KODE DIAGNOSA UNTUK SPESIALIS KEBIDANAN DAN KANDUNGAN DENGAN ANEMIA

NO

ICD 9 CM

SECTIO CESARIA ( 74.99 )

TOTAL TARIF

INDIKASI
ICD 10

KLS I

KLS II

KLS III

1. PREVIOUS SC

O34.2

6.287.900

5.389.600

4.491.300

2. EKLAMSI / PEB

O14.0

6.287.900

5.389.600

4.491.300

3. GAWAT JANIN / FETAL DISTRESS

O68.9

3.276.000

2.807.700

2.340.000

4. KPSW / PROM / KPD

O42.0

6.287.900

5.389.600

4.491.300

5. OLIGOHIDROMNION

O41.1

6.287.900

5.389.600

4.491.300

6. CHF - CONGESTIVE HEART FAILURE

I50.0

6.287.900

5.389.600

4.491.300

7. ASMA BRONCHIAL

J45.9

6.287.900

5.389.600

4.491.300

8. PLASENTA PREVIA TANPA PENDARAHAN

O44.0

6.287.900

5.389.600

4.491.300

9. PLASENTA PREVIA DENGAN PENDARAHAN

O44.1

6.287.900

5.389.600

4.491.300

10. SOLUSIO PLASENTA / ABLATIO PLACENTA

O45.9

6.287.900

5.389.600

4.491.300

11. CEPHALOPELVIC DISPROPORTION

O33.9

6.287.900

5.389.600

4.491.300

12. DIABETES MELITUS

O24.4

6.287.900

5.389.600

4.491.300

13. KJDK

O36.4

6.287.900

5.389.600

4.491.300

14. HIDROPS FETALIS

P83.2

6.287.900

5.389.600

4.491.300

1. MIOMA UTERI

D25.9

10.546.800

9.040.100

7.532.700

2. MIOMA GEBURT

D25.9

10.546.800

9.040.100

7.532.700

N85.0

10.546.800

9.040.100

7.532.700

4. PROLAPSUS UTERI

N81.4

10.546.800

9.040.100

7.532.700

5. TUMOR OVARIUM

D27

10.546.800

9.040.100

7.532.700

HISTEREKTOMI TOTAL/HT (68.9) 3. HIPERPLASIA ENDOMETRIUM

SALPINGO OOPHORECTOMY
BIILATERAL / SOB ( 65.61 )

SALPINGO OOPHORECTOMY
UNILATERA /SOU ATAU
SOD/SOS (65.49)

LAPARATOMY ( 54.19 )

EXCISI ( 83.49 )

KURETASE ( 69.09 )

INDUKSI ( 73.01 )

1. MIOMA UTERI

D25.9

10.546.800

9.040.100

7.532.700

2. MIOMA GEBURT

D25.9

10.546.800

9.040.100

7.532.700

3. HIPERPLASIA ENDOMETRIUM

N85.0

10.546.800

9.040.100

7.532.700

4. PROLAPSUS UTERI

N81.4

10.546.800

9.040.100

7.532.700

5. TUMOR OVARIUM

D27

10.546.800

9.040.100

7.532.700

1. KISTA OVARIUM

N83.2

10.546.800

9.040.100

7.532.700

1. ECTOPIC PREGNANCY

O00.9

9.231.200

7.911.700

6.593.700

2. KISTA COKLAT

N80.9

9.231.200

7.911.700

6.593.700

1. KISTA BARTOLINI

N75.0

13.843.400 11.865.800

9.888.200

2. POLIP VAGINA

N84.2

13.843.400 11.865.800

9.888.200

3. POLIP CERVIX

N84.1

13.843.400 11.865.800

9.888.200

1. ABORTUS INKOMPLIT

O06.9

6.805.400

5.833.800

4.861.500

2. ABORTUS IMMINENS

O20.0

6.805.400

5.833.800

4.861.500

3. BLIGHTED OVUM / BO

O02.0

6.805.400

5.833.800

4.861.500

4. POLIP ENDOMETRIUM

N84.0

6.805.400

5.833.800

4.861.500

5. HIPERPLASIA ENDOMETRIUM

N85.0

6.805.400

5.833.800

4.861.500

6. MISSED ABORTION

O02.1

6.805.400

5.833.800

4.861.500

7. RETENSIO PLASENTA

O73.0

6.805.400

5.833.800

4.861.500

8. MOLA HIDATIDOSA

O01.9

6.805.400

5.833.800

4.861.500

1. KJDK

O36.4

3.950.300

3.386.000

2.821.600

CATATAN:
Tarif ini berlaku jika terdapat diagnosa tambahan Anaemia Unspecified (D64.9)

