I-4-10,Q-5-30) Severity 3
I214 Acute subendocardial myocardial infarction (I-4-10,Q-5-30) Severity 3

I219 Acute myocardial infarction, unspecified (I-4-10,Q-5-30) Severity 3

I233 Rupture cardiac wall without haemopericardium as current complication following acute myocardial infarction (I-4-10,Q
Severity 3
D460 Refractory anaemia without sideroblasts, so stated (D-4-13,Q-5-33) Severity 2
D461 Refractory anaemia with sideroblasts (D-4-13,Q-5-33) Severity 2
D462 Refractory anaemia with excess of blasts (D-4-13,Q-5-33) Severity 2
D463 Refractory anaemia with excess of blasts with transformation (D-4-13,Q-5-33) Severity 2
D464 Refractory anaemia, unspecified (D-4-13,Q-5-33) Severity 2
D500 Iron deficiency anaemia secondary to blood loss (chronic) (D-4-13,Q-5-33) Severity 2
D501 Sideropenic dysphagia (D-4-13,Q-5-33) Severity 2
D508 Other iron deficiency anaemias (D-4-13,Q-5-33) Severity 2
D509 Iron deficiency anaemia, unspecified (D-4-13,Q-5-33) Severity 2
D510 Vitamin b12 defic anaemia due to intrinsic factor deficiency (D-4-13,Q-5-44) Severity 2
D511 Vit b12 def anaem select vit b12 malabsorp with proteinuria (D-4-13,Q-5-44) Severity 2
D512 Transcobalamin ii deficiency (D-4-13,Q-5-44) Severity 2
D513 Other dietary vitamin b12 deficiency anaemia (D-4-13,Q-5-44) Severity 2
D518 Other vitamin b12 deficiency anaemias (D-4-13,Q-5-44) Severity 2
D519 Vitamin b12 deficiency anaemia, unspecified (D-4-13,Q-5-44) Severity 2
D520 Dietary folate deficiency anaemia (D-4-13,Q-5-44) Severity 2
D521 Drug-induced folate deficiency anaemia (D-4-13,Q-5-44) Severity 2
D528 Other folate deficiency anaemias (D-4-13,Q-5-44) Severity 2
D529 Folate deficiency anaemia, unspecified (D-4-13,Q-5-44) Severity 2
D530 Protein deficiency anaemia (D-4-13,Q-5-44) Severity 2
D531 Other megaloblastic anaemias, not elsewhere classified (D-4-13,Q-5-44) Severity 2
D532 Scorbutic anaemia (D-4-13,Q-5-44) Severity 2
D538 Other specified nutritional anaemias (D-4-13,Q-5-44) Severity 2
D539 Nutritional anaemia, unspecified (D-4-13,Q-5-33) Severity 1
D550 Anaemia due to glucose-6-phosphate dehydrogenase deficiency (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D551 Anaemia due to other disorders of glutathione metabolism (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D552 Anaemia due to disorders of glycolytic enzymes (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D553 Anaemia due to disorders of nucleotide metabolism (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D558 Other anaemias due to enzyme disorders (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D559 Anaemia due to enzyme disorder, unspecified (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D560 Alpha thalassaemia (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1
D561 Beta thalassaemia (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1

D562 Delta-beta thalassaemia (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1

D563 Thalassaemia trait (D-4-13,Q-5-44) Severity 1
D564 Hereditary persistence of fetal haemoglobin [hpfh] (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1
D568 Other thalassaemias (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1
D569 Thalassaemia, unspecified (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1
D571 Sickle-cell anaemia without crisis (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D572 Double heterozygous sickling disorders (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D573 Sickle-cell trait (D-4-13,Q-5-44) Severity 1
D578 Other sickle-cell disorders (D-4-13,Q-5-44) Severity 1
D580 Hereditary spherocytosis (D-4-13,Q-5-44) Severity 1
D581 Hereditary elliptocytosis (D-4-13,Q-5-44) Severity 1
D582 Other haemoglobinopathies (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 1
D588 Other specified hereditary haemolytic anaemias (P-8-14,D-4-13,P-9-14,Q-5-44) Severity 2
D589 Hereditary haemolytic anaemia, unspecified (D-4-13,Q-5-44) Severity 2
D590 Drug-induced autoimmune haemolytic anaemia (D-4-13,Q-5-44) Severity 2
D591 Other autoimmune haemolytic anaemias (D-4-13,Q-5-44) Severity 2
D592 Drug-induced nonautoimmune haemolytic anaemia (D-4-13,Q-5-44) Severity 2
D593 Haemolytic-uraemic syndrome (D-4-13,Q-5-44) Severity 2
D594 Other nonautoimmune haemolytic anaemias (D-4-13,Q-5-44) Severity 2
D595 Paroxysmal nocturnal haemoglobinuria [marchiafava-micheli] (D-4-13,Q-5-44) Severity 2
D596 Haemoglobinuria due to haemolysis from other external causes (D-4-13,Q-5-44) Severity 2
D598 Other acquired haemolytic anaemias (D-4-13,Q-5-44) Severity 2
D599 Acquired haemolytic anaemia, unspecified (D-4-13,Q-5-44) Severity 2
D600 Chronic acquired pure red cell aplasia (P-8-14,D-4-13,P-9-14,Q-5-33) Severity 2
D601 Transient acquired pure red cell aplasia (D-4-13,Q-5-33) Severity 3
D608 Other acquired pure red cell aplasias (D-4-13,Q-5-33) Severity 3
D609 Acquired pure red cell aplasia, unspecified (D-4-13,Q-5-33) Severity 3
D610 Constitutional aplastic anaemia (P-8-14,D-4-13,P-9-14,Q-5-33) Severity 2
D611 Drug-induced aplastic anaemia (D-4-13,Q-5-33) Severity 3
D612 Aplastic anaemia due to other external agents (D-4-13,Q-5-33) Severity 3
D613 Idiopathic aplastic anaemia (D-4-13,Q-5-33) Severity 3
D618 Other specified aplastic anaemias (D-4-13,Q-5-33) Severity 3
D619 Aplastic anaemia, unspecified (D-4-13,Q-5-33) Severity 3
D62 Acute posthaemorrhagic anaemia (D-4-13,Q-5-33) Severity 2
D640 Hereditary sideroblastic anaemia (D-4-13,Q-5-33) Severity 2
D641 Secondary sideroblastic anaemia due to disease (D-4-13,Q-5-33) Severity 2
D642 Secondary sideroblastic anaemia due to drugs and toxins (D-4-13,Q-5-33) Severity 2
D643 Other sideroblastic anaemias (D-4-13,Q-5-33) Severity 2
D644 Congenital dyserythropoietic anaemia (D-4-13,Q-5-33) Severity 2
D648 Other specified anaemias (D-4-13,Q-5-33) Severity 2
D649 Anaemia, unspecified (D-4-13,Q-5-33) Severity 2
D740 Congenital methaemoglobinaemia (D-4-13,Q-5-44) Severity 2

D748 Other methaemoglobinaemias (D-4-13,Q-5-44) Severity 2

D749 Methaemoglobinaemia, unspecified (D-4-13,Q-5-44) Severity 2
P560 Hydrops fetalis due to isoimmunization (D-4-13,P-8-17,P-9-17,Q-5-41) Severity 3
P569 Hydrops fetalis due to other and unspec haemolytic disease (D-4-13,P-8-17,P-9-17,Q-5-41) Severity 3
P570 Kernicterus due to isoimmunization (D-4-13,P-8-17,P-9-17,Q-5-42) Severity 3
P578 Other specified kernicterus (D-4-13,P-8-17,P-9-17,Q-5-41) Severity 3
P579 Kernicterus, unspecified (D-4-13,P-8-17,P-9-17,Q-5-41) Severity 3
P612 Anaemia of prematurity (D-4-13,P-8-17,P-9-17,Q-5-42) Severity 3
P613 Congenital anaemia from fetal blood loss (D-4-13,P-8-17,P-9-17,Q-5-42) Severity 2
P614 Other congenital anaemias, not elsewhere classified (D-4-13,P-8-17,P-9-17,Q-5-42) Severity 2
R71 Abnormality of red blood cells (D-4-13,Q-5-44) Severity 1
T803 ABO incompatibility reaction (D-4-13,Q-5-41) Severity 2
T804 Rh incompatibility reaction (D-4-13,Q-5-41) Severity 2
T808 Other complications following infusion transfusion & therap inject (D-4-13,Q-5-41) Severity 3
T809 Unspecified complication following infusion transfusion and therapeutic inject (D-4-13,Q-5-41) Severity 3
A021 Salmonella septicaemia (A-4-10,Q-5-42) Severity 3
A207 Septicaemic plague (A-4-10,Q-5-35) Severity 3
A227 Anthrax septicaemia (A-4-10,Q-5-35) Severity 3
A391 Waterhouse-friderichsen syndrome (A-4-10,Q-5-35) Severity 3
A392 Acute meningococcaemia (A-4-10,Q-5-35) Severity 3
A393 Chronic meningococcaemia (A-4-10,Q-5-35) Severity 3
A394 Meningococcaemia, unspecified (A-4-10,Q-5-35) Severity 3
A398 Other meningococcal infections (A-4-10,Q-5-35) Severity 3
A399 Meningococcal infection, unspecified (A-4-10,Q-5-35) Severity 3
A400 Septicaemia due to streptococcus, group a (A-4-10,Q-5-35) Severity 3
A401 Septicaemia due to streptococcus, group b (A-4-10,Q-5-35) Severity 3
A402 Septicaemia due to streptococcus, group d (A-4-10,Q-5-35) Severity 3
A403 Septicaemia due to streptococcus pneumoniae (A-4-10,Q-5-35) Severity 3
A408 Other streptococcal septicaemia (A-4-10,Q-5-35) Severity 3
A409 Streptococcal septicaemia, unspecified (A-4-10,Q-5-35) Severity 3
A410 Septicaemia due to staphylococcus aureus (A-4-10,Q-5-35) Severity 3
A411 Septicaemia due to other specified staphylococcus (A-4-10,Q-5-35) Severity 3
A412 Septicaemia due to unspecified staphylococcus (A-4-10,Q-5-35) Severity 3
A413 Septicaemia due to haemophilus influenzae (A-4-10,Q-5-35) Severity 3
A414 Septicaemia due to anaerobes (A-4-10,Q-5-35) Severity 3
A415 Septicaemia due to other gram-negative organisms (A-4-10,Q-5-35) Severity 3
A418 Other specified septicaemia (A-4-10,Q-5-35) Severity 3
A419 Septicaemia, unspecified (A-4-10,Q-5-35) Severity 3
A427 Actinomycotic septicaemia (A-4-10,Q-5-35) Severity 3
B377 Candidal septicaemia (A-4-10,Q-5-35) Severity 3
R571 Hypovolaemic shock (A-4-10,Q-5-37) Severity 3

