Daftar Tindakan Yang Memerlukan Informed Concent
Daftar Tindakan Yang Memerlukan Informed Concent
NO
1
KSM/INSTALASI
/UNIT
KSM Bedah
1
Saraf
2
TINDAKAN
Amygdala Hypocampectomy (Epilepsi)
Anterior Temporomesial Lobectomi (Epilepsi)
Cingulotomy (Psichiatric)
10
11
Denervasi Facet
12
13
Eksisi Ensefalokel/Mielokel
14
15
Eksisi Osteoma/Osteositosis
16
17
18
NO
KSM/INSTALASI
/UNIT
TINDAKAN
19
Dura
20
21
22
23
Hemisferektomi (Epilepsi)
24
Hemisferoktomi (Epilepsi)
25
26
28
29
30
31
32
33
34
35
Laminoplasti
36
37
38
39
Lesionectomy (Epilepsi)
40
Lobektomi (Epilepsi)
41
Mesencephalectomy (Pain)
42
Mikrodisekktomi HNP
43
44
Neurektomi/Neurolise
45
Neuroendoskopi (Otak,Spinal)
46
Neuroplasti
47
Omaya drain
27
NO
KSM/INSTALASI
/UNIT
TINDAKAN
48
49
50
51
52
53
54
Revisi VP Shunt
55
56
Rhizotomy (Pain)
57
58
59
60
Simpatektomi Perkutan
61
SLTH
62
63
64
Suturektomi Kraniostenosis
65
68
Thalomotomy (Pain)
Transposisi kraniostenosis,dengan orbital
advancement
Transposisi kraniostenosis,tanpa orbital
advancement
Trepanasi Cedera Kepala (<4jam)
69
70
71
72
73
74
VA Shunt
75
VP Shunt Multiple
66
67
76
NO
2.
KSM/INSTALASI
/UNIT
KSM Bedah
Kepala Leher
TINDAKAN
1
2
Deseksi submandibula
10
flap lokal
11
12
13
flap lokal
14
15
16
17
18
Kulit
19
20
21
22
Ekskokleasi epulis
23
24
25
26
27
28
No
3.
KSM/INSTALASI/
UNIT
KSM
Bedah THT-KL
NO
TINDAKAN
29
30
31
32
33
34
35
36
37
38
39
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Laring/Trakea)
Cald Well Luc
Cochlear Implant/Implan Baha
Dekompresi Nervus Fasialis
DCR
Eksisi Ekstostosis
Ekstirpasi Kista Branchial
Ekstirpasi Kista Ductus Tiroglosus
Ekstraksi granulasi MAE/Kolesteatosis
Ekstraksi Polip
Esofagoskopi Rigid & Fleksibel
Ethmoidektomi (Intranasal)
Ekstraksi Korpus Alienum Kavum Nasi
KSM/INSTALASI/
UNIT
TINDAKAN
19
20
21
22
23
24
25
26
27
NO
28
29
FESS Advance
Frontal Sinusotomi
30
31
32
FOL
33
Glosektomi Total/Parsial
34
Glosektomi Total/Hemiglosektomi+RND
35
Hemiglosektomi+SOHND
36
37
Inversi Grommet
38
Insisi Perikondritis
39
40
41
Imunoterapi
42
Konka Reduksi
43
44
Laringektomi
45
Laringektomi+ND
46
47
48
Laringoskopi Rigid
KSM/INSTALASI/
UNIT
TINDAKAN
49
Laringoskopi Fleksible
50
Laringoskopi Direkta
51
Maksilektomi Total+Rekontruksi
52
Mastoidektomi Radikal
53
Mini FESS
54
55
Myringoplasty/Timpaniplasti
56
Mandibulekromi
57
NO
4
58
Osteotomi+Septum koreksi
68
69
70
Rhinoplasti
71
72
73
74
75
Septum Koreksi+Konkotomi
76
Stapedektomi
77
78
Tiroidektomi Sub-Total
79
Tonsilektomi/Adenoidektomi
80
Tracheostomi
81
Turbinektomi
82
Tiroidektomi Total+ND
83
84
85
KSM/INSTALASI
/UNIT
TINDAKAN
KSM Orthopedi
Dan
Abdominopelvic amputation
Achillotenotomy
Traumatologi
Advancement of tendon
7
8
9
15
16
17
18
20
21
22
Ankle fusion
23
25
26
27
Arthrocentesis
10
11
12
13
14
19
24
NO
KSM/INSTALASI
/UNIT
TINDAKAN
28
Arthrodesis of elbow
29
Arthrodesis of hip
30
Arthrodesis of knee
31
32
Arthrodesis of shoulder
33
34
35
40
41
42
43
44
45
Biopsy of bone
46
47
48
52
Bone graft
Bone marrow or hematopoietic stem cell transplant
(all procedures included in this class
Bunionectomy with soft tissue correction and
arthrodesis
Bunionectomy with soft tissue correction and
osteotomy of the first metatarsal
Bursectomy
53
Bursectomy of hand
54
Bursotomy
36
37
38
39
49
50
51
NO
KSM/INSTALASI
/UNIT
TINDAKAN
55
Bursotomy of hand
56
Carporadial fusion
Closed reduction of dislocation -General
anaesthesia
Closed reduction of dislocation of ankle
57
58
59
60
61
62
63
64
65
69
70
71
66
67
68
72
73
74
NO
KSM/INSTALASI
/UNIT
TINDAKAN
84
85
86
87
88
75
76
77
78
79
89
10
91
92
93
94
95
96
99
100
