KODING ICD

NO NAMA PEMERIKSAAN / TINDAKAN

IX-CM

1 95.01 Limited Eye Examination

2 95.02 Comprehensive Eye Examination
3 95.03 Extended Eye Examination / Work-Up
4 95.04 Eye Examinatioin Under Anesthesia
5 95.05 Visual Field Study
6 95.06 Color Vision Study
7 95.11 Fundus Fotography
8 95.12 Fluorescein Fundus Angiography
9 95.13 Ultrasound Study Of Eye
10 95.14 X-Ray Study Of Eye
11 95.15 Ocular Motility Study
12 95.16 P32 and Other Tracer Study of Eye
13 95.21 ERG
14 95.22 EOG
15 95.23 VEP
16 95.24 ENG
17 95.25 EMG
18 95.26 Tonography ( Glaucoma Testino )

19 95.31 Fitting & Dispensing Spectacle

20 95.32 Prescription, Fitting, Dispensing Contact Lens

21 95.33 Dispensing Of Other Low Vision Aids
22 95.34 Ocular Prosthetic
23 95.35 Orthopic Training
24 95.36 Ophtalmologic Counseling & Instruction
25 87.03 Computerized Axial Tomography of Head
26 89.11 Tonometry
27 16.21 Ophtalmoscopy
28 08.21 Excision Of Chalazion
29 08.93 Other Epilation Of Eyelid
30 09.19 Other Diagnostic Procedures Of Lacrimal System
31 10.29 Other Diagnostic Procedure On Conjungtiva
32 10.91 Subconjungtival Injection
33 11.21 Scraping Of Cornea
34 11.29 Other Diagnostic Procedure On Cornea
35 11.39 Other Exicision Of Pterygium
36 13.59 ECCE
37 13.41 Phacoemulsification
38 13.64 Diccision Of Secondary Membrane ( After Cataract )
39 14.21 Destruction Of Chorioretinal Lesion By Diathermy
40 14.22 Destruction Of Chorioretinal Lesion By Cryotheraphy
41 14.24 Destruction Of Chorioretinal Lesion By Laser Photocoagulation
42 14.75 Injection Of Vitreous Substitute
43 96.51 Irigation Of Eye
44 98.21 Removal Of Supervicial Foreign Body From Eye Without Incision
KLAIM INA-CBGS KETERANGAN

Rp 192,100.01
Rp 223,800.00
Rp 223,800.00
Rp 223,800.00
Rp 223,800.00 Perimetri
Rp 223,800.00 Isihara
Rp 252,200.00 Foto Fundus
Rp 252,200.00
Rp 252,200.00 USG Mata
Rp 252,200.00 Rontgen Mata
Rp 223,800.00 Pem. Motilitas Mata
Rp 252,200.00 OCT
Rp 252,200.00
Rp 252,200.00
Rp 223,800.00
Rp 252,200.00
Rp 252,200.00
Rp 252,200.00 Tonography
Kacamata untuk High Miop,
Rp 223,800.00
Anisometrop, Low Vision
Rp 223,800.00
Rp 223,800.00
Rp 223,800.00
Rp 223,800.00 Cam Vision
Rp 223,800.00
Rp 948,000.00 CT Scan Kepala
Rp 223,800.00 Tonometri
Rp 223,800.00 Funduskopi
Rp 533,700.00 Eksisi Chalazion
Rp 533,700.00
Rp 533,700.00
Rp 268,500.00
Rp 268,500.00 Injeksi Subkonjungtiva
Rp 533,700.00
Rp 533,700.00
Rp 934,000.00
Rp 3,671,000.00
Rp 7,342,000.00
Rp 3,671,000.00 Yag Laser
Rp 1,562,600.00
Rp 1,562,600.00
Rp 499,300.00
Rp 1,562,600.00 Injeksi Vitreal
Rp 223,800.00 Irigasi Mata
Rp 268,500.00 Benda Asing