Special
2

No

List Item Special CMG

Tipe Special CMG

Koefisien Top Up

Other CT Scan

Special Investigation

1.5

Nuclear Medicine

Special Investigation

1.5

MRI

Special Investigation

1.5

Diagnostic & Imaging of Eye

Special Investigation

1.5

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
36
37
38
39
40
41

Special Penunjang
Kode INA CBG's

Prosedur Rawat Jalan

Prosedur Rawat Jalan

Prosedur Rawat Jalan

Prosedur Rawat Jalan

enunjang
Kode ICD 10
8741 Computerized axial tomography of thorax Class III
8771 Computerized axial tomography of kidney Class III
8801 Computerized axial tomography of abdomen Class III
8838 Other computerized axial tomography Class III
8898 Bone mineral density studies Class III
9201 Thyroid scan and radioisotope function studies Class III
9202 Liver scan and radioisotope function study Class III
9203 Renal scan and radioisotope function study Class III
9204 Gastrointestinal scan and radioisotope function study Class III
9205 Cardiovascular and hematopoietic scan and radioisotope function study Class III
9209 Other radioisotope function studies Class III
9211 Cerebral scan Class III
9212 Scan of other sites of head Class III
9213 Parathyroid scan Class III
9214 Bone scan Class III
9215 Pulmonary scan Class III
9216 Scan of lymphatic system Class III
9218 Total body scan Class III
9219 Scan of other site Class III
8891 Magnetic resonance imaging of brain and brain stem Class III
8892 Magnetic resonance imaging of chest and myocardium for evaluation of Class III
8893 Magnetic resonance imaging of spinal canal Class III
8894 Magnetic resonance imaging of musculoskeletal Class III
8895 Magnetic resonance imaging of pelvis, prostate, and bladder Class III
8896 Other intraoperative magnetic resonance imaging Class III
8897 Magnetic resonance imaging of other and unspecified sites Class III
8705 Contrast dacryocystogram Class III
8714 Contrast radiogram of orbit Class III
8882 Ocular thermography Class III
9511 Fundus photography Class III
9512 Fluorescein angiography or angioscopy of eye Class III
9513 Ultrasound study of eye Class III
9514 X-ray study of eye Class III
9516 P32 and other tracer studies of eye Class III
9521 Electroretinogram (ERG) Class III
9522 Electro-oculogram (EOG) Class III
9524 Electronystagmogram (ENG) Class III
9525 Electromyogram of eye (EMG) Class III
9526 Tonography, provocative tests, and other glaucoma testing Class III

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
36
37
38
39
40
41
42
43
44

45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92

93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140

141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188

189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236

237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284

285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332

333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380

381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428

429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
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477
478
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525
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531
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541
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573
574
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579
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581
582
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584
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621
622
623
624
625
626
627
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629
630
631
632
633
634
635
636
637
638
639
640
641
642
643
644
645
646
647
648

DIAGNOSA
Ablasio Retina
Abortus Imminance
Abortus Incompit
Abrasio

Absces
Achalasia
Acne Vulgaris
Adenomatous Goiter
ADHD
Adnexitis / PID
Adonemyosis
Agioderma / Anaphylacti Shock
Alopepsia Areata
Amenorrhoe
Amnesia
Amubiasis
Anemia
Aneurysma Aorta
Angina Pectoris
Anorexia
Anxietas / Gangguan Cemas
APB / Ante Partum Bleeding
Aphakia

Appendicitis
Aritmia Cordis
ARMD
Arthritis
Ascariasis
Ascites
ASHD / ASD ( Anterio Sclerosis Disease )
ASI
Asphyxia Neonatus
Aspirasi
Asthenia
Asthma Bronchiale
Astrocytoma
Atheroma Humeri
Atralgia / Haematros
Atresia Ani
Atrial Fibrilasi / AF
Atrial Septal Defect / ASD
Autisme
Auto Imun Disease / AID
AV Block

AVM
Azotenia
Bartholinitis
Basalioma / BCC

Basedow
Batu Empedu
Batu Ginjal / Ureter / Batu Ren
Batu Pyelum
Batu Urethra
BBB / BSK
BBLR
Bell Palsy / BP
Bilirubinemia
BKB
Bleeding Post TE
Bligted Ovum
Bone Spur
BPH / Benign Prostate Hiperplasi
Branch Retinal Vein Occlusion / BRTO

Bronchietasis
Bronchiolitis
Bronchitis
Bronchitis Acut
Broncho Pnemonia
Bulous Pempigoid
Bursitis Elbow
Calcaneal Spur
Canal Stenosis
Cancer Adeno
Cancer Bronchogenic
Cancer Cervix / Ca Cervix
Cancer Colon / Ca Colon
Cancer Hepar
Cancer Liver / Ca Liver
Cancer Mamae / Ca Mamae
Cancer Mata
Cancer Nasopharing / Ca Nasopharing
Cancer Neck / Tengkuk
Cancer Ovarium / Ca Ovarium

Cancer Paru / Ca Paru

Cancer Prostat
Cancer Rectum
Cancer Rectum / Regtosigmoid / Ca Regtosigmoid
Cancer Sigmoid
Cancer Telinga
Cancer Thyroid / Kulit
Candidiasis
Carbuncle

Cardiac Arrest
Cardiomegali
Cardiomegali / Left Ventriculus Hypertrophy
Cardiomyopathy / CMP
Carries Gigi
Cephalgia
Cerebral Palsy / CP
CHD / Congenetal Heart Disease
Chest Paint
CHF / Congestive Heart Failure
Chikungunya
Cholelithiasis
Chondromalacia Patella
Chorea
CIN
Cirrhosis Hepatis / CH / SH
Cistitis

CKD
Claudication Interminten
Clavus
Combustio
Commond Cold / CC / BATUK
Commotio Cerebri ( COR COS COB )
Compresi Tulang Belakang / CTB
Condiloma Akuminata
Congenetal Anomali Knee / CAK
Congenetal Heart Disease / CHD
Contusio Masculorum / Muscle SPASME
Conyungtivitis
COPD / PPOK
Corpus Alienum
Corpus Diabetikum
Coxitis
Cracked Nipple
CRF / GGK
CRS / Cervixal Root Syndrom
Crush Injury
CRVO
CSCR
CTEV
CTS
CVA Bleeding
CVA Infark
Cyste Clavicula
Cyste Conjungtiva
Cyste Dermoid / SOP
Cyste Ductus Thyroglosus / CDT
Cyste Gaster

Cyste Liver / Hepar

Cyste Ovarium
Cyste Paru
Cyste Renal / Ginjal
Cyste Rongga Mulut
Death Conceptus
Death On Arrivle / DOA
Decompensasi Cordis / DC
Decubitus
Dehidrasi
Delay Union Fracture / DUF
Dellirium
Demensia
Demensia Vasculer
Denguar vain syndrom / DVS
Depresi / Gangguan Expresif
Dermatitis
Dermato Mycosis
Development Delay
Dengue Fever

DHF
Diabetes Mellitus / DM
Diaper Rash
Diphteria
Dilatasi Ureter
Disfungsi Otonomik
Dislokasi
DKD
DMPS

Down Syndrom
Drug Eruption
Drug Intolerance

Dry Eyes
Dysentri Basiler
Dysfungsi Ereksi
Dysfungsional ( Icterus Bleeding / DUB )
Dyslipidemia
Dysmenorrhoe

Dyspepsia
Dyspneu / HICCUP
Dysuria
Eklamsia / PEB

Empyema paru
Encephalitis
Encephalocel
Encephalopathy
Endometriosis
Epidedinitis

Epidural / Subdural Hematom

Epilepsi
Epistaxis
EPS ( EXTRA PIRAMIDA SYNDROME )
ERB Palsy
Erosi Papila Mamae

Erosi Portio
Erysipelas
Erythema

Esophagitis
Excoriasi
Faringitis
Fascitis
Fatty Liver / FL
Febris Convulsi / FC
Febris Unknown Origin / OF / FUO
Fibro Adeno Mammae / FAM
Fibroma
Fibroxantoma
Finger Tip Injuery
Fissur Uteri
Fissure Ani

Fissure Pubis / FS
Fistel MAE
Fistel Perianal
Fistel Preauricle
Fistel Umbilicalis
Flatulence
Folikulitis
Fracture Anggota Gerak / of Lamb
Fracture Badan/Tubuh
Fracture Femur
Fracture Tengkorak
Frozen Shoulder
FT / Fisio Terapi
Furuncle
Ganggren Pedis
Gangguan Afektif
Gangguan Berbicara Expresif / GBE
Gangguan Daya Dengar / GDD
Gangguan Haid
Gangguan Kelopak Mata / GKM
Gangguan Panik / Proses berfikir / Psikotik
Gangguan Penyesuaian
Gangguan Perkembangan Gigi
Gangguan Refraksi
Gangguan Smatoform / Faham Somatik
Gangguan Waham

Ganglion Carpi
Gastritis / Gastropati
GE dengan Infeksi / Colitis
GE Non Infeksi
General Cek Up
GERD / Esophagus
Gingivitis