101
90
97
98
NO
KSM/INSTALASI
/UNIT
TINDAKAN
102 Excision of semilunar cartilage of knee
103 Excision of tendon for graft
104 Excision of tendon of hand for graft
Excision or correction of bunionette, That with
105
osteotomy
Excision or destruction of intervertebral disc,
106
unspecified
107 Exploration of tendon sheath
108 Exploration of tendon sheath of hand
109 Exploratory thoracotomy
110
Fasciotomy
111
Fasciotomy of hand
112
Finger reattachment
113
114
Foot reattachment
11
115
116
117
118
119
NO
TINDAKAN
KSM/INSTALASI/
UNIT
130
131
132
133
134
135
139
140
136
137
138
12
142
143
144
148
149
150
152
153
141
145
146
147
154
NO
KSM/INSTALASI
/UNIT
TINDAKAN
Insertion or replacement of interspinous process
device(s)
Insertion or replacement of pedicle-based dynamic
156
stabilization device(s)
157 Insertion or replacement of skeletal muscle stimulator
158
Internal fixation of bone without fracture reduction
159
Interphalangeal fusion
160 Interthoracoscapular amputation, Forequarter
amputation
161 Intra-operative neurophysiologic monitoring Neuromonitoring
162
Intervertebral chemonucleolysis
163
Limb lengthening procedures
164
Limb shortening procedures
165
Local excision of lesion or tissue of bone
166
Lower leg or ankle reattachment
155
13
167
NO
KSM/INSTALASI/
UNIT
TINDAKAN
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
NO
dislocation
Open reduction of dislocation of unspecified siteNeglected dislocation
Open reduction of dislocation of wrist -Fresh dislocation
Open reduction of fracture with internal fixation- radius
and ulna-Simple fracture
Open reduction of fracture with internal fixationunspecified site (Periarticular Major Bone )
Open reduction of fracture with internal fixation-carpals
and metacarpals - plate & screws
Hand NOS -Plate & Screw
Open reduction of fracture with internal fixation-carpals
and metacarpals - plate & screws
Hand NOS -Plate & Screw
Open reduction of fracture with internal fixation-carpals
and metacarpals - simple implants (K-wire)
Hand NOS -implant sederhana (K-wire)
Open reduction of fracture with internal fixation-femurComminutive or Segmental
Open reduction of fracture with internal fixation-femurSimple fracture
KSM/INSTALASI
/UNIT
TINDAKAN
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
NO
KSM/INSTALASI
/UNIT
TINDAKAN
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
NO
KSM/INSTALASI
/UNIT
TINDAKAN
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
NO
KSM/INSTALASI
/UNIT
TINDAKAN
300 Refusion of dorsal and dorsolumbar spine, posterior
column, posterior technique
301 Refusion of lumbar and lumbosacral spine, anterior
column, anterior technique
302 Refusion of lumbar and lumbosacral spine, anterior
column, posterior technique
303 Refusion of lumbar and lumbosacral spine, posterior
column, posterior technique
304 Refusion of other cervical spine, anterior column,
anterior technique
305 Refusion of other cervical spine, posterior column,
posterior technique
306 Refusion of spine, not elsewhere classified
307 Refusion of spine, not otherwise specified
308 Release of carpal tunnel
309 Release of clubfoot, not elsewhere classified
310 Release of tarsal tunnel
311 Removal of (cement) spacer
312 Removal of bone growth stimulator (invasive)
313 Removal of foreign body from spinal canal
314 Removal of implanted devices from bone - carpals
and metacarpals-Plate & screw
315 Removal of implanted devices from bone - carpals
and metacarpals-simple implants (K-wire)
316 Removal of implanted devices from bone - External
fixator device (invasive) (