S KEBIDANAN DAN KANDUNGAN DENGAN ANEMIA

KETERANGAN

BIAYA KLAIM RENDAH

KODE DIAGNOSA UNTUK SPESIALIS KEBIDANAN DAN KANDUNGAN TANPA ANEMIA

NO

ICD 9 CM

TOTAL TARIF

INDIKASI
ICD 10

SECTIO CESARIA ( 74.99 )

HISTEREKTOMI TOTAL/HT (68.9)

KLS I

KLS II

KLS III

1. PREVIOUS SC

O34.2

5.698.100 4.883.600 4.069.700

2. EKLAMSI / PEB

O14.0

5.698.100 4.883.600 4.069.700

3. GAWAT JANIN / FETAL DISTRESS

O68.9

2.727.700 2.338.000 1.948.400

4. KPSW / PROM / KPD

O42.0

5.698.100 4.883.600 4.069.700

5. OLIGOHIDROMNION

O41.1

5.698.100 4.883.600 4.069.700

6. CHF - CONGESTIVE HEART FAILURE

I50.0

5.698.100 4.883.600 4.069.700

7. ASMA BRONCHIAL

J45.9

5.698.100 4.883.600 4.069.700

8. PLASENTA PREVIA TANPA PENDARAHAN

O44.0

5.698.100 4.883.600 4.069.700

9. PLASENTA PREVIA DENGAN PENDARAHAN

O44.1

5.698.100 4.883.600 4.069.700

10. SOLUSIO PLASENTA / ABLATIO PLACENTA

O45.9

5.698.100 4.883.600 4.069.700

11. CEPHALOPELVIC DISPROPORTION

O33.9

5.698.100 4.883.600 4.069.700

12. DIABETES MELITUS

O24.4

5.698.100 4.883.600 4.069.700

13. KJDK

O36.4

5.698.100 4.883.600 4.069.700

14. HIDROPS FETALIS

P83.2

5.698.100 4.883.600 4.069.700

1. MIOMA UTERI

D25.9

7.469.200 6.402.000 5.335.100

2. MIOMA GEBURT

D25.9

7.469.200 6.402.000 5.335.100

3. HIPERPLASIA ENDOMETRIUM

N85.0

7.469.200 6.402.000 5.335.100

4. PROLAPSUS UTERI

N81.4

7.469.200 6.402.000 5.335.100

5. TUMOR OVARIUM

D27

7.469.200 6.402.000 5.335.100

SALPINGO OOPHORECTOMY
BIILATERAL/SOB (65.61)

1. MIOMA UTERI

D25.9

7.469.200 6.402.000 5.335.100

2. MIOMA GEBURT

D25.9

7.469.200 6.402.000 5.335.100

3. HIPERPLASIA ENDOMETRIUM

N85.0

7.469.200 6.402.000 5.335.100

4. PROLAPSUS UTERI

N81.4

7.469.200 6.402.000 5.335.100

5. TUMOR OVARIUM

D27

7.469.200 6.402.000 5.335.100

N83.2

7.469.200 6.402.000 5.335.100

1. ECTOPIC PREGNANCY

O00.9

8.041.700 6.893.600 5.744.100

2. KISTA COKLAT

N80.9

8.041.700 6.893.600 5.744.100

1. KISTA BARTOLINI

N75.0

6.901.200 5.914.700 4.929.400

2. POLIP VAGINA

N84.2

6.901.200 5.914.700 4.929.400

3. POLIP CERVIX

N84.1

6.901.200 5.914.700 4.929.400

1. ABORTUS INKOMPLIT

O06.9

3.871.200 3.317.900 2.765.200

2. ABORTUS IMMINENS

O20.0

3.871.200 3.317.900 2.765.200

3. BLIGHTED OVUM / BO

O02.0

3.871.200 3.317.900 2.765.200

4. POLIP ENDOMETRIUM

N84.0

3.871.200 3.317.900 2.765.200

5. HIPERPLASIA ENDOMETRIUM

N85.0

3.871.200 3.317.900 2.765.200

6. MISSED ABORTION

O02.1

3.871.200 3.317.900 2.765.200

7. RETENSIO PLASENTA

O73.0

3.871.200 3.317.900 2.765.200

8. MOLA HIDATIDOSA

O01.9

3.871.200 3.317.900 2.765.200

O36.4

2.954.300 2.532.200 2.110.000

SALPINGO OOPHORECTOMY
UNILATERAL/SOU ATAU SOD/SOS 1. KISTA OVARIUM
(65.49)
LAPARATOMY ( 54.19 )

EXCISI ( 83.49 )

KURETASE ( 69.09 )

INDUKSI ( 73.01 )
1. KJDK
CATATAN :
Tarif ini juga berlaku untuk diagnosa Anaemia complicating, childbirth and the puerperium (O99.0)

IS KEBIDANAN DAN KANDUNGAN TANPA ANEMIA

KETERANGAN

TARIF KLAIM RENDAH