Glaucoma
Gonitis

Gonorrhoe
Gouth Arthritis / GA
Granuloma
Graves Diasease
Hamil Normal
Hemangium Cavernosum
Hematemisis Melena / HM
Hematocel
Hematochesia
Hematoma
Hematuri
Hemipareze / Paraesthesia / Parase / Paralysis
Hemorrhoid
Hepatitis
Hepatitis A
Hepatitis Acut
Hepatitis B
Hepatitis C
Hepatoma
Hepatomegali
Hernia Inguinalis Lateralis / HIL
Hernia Nukleus Pulposus / HNP
Herpes Zooster
HIV / Human Immunodeficiency Virus
HPP / Haemorhagia Post Partum
HRP
Hydradenitis
Hydramion
Hydrocele
Hydrocephalus
Hydronephrosis
Hymen Imperforata
Hyper Cholesterol
Hyper Keratosis
Hyper Thyroid
Hyper Trigliceride
Hyper Uricemia / Hyper Uric Acid
Hyperbilirubin
Hyperglicemia

Hyperhidrosis
Hyperpigmentasi
Hyperplasia
Hypertensi / HT
Hypertensi Haert Disease / HHD
Hypertensi Heart Failure / HHF
Hypoglicemia
Hypokalemia
Hypospadania
Hypotensi
Hypremisis Gravidarum
IBS

Ichtiosis
Icterus
Icterus Neonaturum
Ileus
Imaturitas Reaction
Impaired Bowel Movement
Impetigo
Imunisasi BCG
Imunisasi Campak
Imunisasi DPT
Imunisasi Engerik
Imunisasi FLU

Imunisasi
Imunisasi
Imunisasi
Imunisasi
Imunisasi
Imunisasi
Imunisasi
Imunisasi

HB, Jek
Heberix
Hepatitis B
Hepavak
Infaric HIB
Infarix
Polio
TT

Imunisasi Vaxigrib

Incontinensi Alvi
Incontinensi Urine
Infark Myocard Acut / IMA
Infeksi Paru

Infeksi Saluran Kencing / ISK

Infeksi Virus / ILO
Infertility
Infiltrat
Ingrowing Nail
Insect Bite
Insomnia
Intelorence Food
Internal Bleeding
Intertigo Contagiosa
Intoxicasi

Intra Cranial Hematom / ICH

Invaginasi
IQ Ambang
IRBBB
Iritasi Anus

Ischialgia
ISPA
ITP / Purpura
IUFD
IUGR / Intra Uterin Growth Rate
Katarak
KB

Kelainan Dento facial / Maloklusi

Kelloid
Keracunan Alkohol
Keracunan Baygon

Keracunan makanan
Keracunan Minyak Tanah
Keracunan Obat
Keratitis
Keratosis
Khalazion

Koch Pulmonum / KP
Kolik Abdomen
Kolik Renal / Colik Renal
Kolik Urether / Colik Ureter
Kontraktur
Kracunan Obat serangga
Labio Schizis

LAD
Laringitis
Larva Migrasi

Leucemia / CLL
Leucoderma
Leucorrhoe
Leucositosis
Liver Impermaint
Low Back Pain / LBP
Luka Infeksi

Lymphadenitis
Lymphadenitis Tuberculose
Lymphoma Maligna
Lymphoma Non Hodgkin's / LNH
Lympoma Hodgkin"s
Lypoma
Maculopathy
Malabsorsi Syndrom
Malaise

Malnutrisi
Mamae Aberans
Mastalgia
Mastitis
Mega Colon Congenetal / Hirschprungs Disease
Melasma
Mengioma Retro Bulber
Meningioma
Meningitis Tuberculose
Meningo Encephalitis
Menometroharrgia
Menopouse
Menstruatie
Mental Retardasi / RM
Migrain
Miliaria
Minieres Syndrom
Mitral Regurgitasi / RM
Mitral Stenosis / MSI
Mola Hydatidosa
Monoliasis
Morbilli
Morbus Hansen
Motor Delayed
MOW

Mucocele Bibir
Mucositis Lingual

Myalgia
Myastenia Gravis
Myeloma

Myocard Ischemic
Myoma Uteri
Myophaty
Myositis
Myringitis
Nail Avulsion
NCD
Necrose
Neonatus
Neoplasma Jinak Lain
Nephritis
Nephrotic Syndrom / SN

Nervus Pigmentosus
Neuralgia
Neurasthenia
Neuritis Obtica
Neuro Fibroma
Neurophaty

Neurosa
NIDDM
NPDR
Obesitas
Obstipasi
Obtruksi Ductus Nasolakrimal / ODNL

Oclusiveva
Oedema Anasarka
Oedema Limb
Oedema Paru
Oedema Scrotum
Oklusi Arteri Cruris
Oklusi Tuba
Oligohidramion
Oligoria
OMI
OMP + Gangguan Mastoid + Telinga Tengah
Oral Thrush
Orchitis
Oshopagitis
Osteo Arthrosis / OA
Osteo Sarkoma
Osteofit
Osteoma / mandibulla

Osteomyelitis
Osteophyt
Osteoporosis
Otitis Externa
Oxyoris (Cacingan)
PAC ( Prematur Atrial Contraction )
PAD ( Periferal Arterior Disease )
Palato Schizis
Palpitasi
Pankreatitis

Papiloma
Parese
Parkinson
Paronichia
Parotitis
PDA
Pempigus Coutaugiosa
Pensito Penia
Peny Hidung dan Sinus Hidung Lain
Peny Telinga dan Proses mastoid
Peny Tonsil dan Adenoid kronik
Penyakit gusi + jaringan priodontal
Penyakit Jantung Koroner / PJK
Penyakit kelamin / FA / Flour Albus

Penyakit Pulpa dan peridontal

Periappendicular / PAI
Periksa lanjutan
Peritonitis
Persistensi
Pertusis
Petechiae

Pharingitis Akut
Phemosis
Pitiriasis Alba
Pityriasis Versikolor
Placenta Previa
Plantar Facitis
Plebitis
Pleura Effusion
Pnemonia
Pneumothorax
Policetemia
Polyciria
Polyp Blader
Polyp Cervix
Polyp Nasal
Post CVA
Post Partum
PPH
Prematur Ruptur Membran / PRM

Presbikusis
Prolap Uteri
Proptosis / Exopthalmus

Prostatitis
Prurigo Van Hebra

Pruritus
Pseudofakia
Psikosa
Psikosomatis
Psoriaris Vulgaris
Pulpitis

PVC / NSR
Pyelonephritis

Pyoderma
Radang Kelopak Mata / Hordeolum
Ragaden
Raynaud's Disease
RBBB
Reaksi Conversi
Regurgitasi Aorta

Remathoid Arthritis
Renal Tubulae Ascidosis

Retensio Urine
Retinitis Pigmentosa
RHD / Penyakit Jantung Rematik
Rhinitis Alergi
Rubella
Ruptur Cornea

Ruptur Tendon
Ruptur Vesica Urinaria
Scabies
Schizoprenia
Scoliosis
Sellulitis / Phlegmon
Sepsis
Serumen Obsturan
Sigelosis
Sinus Bradicardia
Sinus Tachicardia
Sinusitis Maxilaris
Skin tag / Skin Defect
SLE
SMD
Snake Bite
Spasme
Speech Dellay
Spermatocel
Spina Bifida / Meningocele
Spondilitis TB
Spondilolithesis / Scralisasi
Spondylosis
Sprain
Squele TB
SSS
Status Asmaticus
Stenosis Renal
Steroid With Drawl
Steven Johnson Syndrom / SJS
Stomatitis
Strabismus

Stricture Ureter
Stricture Urethra
Struma Uninodosa
Surat Keterangan Sehat / SKS
SVT
Syncope
Tachicardia
Talipes Equinovarus
Tendinitis
Tendo Vaginitis

Tension Head Ache / THA

Tetanus
Tetralogi Fallot

Thalazemia
Thoracic Syndrom
Thyroid Heart Disease
TIA / Transent Ishemic Atfack
Tic Facialis
Tinea Corporis
Tinea Ungulum / Onychomycosis
Tonsilitis Acut
Torsio Testis
Torticollis
Toxo
Trauma Abdomen / Trauma Tumpul
Trauma Capitis / kepala
Trauma Chemis / Trauma Kulit

Trauma Electric
Trauma Mekanik
Trauma Oculli / Gangguan Bola Mata
Traumatic Amputasi
Tricomonas
Triger Finger
Tringer Thumb
Tuberculose Miliere
Tuberculose Spine
Tumor Kepala

Tumor Abdomen
Tumor Axilla
Tumor Buccal
Tumor Collie

Tumor Ginjal
Tumor Hidung / Neuroma
Tumor Kulit / Cubiti

Tumor Liver
Tumor Mamae
Tumor Mata
Tumor Otak
Tumor Paru
Tumor Pedis / Chondroma
Tumor Soft Tissue
Typhoid Fever / TF
Ulkus Duodenum
Ulkus Lingual
Ulkus Pedis
Ulkus Pepticum
Ulkus Perianal
Undercender Testicle

Unstable Lumbo Sacral

Unstable Pelvis

Ureteritis
Urolhitiasis
Urtikaria
USD
Uveitis
Vaginitis
Vaksinasi Influensa
Varicella
Varices kaki
Varices Labia
Varices Oeshophagus
Varicocel
Vasculitis
Vena Sectie
Vertigo
Veruca Vulgaris
Vesicocel
Vitiligo
Vitrius Floaters
Vitrius Opaecyti
Vocal Nodule
Vomiting
Von Willebrad's Disease
Vulnus Appertum / Degloving / Laserasi / Circumsisi / V APP

Vulnus Ictum / V Ictum

Vulnus Schisom / V Schisom
hemaptoe

CODE
ICD X
H 33.2
O 20.0
O 06
T 14.0

L 02
K 22.0
L 70.8
E 04.9
F 90
N 73
N 80.0
T 78
L 63
N 91.2
R 41.3
A 06
D 61
I 71
I 20
R 63
F 41
O 46.9
H 27.0

K 35
I 49
H 35
M 13
B 37
R 18
I 70
I 35.2
P 21
P 24
R 53
J 45
C 71
I 70
M 25
Q 42.3
I 48
Q 21.1
F 84.0
M 35
I 44

Q 27
R 79.8
A 54.1
G 25

E 05.0
K 80
N 28
N 20
N 21.1
N 21.0
P 07
G 51.0
E 80.4
R 05
T 81.0
O 02.0
M 77.9
N 40
H 34.8

J 47
J 21
J 40
J 20
J 18
L 42.0
M 70
M 77.3
M 48.0
C 11
C 34
C 53
C 18
C 78.7
C 78.7
C 50
C 69.1
C 11
C 76
C 56
C 34
C 61
C 20
C 19
C 18.7
C 44
C 73
B 37
L 02

I 46
I 51
I 57
I 42
K 02
R 51
G 80
Q 24
R 07
I 50
A 92.0
K 80.2
M 22.4
G 25.5
N 87
K 74.6
N 30

N 28
I 73
L 84
T 22
J 00
S 06
G 54
A 63
Q 74.1
Q 24
T 14
H 10
J 44
S 36.5
E 10.1
M 13.1
N 46.0
N 18
M 53.1
S 67
H 34
H 35.7
Q 66.0
G 56.0
I 61
I 63
M 85.6
H 11.4
D 23
Q 89
C 16

K 76.8
N 83.2
J 98.4
Q 61
K 09.8
O 95
R 98
I 51
L 89
E 86
M 84.2
F 05
F 03
F 01
M 65.4
F 32
L 30
B 36
R 62.9
A90

A 91
E 14
L 22
A36.9
N 28.8
G 93
S 43.0
N 08
D 46.0

Q 20
L 27.0
E 74

K 10.3
A 03
F 52
N 93
E 78.5
N94.6
K 30
R 06
R 30.0
O 15
J 86
A 86
Q 01.1
I 67
N 80
N 45

S 06
G 40
R 04.0
G 25
P 14.0
D 26.6

N 86
A 46
L 53

K 20
T 07
J 02
M 72
K 76.0
R 56
R 50
N 60
M 72
L 02
S 69
R 62
K 60.2

M 75.0
H 61
K 60.3
T 06
Q 64.8
Q 64.8
L 73
T 02
Z 50
S 72
S 02
M 75.0
Z 50
L 02
R 02
F 39
F 80
H 90
N 91
H 02
F 99
F 43
K 00
H 52
F 45
F 22

M 67
K 29
A 09
K 52.9
Z 00.0
K 21.0
K 05

H 40
M 17

A 54
M 10.0
L 92
E 05
Z 34
D 17.2
K 92
N 83.8
K 62.5
S 09
R 31
G 83
I 84
K 75
B 15
K 72.0
B 16
B 17.1
C 22.0
R 16.2
K 40
M 51.2
B 00
B 24
O72.1
Z 35
L 73.2
O 40
N 43.3
G 31
N 13.2
Q 52.3
E 78
L 85
E 05
E 78.1
E 79.0
E 80.6
R 73

R 61
L 81
N 85
I 10
I 11
I 11
E 16.2
E 87.6
Q 54
I 95
O 21.0
K 58
Q 80
R 17
P 59
K 56
F 61
R 25.8
L 01
Z 23.2
Z 24.4
Z 27.1
Z 23.0
Z
Z
Z
Z
Z
Z
Z
Z

23.0
23.0
24.6
24.4
23.0
23.0
24.0
23.5

R 15
R 32
I 21
J 98

N 39.0
B 34
N 97
R 89
T 14
G 47
K 90.4
R 58
L 30
T 65

I 61
K 56.1
F 70
I 45.4
K 62.8

M 54.3
J 39
D 69
P 95
P 05
H 26
Z 30
K 07
L 91
X 65
X 68

A 05
X 46
T 65
H 16
L 82
H 00.1

A 16
R 10.4
N 23
N 23
M 62.4
T 60.0
Q 38.0

I 45
J 04
B 76.0

C 95
L 81
N 89
D 72.8
K 72
M 54.5
L 98.4

L 04.0
A 18.2
C 85
C 85
C 81
D 17
H 35
K 90
R 73

E 46
Q 83.8
N 64.4
N 61
Q 43.1
L 81.1
D 31.6
D 32
A 17 / G 01
A 39
N 92.1
N 95
N 92.6
F 79
G 43
L 74
H 81.0
I 34
I 05
D 39.2
B 27
B 05
A 30
M 84.2
z 30.2

K 13
D 70

M 79.1
G 70.0
C 90

I 25.1
D 25
G 72
M 60
H 73
L 60
I 51
R 02
Z 38.0
D
N 11
N 04
D 22
M 79
F 45
H 46
Q 85
G 58

F 48
E 11
H 35.0
E 66.9
K 59
H 04
I 82.2
R 60.1
R 60
J 81
N 50.8
I 80.3
N 97.1
O 11.0
R 34
I 25.2
H 65
B 37.0
N 45
K 20
M 15
C 40
M 25.7
D 16.5

M 86
N 25
M 81
H 60
B 80
I 49.1
I 73 - 09
Q 35
R 00.2
K 85

D 10
G 81
G 20
L 03.0
K 11
Q 25.0
L 12
D 61
J 30
H 60
J 35
L 40
I 25.1
A 59

K 05
K 35.1
K 65
K 00
A 37
R 23.3

J 02
N 47
L 30.5
B 36.0
O 44.1
M 72.2
I 80
J 90
J 18
J 93
D 75.1
R 35
D 41
N 84.1
J 33
I 69
O 90
I 27
O 42

H 91
N 81
H 05.2
N 41
L 28

L 29
Z 96.1
F 29
F 45
L 40
K 04

I 49
N 12

L 08
H 00
I 73.1
I 45
F 44
I 35.1

M 06
N 25.8

R 33
H 35.5
I 09
J 30
B 06
S 05.3

S 66.6
N 32.4
B 86
F 20
M 41
L 03
A 41
H 61.2
A 03
R 00.1
I 47
J 32
R 23.1
M 32
H 35
T 63.0
R 25.2
F 80
N 43.4
Q 05
A 18
M 43
M 47
T 14.3
B 90
I 49.5
J 46
I 70
E 27.3
L 51
K 12
H 50.9

N 13.5
N 35
E 01.1
A 74
I 47.1
R 55
R 00
Q 66.0
M 76
M 65

G 44.2
A 35
Q 21.3

D 56
G 54.0
E 05
G 45
G 25
B 35.4
B 35.1
J 03
N 44
M 43.6
B 58.9
S 39
S 09
T 30.4

T 75
S 19
H 43
S 68.2
A 59.
M 65
M 65.3
A 19
A 18.0
D 04.4

D 36.7
D 21
C 06.9
C 77
D 30.0
D 36
D 23

C 22.7
D 24
D 31
D 33.2
D 14
D 16
D 21.1
A 01.0
K 26
K 14
L 97
K 27
K 62
Q 35

Q 76.4
M 53.7

N 28
N 20
L 50
Q 21
H 20
N 76.0
B 01
I 83
I 86
I 85
I 86.1
I 77.6
T 80.1
R 42
B 07
R 33
L 80
H 43.3
H 43
J 38.2
R 11
D 68.0
T 01
S 91.3
r04.2

Kode
A01.0
A09
A15.8
A16.0
A18.2
A18.3
A35
A36.9
A37.0
A46
A54.1
A59
A86
A90
A91
A92.0
B17.1
B24
B34.8
B35.1
B35.4
B36.0
B37.0
B58.9
B76.0
B80
B86
C06.9
C20
C22.0
C22.7
C50.9
C56
C61
C67.9
C73
D04.4
D06.9
D16.5
D17.2
D17.7
D21.1
D24
D26.6
D30.0
D33.2
D36.7
D39.2
D46.0

Count - Diagnosa
1
1
1
1
2
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

D56.8
D68.0
D69.3
D72.8
D75.1
E01.1
E04.8
E04.9
E05.0
E05.9
E10.1
E10.8
E11.8
E14.8
E16.1
E16.2
E27.3
E46
E66.9
E78.1
E78.5
E79.0
E80.4
E80.6
E86
E87.6
E88.0
F03
F20.9
F29
F43.9
F48.8
F48.9
F61
F70
F79
F84.0
F99
G03.8
G20
G25.5
G44.2
G47.9
G51.0
G52.6
G54.0
G56.0
G62.9
G70.0
G83.0
G93.4
H00.1
H05.2

2
1
1
1
1
1
1
1
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
1
1
1
1
2
1
1
1
1

H11.0
H11.4
H16.0
H26.2
H26.8
H27.0
H33.2
H34.8
H35.0
H35.5
H35.7
H40.2
H43.3
H44.0
H46
H50.9
H52.0
H52.1
H52.4
H52.6
H61.2
H81.0
H81.4
H93.1
I10
I11.0
I11.9
I15.8
I20.9
I21.9
I25.1
I25.2
I25.8
I35.1
I35.2
I47.1
I48
I50.0
I61.9
I63.6
I63.8
I70
I73.1
I77.6
I80.3
I82.2
I86.1
I95.8
J01.8
J02.9
J06.9
J11.1
J18.0

1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
2
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

J18.8
J20.8
J31.0
J33.9
J38.2
J40
J44.8
J45.9
J46
J47
J81
J90
K02.1
K04.0
K04.1
K05.0
K05.1
K05.2
K05.3
K09.8
K12.1
K20
K21.0
K22.0
K27.7
K29.1
K29.5
K29.6
K29.7
K30
K35.0
K35.1
K36
K40.3
K40.9
K52.9
K56.1
K56.7
K59.0
K59.3
K60.3
K62.5
K62.8
K65.0
K72.0
K74.6
K75.9
K76.0
K76.8
K80.2
K80.8
K85
K90.4

1
1
1
1
1
1
1
1
1
1
1
1
2
2
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2
1
2
1
1
2
1
1
1
1
2
1
1
1
2
1
1

K90.8
K91.8
K92.1
L03.0
L03.8
L04.0
L30.5
L30.8
L42.0
L70.8
L73.2
L81.1
L82
L84
L89
L89.0
L91.8
L97
L98.4
M10.0
M10.9
M13.1
M13.8
M15.4
M22.4
M25.7
M43.6
M48.0
M51.2
M53.1
M53.7
M54.3
M54.5
M62.4
M65.3
M65.4
M66.4
M67.4
M70.5
M72.2
M75.0
M77.3
M77.9
M79.1
M84.2
M85.6
M96.8
N04
N11.8
N13.2
N18.0
N19
N20.0

1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
2
1
1
1
1
1
2
2
1
1
1
2
3
3
1
2

N20.1
N21.0
N21.1
N30.1
N35.8
N39.0
N39.8
N40
N43.3
N46.0
N47
N49.8
N61
N75.8
N76.0
N80.0
N83.2
N84.1
N90.8
N91.2
N92.1
N92.6
O00.8
O02.0
O02.1
O02.8
O03
O04
O05.4
O10.9
O11.0
O12.2
O14.0
O14.1
O20.8
O21.0
O24.9
O25
O30.0
O32.0
O32.1
O32.2
O33.8
O34.2
O36.4
O36.5
O36.8
O40
O41.0
O42.0
O42.1
O43.2
O43.8

1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
2

O44.0
O44.1
O46.8
O46.9
O47.0
O47.1
O48
O60.1
O61.0
O66.2
O66.9
O68
O70.1
O72.0
O72.1
O72.2
O73.1
O75.7
O80.0
O80.1
O81.4
O82.0
O82.1
O84.0
O84.1
O84.2
O86.8
O95
O99.0
P00.0
P01.1
P01.3
P01.5
P01.7
P02.0
P02.4
P03.1
P03.3
P03.4
P03.6
P03.8
P05.9
P07.1
P07.3
P08.0
P08.2
P12.0
P14.0
P20.1
P21.0
P21.1
P21.9
P22.9

1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
1

P24.1
P24.8
P25.2
P28.4
P28.5
P36.1
P36.8
P37.5
P51.9
P54.1
P54.2
P54.8
P55
P59.8
P70.4
P78.3
P91.5
P92.2
P94.0
P95
Q00.0
Q01.1
Q02
Q03.0
Q03.9
Q05
Q20
Q21
Q21.1
Q21.3
Q24
Q25.0
Q27
Q35
Q35.0
Q38.0
Q42
Q42.3
Q43.1
Q52.3
Q54
Q61
Q64.8
Q66.0
Q69.9
Q74.1
Q76.4
Q80
Q83.8
Q85
Q89
R00
R00.1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
2
1
1
2
1
1
1
1
2
1
1
1
2
2
1
1
1
1
1
1
1
1
2

R00.2
R02
R04.0
R04.2
R05
R06
R06.0
R07
R07.3
R10.4
R11
R15
R16.2
R17
R18
R23.1
R23.3
R25.2
R25.8
R30.0
R31
R32
R33
R34
R35
R41.3
R42
R50
R50.9
R51
R53
R55
R56
R56.0
R57.1
R57.8
R58
R60
R60.1
R61
R62
R62.9
R63
R73
R73.9
R79.8
R89
R95
R98
S01.0
S01.1
S01.3
S01.4

1
3
1
1
2
1
1
1
1
2
2
1
1
1
1
1
1
1
1
1
1
1
3
1
1
1
1
1
2
2
1
1
1
1
1
1
2
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1

S02
S02.0
S02.4
S05.3
S06
S06.0
S06.2
S09
S09.8
S19
S31.4
S32.0
S36.5
S39
S42.0
S43.0
S50
S51.8
S52.4
S61.8
S62.7
S66.6
S67
S68.2
S69
S72
S82.7
S91.3
S93.3
S98.4
T01
T01.8
T02
T06
T07
T14
T14.0
T14.3
T22
T30.4
T31.8
T60.0
T63.0
T65
T75
T78
T80.1
T81.0
X46
X65
X68
Z00.0
Z00.1

1
1
1
1
2
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
2
1

Z01.0
Z01.2
Z01.3
Z01.6
Z01.7
Z02.0
Z02.1
Z03.0
Z03.1
Z03.8
Z04.0
Z04.1
Z04.2
Z04.3
Z08.0
Z08.2
Z09.0
Z09.4
Z09.8
Z23
Z23.0
Z23.2
Z23.5
Z24
Z24.0
Z24.4
Z24.6
Z27.1
Z30
Z30.0
Z30.2
Z33
Z34
Z34.8
Z35
Z35.5
Z35.6
Z35.8
Z35.9
Z37.0
Z37.1
Z37.2
Z37.3
Z37.4
Z37.5
Z37.6
Z37.7
Z37.9
Z38.0
Z38.1
Z38.2
Z38.3
Z38.4

1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
5
1
1
1
1
2
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1

Z38.5
Z38.6
Z38.7
Z38.8
Z39.2
Z50
Z87.6
Z93
Z96.1
A03.9
B77.9
B37.9
C11.1
C11.9
C34.9
C85.9
D25.9
D23.9
D64.9
E78.0
A06.9
F80.9
F45.8
A05.8
A17.0
A39.8
A30.8
F45.9
A41.9
M46.9
A19.0
A54.9
A59.9
A63.8
B01.9
B02.9
B05.9
B06.9
B07.9
B15.9
B16.9
B27.9
B90.9
C18.9
C53.9
C81.9
C90.0
C95.9
D14.3
D32.9
D41.4
F01.9
F05.9

1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

F22.0
F32.9
F38.8
F41.1
F43.0
F44.9
F48.0
F52.9
F90.9
G25.6
G40.9
G43.9
G45.9
G54.4
G58.8
G72.9
G80.9
G81.9
G91.9
G93.9
H00.0
H02.9
H10.9
H16.8
H40.9
H52.7
H60.8
H73.0
H90.2
I05.0
I09.0
I34.0
I42.8
I44.3
I46.9
I49.9
I51.7
I70.0
I73.9
I80.8
I83.9
I84.9
I85.9
I93.4
I95.9
J00.0
J03.9
J04.0
J21.9
J30.4
J32.0
J33.8
J35.0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

J93.9
K00.8
K11.2
K35.9
L02.9
L03.9
L12.9
L30.9
L51.1
L73.9
L74.3
L81.0
L81.5
L92.9
M06.9
M13.9
M17.9
M25.5
M32.9
M41.9
M43.1
M47.9
M71.9
M72.9
M81.8
M86.9
N18.9
N30.9
N41.0
N50.1
N60.3
N80.9
N87.0
N87.1
N93.9
N94.6
N94.8
N95.9
N97.8
O63.9
P24.9
Total Result

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
806

Kode
O14.0
O14.1
O42.0
O42.1
O63.9
O63.9
O34.2
O75.7
O30.0
O48
O66.9
O43.2
O43.8
O44.0
O44.1
O33.8
O24.9
O36.8
O10.9
O12.2
N75.8
O36.4
O60.1
O36.5
O32.1
O32.2
Q35.0
O66.2
O03
O04
O47.0
O47.1
O32.0
O99.0
O33.8
O21.0
O70.1
O86.8
O41.0
O68
O25
O00.8
O43.8
S31.4
O61.0
O80.0
O80.1

O81.4
O82.0
O82.1
O84.0
O84.1
O84.2
Z37.0
Z37.1
Z37.2
Z37.3
Z37.4
Z37.5
Z37.6
Z37.7
Z37.9
O02.0
O02.1
O02.8
O20.8
O46.8
O72.0
O72.2
O73.1
O05.4
P21.0
P21.1
P21.1
P59.8
P24.8
Q42
P07.3
P05.9
P07.1
P95
K59.3
Q69.9
Q03.9
P01.7
P03.1
P02.4
Q00.0
P28.4
P24.1
Z33
P08.0
P92.2
P95
P03.3

P03.4
P12.0
P91.5
P78.3
P03.6
P20.1
P54.8
Q03.0
P01.3
P70.4
P21.9
P54.1
P37.5
P94.0
P03.1
P51.9
P25.2
P55
P02.0
P54.2
P22.9
P28.5
P36.8
R95
P01.5
P01.1
P36.1
P00.0
P02.0
P08.2
P03.8
Q02
Q43.1
Z38.0
Z38.1
Z38.2
Z38.3
Z38.4
Z38.5
Z38.6
Z38.7
Z38.8
A91
I84.9
A90
A01.0
R07.3
G93.4

K65.0
M13.8
R50.9
J06.9
D56.8
J00.0
K12.1
J02.9
J03.9
R05
A15.8
A18.3
K30
K27.7
R11
R10.4
J46
J45.9
R51
H52.1
S50
S01.4
K36
K35.0
K35.1
I10
I15.8
I20.9
R00.1
I21.9
A37.0
E88.0
J11.1
J44.8
R58
G47.9
H26.8
H26.2
H40.2
S06.0
S09.8
K59.0
L02.9
J18.8
J18.0
J20.8
J40
I63.8

I63.6
F48.8
K75.9
E10.1
E10.8
E11.8
E14.8
K90.8
K62.5
K56.7
K56.1
S61.8
B34.8
A09
K29.6
K29.1
K29.5
H81.4
L91.8
D17.7
H44.0
R56.0
G03.8
D25.9
N83.2
L03.8
L03.0
N40
N20.0
N20.1
N21.0
N13.2
N19
N11.8
N30.1
N35.8
N39.8
R33
N49.8
I25.8
I25.2
I95.8
H16.0
N13.2
S02.4
S02.0
S06.2
K92.1

K40.3
K40.9
H11.0
S51.8
S93.3
S91.3
C67.9
T31.8
M70.5
S32.0
S01.0
L30.8
R73.9
E16.1
J90
R57.8
C50.9
N90.8
D69.3
M66.4
L89.0
E04.8
K80.8
S98.4
T01.8
E86
R57.1
R06.0
S82.7
S62.7
S42.0
S52.4
I25.1
G51.0
R04.2
J31.0
M67.4
K76.0
E05.9
R02
M79.1
J01.8
J33.9
S01.1
S01.3
G83.0
D06.9
M10.9

K91.8
M96.8
C22.7
G70.0
Z00.0
Z01.2
Z01.3
Z01.6
Z01.7
Z02.0
Z02.1
Z03.0
Z03.1
Z03.8
Z04.0
Z04.1
Z04.2
Z04.3
Z08.0
Z08.2
Z09.0
Z09.8
Z09.4
Z39.2
Z87.6
Z00.1
Z30.2
Z03.1
Z35.9
Z35.8
Z35.5
Z35.6
Z34.8
Z24
Z01.0
Z30.0
Z93
Z23
F43.9
G52.6
E78.5
G62.9
K02.1
K04.0
I61.9
H52.0
H52.1
H93.1

R50.9
K29.7
I50.0
I11.0
I11.9
M54.5
N18.0
A16.0
M15.4
G20
F20.9
F48.9
H52.0
H52.1
H52.4
H52.6
K02.1
K04.0
K04.1
K05.0
K05.1
K05.2
K05.3
H33.2
T14.0

K22.0
L70.8
E04.9
F90.9
N18.0
N18.0
N80.0
T78
N91.2
R41.3
A06.9
D64.9
R63
F41.1
O46.9
H27.0

K35.9
M13.9
B77.9
R18
I70
I35.2
P21.9

P24.9
R53
I70.0
M25.5
Q42.3
I48
Q21.1
F84.0
I44.3
Q27
R79.8
A54.1
E05.0
K80.8
N20.0
N21.1
N21.0
G51.0
E80.4
R05
T81.0
M77.9
H34.8

J47
J21.9
L42.0
M71.9
M77.3
M48.0
C11.1
C53.9
C18.9
C50.9
C11.9
C56
C34.9
C61
C20
C73
B37.9
I46.9
I51.7
I42.8
R51
G80.9
Q24
R07
A92.0

K80.2
M22.4
G25.5
N87.0
K74.6
N87.1
N30.9

I73.9
L84
T22
S06
G54.4
A63.8
Q74.1
Q24
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H10.9
S36.5
M13.1
N46.0
N18.9
M53.1
S67
H35.7
Q66.0
G56.0
M85.6
H11.4
Q89
K76.8
N83.2
Q61
K09.8
O95
R98
L89
M84.2
F05.9
F03
F01.9
M65.4
F32.9
L30.9
R62.9

A36.9
G93.9
S43.0
D46.0

Q20
F52.9
N93.9
N94.6
R06
R30.0
A86
Q01.1
I93.4
N80.9
S06
G40.9
R04.0
P14.0
D26.6

A46
K20
T07
M72.9
R56
R50
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S69
R62
K60.3
T06
Q64.8
Q64.8
L73.9
T02
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M75.0
Z50
R02
F38.8
F80.9
H90.2
H02.9
F99
F43.0
K00.8
H52.7
F45.8
F22.0
M67.4
K52.9

Z00.0
K21.0
H40.9
M17.9

A54.9
M10.0
L92.9
E05.0
Z34
D17.2
N94.8
K62.5
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R31
G81.9
K75.9
B15.9
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B16.9
B17.1
C22.0
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B02.9
B24
O72.1
Z35
L73.2
O40
N50.1
N43.3
G91.9
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Q52.3
E78.0
E05.9
E78.1
E79.0
E80.6
R73
R61
L81.0
E16.2
E87.6
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I95.9
O21.0

Q80
R17
F61
R25.8
Z23.2
Z24.4
Z27.1
Z23.0
Z23.0
Z23.0
Z24.6
Z24.4
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Z23.5
R15
R32
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R58
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M54.3
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A05.8
X46
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H16.8
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R10.4
M62.4
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Q38.0

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B76.0

C95.9
L81.5
D72.8
M54.5
L98.4

L04.0
A18.2
C85.9
C81.9
R73
E46
Q83.8
N61
Q43.1
L81.1
D32.9
A17.0
A39.8
N92.1
N95.9
N92.6
F79
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L74.3
H81.0
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D39.2
B27.9
B05.9
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Z30.2

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M81.8
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M06.9
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S66.6
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M41.9
L03.9
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M32.9
T63.0
R25.2
F80.9
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M43.1
M47.9
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L51.1
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H50.9

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I47.1
R55
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D56.8
G54.0
G45.9
G25.6
B35.4
B35.1
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B58.9

S39
S09
T30.4

T75
S19
S68.2
A59.9
M65.3
A19.0
D04.4

D36.7
C06.9
D30.0
D23.9

D24
D33.2
D14.3
D21.1
L97
Q35

Q76.4
M53.7

Q21
N76.0
B01.9
I83.9
I85.9
I86.1
I77.6
T80.1
R42
B07.9
R33
H43.3
J38.2
R11
D68.0
T01
S91.3
G58.9
H93.1

Diagnosa
PER/ Moderate Pre Eclamsia
PEB/ Severe Pre Eclamsia
KPD -24 Jam
KPD +24 Jam
PFL
PFA
SC Riwayat SC
Spontan Riwayat SC
Gemelly
Post Date
Gagal Drip
Placenta Accreta
Placenta Other Dissorder
PP/ Placenta Previa Tak Berdarah
PP/ Placenta Previa Berdarah
CPD/ Chepalo Pelvis Disporposional
Diabetes Ibu Hamil
Ibu Rawat Inap Hamil
Hypertensi Ibu Persalinan
Oedema Portio
Bartholinitis
IUFD Ibu
Persalinan Prematur
IUGR Ibu
Letsu Ibu
Letli Ibu
Anencepalus Ibu
Bayi Besar Ibu
Spontan Abortion
Medical Abortion
False Labour Before 37 Weeks
False Labour After 37 Weeks
Maternal Care For Unstable Lie
Anemia Komplikasi Ibu Hamil
Cephalopelvic Disproportion
Hyperemesis Gravidarum
Rupture Perineum
Puerperal Infection
Oligohidramnion
Fetal Distress
Malnutrusi Ibu Hamil
Kehamilan Ektopik Terganggu
Other Placental Disorders
Open Wound Of Vagina & Vulva
Failed Medical Forceps
Spontaneous Vertex Delivery
Spontaneous Brach Delivery

Vacuum Extractor Delivery

Delivery by Elective SC
Delivery by Emergency SC
Multiple Delivery, All Spontaneous
Multiple Delivery, All Vacuum
Multiple Delivery, All by SC
Single Live Birth
Single Still Birth
Twins, Both Live Born
Twins, One Live Born & One Still Born
Twins, Still Born
Other Multiple Birth, All Live Born
Other Multiple Birth, Some Live Born
Other Multiple Birth, All Still Born
Other Multiple Birth, Unspesified
BO/ Blighded Ovum
Missed Abortus/ Abortus Imminens
Dead Conceptus
Perdarahan Awal Kehamilan
Perdarahan Sebelum Persalinan
Perdarahan Akreta Plasenta
Perdarahan Post Partum
Sisa Placenta tanpa Perdarahan
Abortus Incomplete
Asphyxia Berat
Asphyxia Sedang
Asphyxia Ringan
Ikterus
Pneumonia Bayi/ Aspirasi
Atresia Ani
Prematur
IUGR Anak
BBLR
IUFD / fetal death
Megacolon
Polyductily
Hydrochepalus
Letsu Bayi
Letli Bayi
Tali Pusat Menumbung
Anencepalus Bayi
Apnea Bayi
Aspirasi Pnemonia Bayi
Bayi Belum Lahir
Bayi Besar
Bayi Kurang Minum
Bayi Mati
Bayi Lahir Vakum

Bayi Lahir SC
Cepalhematoma Bayi
Koma Bayi
Diare Bayi Baru Lahir
Drip Bayi Normal
Fetal Bayi
Hematoma Bayi
Hidrocepalus Bayi
Hidrom Neos Bayi
Hipoglikemia Bayi
Hipoksia Bayi
Melena Bayi
Monoliasis Bayi
Mysatenia Gravis Bayi
Obstruksi Anus (Bawaan Lahir)
Perdarahan Tali Pusat Bayi
Pnemonia Deastinum Bayi
Penyakit Hemolitik Janin/ Bayi
Placenta Previa Bayi
Rectal Bleeding Bayi
Respiratory Distress Bayi
Respiratory Failure Bayi
Bacterial Sepsis of Newborn
Sindrom Mendadak Bayi
Gemelly Bayi
Fetus & Newborn Affected Cervix
Bayi Panas/ Febris
Bayi Dipengaruhi Hipertensi Ibu
Bayi Dipengaruhi Plasenta Previa
Bayi Postdate
Bayi Dipengaruhi Komplikasi Ibu
Microcephaly
Hirschsprung Disease
Singleton, Born in Hospital
Singleton, Born Outside in Hospital
Singleton, Unspesific of Birth
Twin, Born in Hospital
Twin, Born Outside in Hospital
Twin, Unspesific of Birth
Other Multiple, Born in Hospital
Other Multiple, Born Outside Hospital
Other Multiple, Unspesific of Birth
Demam Berdarah/ DHF
Haemorrhoids
Dengue Fever/ DF
Thypoid Fever
Chest Pain
Encephalopathy

Peritonitis Akut
Other Specified Arthritis
Demam/ Febris
ISPA
Other Thalasemia
Common Cold/ Nasofaringitis
Stomatitis
Faringitis
Tonsilitis Akut
Hiperaktif Bronkus/ Batuk
TBC/ KP (Koch Pulmonal)
Peritonial TB
Dispepsia
Ulkus Peptikum
Mual/ Muntah/ Vomiting
Nyeri Perut/ Abdomen
Asma Akut
Asma
Headace/ Cephalgia
Myopi
Contusio Elbow (Siku Lecet)
Luka Lecet Pipi
Apendicities Kronis
Apendicities Akut
Apendicities Akut Perforasi
Hypertensi/ HT Grade I/ Primer
Hypertensi/ HT Grade II/ Sekunder
Angina Pectoris
Brachicardia
Infark Myocard Akut
Batuk
Disorders Plasma Protein Metabolism
Flu
PPOK/ COPD
Haemorrhage
Insomnia
Katarak
Katarak Sekunder/ OD
Glaucoma Acute
COR/ COS/ CKR/ CKS
COB
Konstipasi
Furuncle, Carbuncle
Pneumonia
Bronkopnemonia
Bronkitis Akut
Bronkitis
CVA infark

CVA Trombolik
Neurosis Psikosa
Hepatitis
DM Insulin Ketoasidosi
DM Insulin
DM Non Insulin / NIDDM
Unspesific Complication DM dengan koma
Malabsorbsi Usus
Hemoroid
Ileus Obstruksi
Intussusception
Open Wound Wrist & Hand
Other Viral Infection
Gastroenteritis Akut / GEA / Dysentri Basiler / Colitis
Gastritis Perdarahan
Gastritis Akut
Gastritis Krnonis
Vertigo
Keloid
Lipoma
Endopthalmitis
Febris Convulsi
Meningitis
Myoma Uteri
Cysta Ovarium
Selulitis Unspesifik
Selulitis Kaki
BPH / Hyperplasia Of Prostate
Calculus Of Kidney/ Nephrolithiasis
Calculus Of Ureter
Calculus In Bladder
Hydronephrosis
Kidney Failure
Pyelonephritis
Interstitial Cystisis
Strikture Urethra
Urinary Tract Infection
Retensio Urine
Inflammatory Male Genital
Iskemik Kronis/ Jantung
Old Myocard Acute
Hipotensi
Ulkus Kornea/ Keratitis
Hidroneprosis
Fraktur Maxilaris
Fraktur Cranii
Contusio Cerebri
Melena

Hernia
HIL
Pterygium
Luka Terbuka Tangan
Dislokasi Kaki
Luka Terbuka Kaki
Carcinoma Bladder/ Buli
Terbakar 80%
Bursitis
Fraktur Lumbar
Luka Lecet Pelipis Kepala
Dermatitis
Hiperglikemia
Hipoglikemia
Efusi Pleura
Shock
Fibroadenomatosis
Disorder Vulva & Perineum
Ideopatic Trombocytopenia Purpuralis
Rupture Tendon
Ulkus Diabetikum
Nontoxic Goitre
Other Cholelithiasis
Amputasi Kaki
Vulnus Appertum
Dehidrasi Berat
Hypovolaemic Shock
Dyspnea
Fracture Tibia & Fibula
Fracture Finger
Fracture Clavicle
Fracture Radius & Ulna
Penyakit Jantung Koroner
Bell Palsy
Haemoptysis
Chronic Rhinitis
Ganglion
Fatty Liver
Thyrotoxicosis
Gangren
Myalgia
Sinusitis
Polip Nasal
Laserasi Mata
Laserasi Telinga
Diplegia
Carcinoma Cervix
Gout

Other Post Procedural Disorders Of Digestive

Musculoskeletal Disorders
Carcinomas Liver
Myasthenia Gravis
General Check Up
Periksa Gigi
Periksa Tekanan Darah
Periksa Radiologi
Periksa Laboratorium
Periksa Kesehatan untuk Pendidikan
Periksa Kesehatan untuk Kerja
Observasi Suspek TBC
Observasi Suspek Neoplasma
Observasi Suspek Penyakit Lainnya
Observasi Alkohol/ Narkoba
Periksa Akibat Kecelakaan di Jalan Raya
Periksa Akibat Kecelakaan Kerja
Periksa Akibat Kecelakaan Lainnya
Kontrol Setelah Operasi Neoplasma
Kontrol Setelah Kemoterapi
Kontrol Setelah Operasi
Kontrol Setelah Rawat Inap
Kontrol Setelah Patah Tulang
Kontrol Post Partum
Kontrol Bayi Post MRS
Kontrol Bayi Sehat
Sterilisasi (MOW)
Observasi Neoplasma
Periksa Sebelum Curettage
Primi Tua Primer
Primi Tua Sekunder
Primigravida < 17 th
Pemeriksaan Kehamilan
Imunisasi
Periksa Mata
Konsultasi Kontrasepsi
Colostomy Kontrol
Vaksinasi
Stres tidak diketahui penyebapnya
Tic Facial
Dyslipidemia
Neurophaty/Polyneurophaty
Carries of dentin
Pulpitis
ICH
Hypermetrophia
Myopia
Tinitus

Fever / Febris ( Of )
Gastritis unspesified
Congestive Heart Failure ( Chf )
Hypertensive Heart Failure ( Hhf )
Hypertensive Heart Disease ( Hhd)
Low Back Pain ( Lbp )
Esrd
Tb Paru
Erosive (Osteo)Arthrosis ( Oa )
Parkinson's Disease
Schizophrenia
Neurotic Disorder
Hypermetropia
Myopia
Presbyopia
Disorder Of Refraction/ Gangguan Mata
Carries Of Dentine
Pulpitis
Necrosis Of Pulp
Acute Gingivitis
Kronik Gingivitis
Acute Peridontitis
Kronik Peridontitis
Ablasio Retina
Abrasio

Achalasia
Acne Vulgaris
Adenomatous Goiter
ADHD / hyperkinetic
Ckd
Ggk
Adonemyosis
Agioderma / Anaphylacti Shock
Amenorrhoe
Amnesia
Amubiasis
Anemia
Anorexia
Anxietas / Gangguan Cemas
APB / Ante Partum Bleeding
Aphakia

Appendicitis unspesified
Arthritis
Ascariasis
Ascites
ASHD / ASD ( Anterio Sclerosis Disease )
ASI
Asphyxia Neonatus

Aspirasi
Asthenia
Atheroma
Atralgia / Haematros
Atresia Ani
Atrial Fibrilasi / AF
Atrial Septal Defect / ASD
Autisme
AV Block
AVM
Azotenia
Bartholinitis
Basedow
Batu Empedu
Batu Ginjal
Batu Urethra
BBB / BSK
Bell Palsy / BP
Bilirubinemia
BKB
Bleeding Post TE
Bone Spur
Branch Retinal Vein Occlusion / BRTO

Bronchietasis
Bronchiolitis
Bulous Pempigoid
Bursitis Elbow
Calcaneal Spur
Canal Stenosis
Cancer Adeno
Cancer Cervix / Ca Cervix
Cancer Colon / Ca Colon
Cancer Mamae / Ca Mamae
Cancer Nasopharing / Ca Nasopharing
Cancer Ovarium / Ca Ovarium

Cancer Paru / Ca Paru

Cancer Prostat
Cancer Rectum
Cancer Thyroid / Kulit
Candidiasis
Cardiac Arrest
Cardiomegali
Cardiomyopathy / CMP
Cephalgia
Cerebral Palsy / CP
CHD / Congenetal Heart Disease
Chest Paint
Chikungunya

Cholelithiasis
Chondromalacia Patella
Chorea
CIN grade I
Cirrhosis Hepatis / CH / SH
CIN grade II
Cistitis

Claudication Interminten
Clavus
Combustio
Commotio Cerebri ( COR COS COB )
Compresi Tulang Belakang / CTB
Condiloma Akuminata
Congenetal Anomali Knee / CAK
Congenetal Heart Disease / CHD
Contusio Masculorum / Muscle SPASME
Conyungtivitis
Corpus Alienum
Coxitis
Cracked Nipple
CRF
CRS / Cervixal Root Syndrom
Crush Injury
CSCR
CTEV
CTS
Cyste Clavicula
Cyste Conjungtiva
Cyste Ductus Thyroglosus / CDT
Cyste Liver / Hepar
Cyste Ovarium
Cyste Renal / Ginjal
Cyste Rongga Mulut
Death Conceptus
Death On Arrivle / DOA
Decubitus
Delay Union Fracture / DUF
Dellirium
Demensia
Demensia Vasculer
Denguar vain syndrom / DVS
Depresi / Gangguan Expresif
Dermatitis
Development Delay

Diphteria
Disfungsi Otonomik
Dislokasi
DMPS

Down Syndrom
Dysfungsi Ereksi
Dysfungsional ( Icterus Bleeding / DUB )
Dysmenorrhoe

Dyspneu / HICCUP
Dysuria
Encephalitis
Encephalocel
Encephalopathy
Endometriosis
Epidural / Subdural Hematom
Epilepsi
Epistaxis
ERB Palsy
Erosi Papila Mamae

Erysipelas
Esophagitis
Excoriasi
Fascitis
Febris Convulsi / FC
Febris Unknown Origin / OF / FUO
Fibro Adeno Mammae / FAM
Finger Tip Injuery
Fissur Uteri
Fistel Perianal
Fistel Preauricle
Fistel Umbilicalis
Flatulence
Folikulitis
Fracture Anggota Gerak / of Lamb
Fracture Badan/Tubuh
Fracture Femur
Fracture Tengkorak
Frozen Shoulder
FT / Fisio Terapi
Ganggren Pedis
Gangguan Afektif / HMFD
Gangguan Berbicara Expresif / GBE
Gangguan Daya Dengar / GDD
Gangguan Kelopak Mata / GKM
Gangguan Panik / Proses berfikir / Psikotik
Gangguan Penyesuaian
Gangguan Perkembangan Gigi
Gangguan Refraksi
Gangguan Smatoform / Faham Somatik
Gangguan Waham
Ganglion
GE Non Infeksi

General Cek Up
GERD / Esophagus
Glaucoma
Gonitis

Gonorrhoe
Gouth Arthritis / GA
Granuloma
Graves Diasease / Basedow
Hamil Normal
Hemangium Cavernosum
Hematocel pada perempuan
Hematochesia
Hematoma
Hematuri
Hemipareze / Paraesthesia / Parase / Paralysis
Hepatitis
Hepatitis A
Hepatitis Acut
Hepatitis B
Hepatitis C
Hepatoma
Hepatomegali
Hernia Inguinalis Lateralis / HIL
Hernia Nukleus Pulposus / HNP
Herpes Zooster
HIV / Human Immunodeficiency Virus
HPP / Haemorhagia Post Partum
HRP
Hydradenitis
Hydramion
Hematocel pada laki - laki
Hydrocele
Hydrocephalus
Hydronephrosis
Hymen Imperforata
Hyper Cholesterol
Hyperthyroid
Hypergliceride
Hyper Uricemia / Hyper Uric Acid
Hyperbilirubin
Hyperglicemia
Hyperhidrosis
Hyperpigmentasi
Hypoglicemia
Hypokalemia
Hypospadania
Hypotensi
Hypremisis Gravidarum

Ichtiosis
Icterus
Imaturitas Reaction
Impaired Bowel Movement
Imunisasi BCG
Imunisasi Campak
Imunisasi DPT
Imunisasi Engerik
Imunisasi HB, Jek
Imunisasi Heberix
Imunisasi Hepatitis B
Imunisasi Hepavak
Imunisasi Infaric HIB
Imunisasi Infarix
Imunisasi Polio
Imunisasi TT
Incontinensi Alvi
Incontinensi Urine
Infeksi Saluran Kencing / ISK
Infertility pada wanita
Infiltrat
Ingrowing Nail
Insect Bite
Insomnia
Intelorence Food
Internal Bleeding
Intoxicasi
Invaginasi
IQ Ambang
Iritasi Anus

Ischialgia
Katarak
KB

Keracunan Alkohol
Keracunan Baygon

Keracunan makanan
Keracunan Minyak Tanah
Keracunan Obat
Keratitis
Keratosis
Khalazion

Koch Pulmonum / KP
Kolik Abdomen
Kontraktur
Kracunan Obat serangga
Labio Schizis

Laringitis
Larva Migrasi

Leucemia / CLL
Leucoderma
Leucositosis
Low Back Pain / LBP
Luka Infeksi

Lymphadenitis
Lymphadenitis Tuberculose
Lymphoma / Lymphoma Non Hodgkin's / LNH
Lympoma Hodgkin"s
Malaise
Malnutrisi
Mamae Aberans
Mastitis
Mega Colon Congenetal / Hirschprungs Disease
Melasma
Meningioma
Meningitis Tuberculose
Meningo Encephalitis
Menometroharrgia
Menopouse
Menstruatie
Mental Retardasi / RM
Migrain
Miliaria
Minieres Syndrom
Mitral Regurgitasi / RM
Mitral Stenosis / MSI
Mola Hydatidosa
Monoliasis
Morbilli
Leprosy [Hansen's disease]
Motor Delayed
MOW

Myalgia
Myastenia Gravis
Myeloma

Myophaty
Myringitis
Necrose
Neonatus
Nephritis
Nephrotic Syndrom / SN

Neuritis Obtica
Neuro Fibroma
Neurophaty
Neurosa
NPDR
Obesitas

Konstipasi
Oclusiveva
Oedema Anasarka
Oedema Limb
Oedema Paru
Oklusi Arteri Cruris
Oligohidramion
Oligoria
Oral Thrush
Osteofit
Osteoma / mandibulla

Osteomyelitis
Osteoporosis
Otitis Externa
Oxyoris (Cacingan)
Decom cordis

Palato Schizis
Palpitasi
Pankreatitis

Paronichia
Parotitis
PDA
Pemphigoid
Allergic rhinitis
Chronic tonsillitis
Penyakit kelamin / FA / Flour Albus
Pertusis
Petechiae

Phemosis
Pitiriasis Alba
Pityriasis Versikolor
Placenta Previa
Plantar Facitis
Plebitis
Pneumothorax
Policetemia
Polyciria
Polyp Blader
Polyp Cervix
Polyp Nasal
Proptosis / Exopthalmus

Prostatitis
Pseudofakia
Psikosa
Psikosomatis
Radang Kelopak Mata / Hordeolum
Raynaud's Disease
Reaksi Conversi

Regurgitasi Aorta

Remathoid Arthritis
Retensio Urine
Retinitis Pigmentosa
RHD / Penyakit Jantung Rematik
Rubella
Ruptur Cornea

Ruptur Tendon
Scabies
Schizoprenia
Scoliosis
Sellulitis / Phlegmon
Sepsis
Serumen Obsturan
Sigelosis
Sinus Bradicardia
Sinusitis Maxilaris
Skin tag / Skin Defect
SLE
Snake Bite
Spasme
Speech Dellay
Spina Bifida / Meningocele
Spondilitis
Spondilolithesis / Scralisasi
Spondylosis
Sprain
Squele TB
Steroid With Drawl
Steven Johnson Syndrom / SJS
Stomatitis
Strabismus

Struma Uninodosa
SVT
Syncope
Tachicardia
Talipes Equinovarus
Tension Head Ache / THA
Tetanus
Tetralogi Fallot

Thalazemia
Thoracic Syndrom
TIA / Transent Ishemic Atfack
Tic Facialis
Tinea Corporis
Tinea UnguIum / Onychomycosis
Torticollis
Toxoplasma

Trauma Abdomen / Trauma Tumpul

Trauma Capitis / kepala
Trauma Chemis / Trauma Kulit

Trauma Electric
Trauma Mekanik
Traumatic Amputasi
Tricomonas
Triger Finger
Tuberculose Miliere
Tumor Kepala

Tumor Abdomen
Ca mulut
Tumor Ginjal
Tumor Kulit / Cubiti

Tumor Mamae
Tumor Otak
Tumor Paru
Tumor Soft Tissue
Ulkus Pedis
Undercender Testicle

Unstable Lumbo Sacral

Unstable Pelvis

USD
Vaginitis
Varicella
Varices kaki
Varices Oeshophagus
Varicocel
Vasculitis
Vena Sectie
Vertigo
Veruca Vulgaris
Vesicocel
Vitrius Floaters
Vocal Nodule
Vomiting
Von Willebrad's Disease
Vulnus Appertum / Degloving / Laserasi / Circumsisi / V APP

Vulnus Ictum / V Ictum

Mononeurophaty / tic facialis
Tinitus

Keterangan
Pre Eklamsi Sedang
Pre Eklamsi Berat
Ketuban Pecah Dini
Ketuban Pecah Dini
Pro-long Fase Laten
Pro-long Fase Aktif

Kembar
Lebih bulan
Gagal Rangsang
Plasenta Lengket di Rahim
Placenta Letak Rendah
Marginalis
Pinggul Sempit

HT

Ibu kurang dari < 37 mgg

Intra Uterine Growth Retardation
Oblique

Aborsi Spontan
Aborsi Medis
Persalinan Palsu Kurang 37 Minggu
Persalinan Palsu Lebih 37 Minggu
Perawatan Ibu Persalinan Palsu
CPD
HEG
Robek/ Laserasi Perineum
Infeksi Pasca Persalinan

KEK/ Kekurangan Energi Kronis

KET/ HDK
Plasenta Letak Rendah
Robekan Jalan Lahir/ ROJ
Gagal Drip/ Induksi
Persalinan Normal
Persalinan Letak Sungsang/ Lintang

Persalinan Vakum
Persalinan SC Terencana
Persalinan SC Darurat
Persalinan Multipel, Spontan Semua
Persalinan Multipel, Vakum Semua
Persalinan Multipel, SC Semua
Lahir Satu Hidup
Lahir Satu Mati
Lahir Kembar Hidup Semua
Lahir Kembar, 1 Hidup 1 Mati
Lahir Kembar Mati
Lahir Lebih dari 2, Hidup Semua
Lahir Lebih dari 2, Beberapa Hidup
Lahir Lebih dari 2, Hanya Lahir Saja
Lahir Lebih dari 2, Tidak Spesifik

HPP
Retensio Plasenta
Bayi Kebiru"an Berat (AS 0-3)
Bayi Kebiru"an Sedang (AS 4-7)
Bayi Kebiru"an Ringan (AS 4-7)
Bayi Kuning
Tersedak
Tidak Punya Anus
Kelahiran bayi < 28 mg
Kelahiran bayi < 2500 gram
bayi keluar mati apapun

Letak Sungsang
Letak Lintang
Tali Pusat Keluar Lebih Dulu

Inpartu

Sepsis/ Infeksi Bakteri

Bayi Dipengaruhi KPD

PER/ PEB

PFL/ PFA
Tidak Ada Batok Kepala
Megacolon Bayi
Lahir Satu diluar Rumah Sakit
Lahir Satu Tidak Spesifik
Lahir Kembar di Rumah Sakit
Lahir Kembar diluar Rumah Sakit
Lahir Kembar Tidak Spesifik
Lahir Lebih Dari 2 di Rumah Sakit
Lahir Lebih Dari 2 diluar Rumah Sakit
Lahir Lebih Dari 2 Tidak Spesifik
Wasir
Demam Tipes
Dada Sesak

Artritis
Panas

Masuk Angin

TB Paru
Gangguan Pernapasan

Cholic Abdomen
Bronchiale
Pusing
Rabun Jauh

Darah Tinggi

Brakikardi
OMI
Hypoalbumin
Paru Menahun
Perdarahan
Susah Tidur
Chatarac Secondary to Occular Disorders
Glukoma
Cidera Otak Sedang/ Ringan
Cidera Otak Berat
Sembelit

Stroke

Stroke
Gangguan Psikologi Syaraf
KAD
Type I
Type II
Koma Asidosis Diabetik/ KAD
Wasir
Invaginasi
Luka Robek Pada Tangan
Mencret/Diare/ GEA/ GEADS

Benjolan
Mata Sakit
Kejang

Kista Ovarium

Prostat
Batu Ginjal
Batu Ureter
Batu Kandung Kemih/ BBB
Ginjal Bengkak/ HN/ Akibat Batu Ginjal
Gagal Ginjal
Kantong Kemih Sakit
Stenosis
ISK/ UTI

DM
Ulcer Cornea

Hernia Inguinalis

Combustio Degree 80%

Empisema
Kanker Payudara/ FAM

Tendon Putus
Struma/ Gondok

Sesak Nafas/ Nafas Pendek

Jari
Patah Tulang Belikat
Antebrachii
PJK
Batuk Darah

Sakit Hati
Hyperthyroidism

Luka Mata
Luka Telinga

Asam Urat

Post Kolostomi, Hernia, Ileus

Jaringan Lunak
Hepatoma

Rontgen/ Ronsen

Mabuk/ Mendem/ Oplosan

Tabrakan
Kejatuhan Genting
Jatuh di Toilet
Kista
SC/ BPH/ dll
Post DHF/ ISPA/ dll
Partus Normal
Ikterus/ Aspiksia

Usia Ibu > 35 th

KB
Operasi membuat saluran untuk BAB

Chronic tonsillitis
[Extracted from ICD-10 Second Edition, 2

rom ICD-10 Second Edition, 2005, Diseases of the respiratory system.]