317 Removal of implanted devices from bone - femur
318 Removal of implanted devices from bone - humerus
319 Removal of implanted devices from bone - radius and
ulna
320 Removal of implanted devices from bone - scapula,
clavicle, and thorax (ribs and sternum)
321 Removal of implanted devices from bone unspecified site (Phalanges (of foot) (of hand)) - Plate
18
322
323
324
325
326
NO
& Screw
Removal of implanted devices from bone unspecified site (Phalanges (of foot) (of hand)) simple implants (K-wire)
Removal of implanted devices from bone -patella
Removal of implanted devices from bone- tarsals and
metatarsals- simple implants (K-wire)
Removal of implanted devices from bone- tibia and
fibula
Removal of implanted devices from bone-other
(Pelvic bone and Vertebraae)
KSM/INSTALA
SI/UNIT
TINDAKAN
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
NO
357
Subtalar fusion
358
359
Suture of Artery
360
KSM/INSTALASI
/UNIT
TINDAKAN
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
378
379
380
381
382
383
384
389
390
391
392
393
394
NO
KSM/INSTALASI
/UNIT
KSM BEDAH
THORAKS
DAN
KARDIOVASKULAR
TINDAKAN
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 Repair Fistula Bronkopleural
39 Repair Laserasi Diafragma
NO
TINDAKAN
KSM/INSTALASI
/UNIT
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
NO
KSM/INSTALASI/
UNIT
TINDAKAN
76 Rastelli Procedure (right Ventricle-Pulonary Artery
Conduit)
77 Repair (Eksisi) Aneurisma Jantung
78 Repair Aorta Torakalis (38.34)
79 Repair Atrioventricular Septal Defect (35.54)
Repair Total Anomalous Pulmoanry Venous Connection
80
(TAPVC) (35.82)
81 Repair Transposition of Great Arteries (TGA) (35.84)
82 Repair Trunkus Arteriosus (35.83)
83 Revisi/Aff Pace Maker Permanen (diluar alat) (37.89)
84 Septostomi Terbuka Septum Atrium (35.41)
85 Total Koreksi Tetralogy of Fallot (TOF) (35.81)
86 Tricuspid Valve Repair (TVR) (35.14)
Tricuspid Valve Repair (TVR) dengan Bioprosthesis Valve
87
(35.27)
Tricuspid Valve Repair (TVR) dengan Mechanical Valve
88
(35.28)
89 Ventricle Septal Defect (VSD) Closure (35.5)
90 Amputasi Above Knee (AK) (84.17)
91 Amputasi Below Knee (BK) (84.14)
92 Arterial Pungsi, Kanulasi, Sectie (38.91)
93 Arteriovenous Shuntt (AV Shunt) Brakiosefalika (39.42)
94 Arteriovenous Shuntt (AV Shunt) Radiosefalika (39.27)
95 Bedah Varises Insisi Babcock (38.5)
96 Biopsi Pembuluh Darah (Perifer) (38.21)
97 Debriment-Nekrotomi Luka Gangren (86.22)
98 Disartikulasi Sendi Ekstremitas (84.13)
Eksisi Biopsi
Tumor
Pembuluh
Darah
3
4
Embolektomi/Trombektomi Aorta
Embolektomi/Trombektomi Pembuluh Darah Arteri Abdominal
Embolektomi/Trombektomi Pembuluh Darah Arteri
Ekstremitas Bawah
Embolektomi/Trombektomi Pembuluh Darah Ekstremitas Atas
(diluar alat)
Embolektomi/Trombektomi Pembuluh Darah Ekstremitas
Bawah(diluar alat)
Embolektomi/Trombektomi Pembuluh Darah Regio servikal
(Karotis, Jugular) (diluar alat)
Evakuasi Hematom di Ekstremitas (Pasca Pungsi HD/
Traumatik)
Fasciotomy
Ligasi Vaskular Ekstremitas
Mutilasi Digiti Ekstermitas
5
6
7
8
9
10
11
12
NO
KSM/INSTALASI
/UNIT
TINDAKAN
13
14
15
16
17
18
19
20
21
22
23
24
25
26
KSM BEDAH
27
1
DIGESTIVE
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
NO
Abdominoplasty
Apendektomi
Apendektomi dgn penyulit major
Apendektomi dgn penyulit minor
Apendektomi laparoskopik
Bilio-difgestif anastomosis tanpa penyulit
Biliodigestif dengan penyulit mayor
Biliodigestif dengan penyulit minor
Biopsi insisional, local anastesi
Biopsi rectum
Eksisi hemoroid eksterna
Eksplorasi duktus bilier & cholangiografi intra operatif
Esofagotomi
Fistulotomi
KSM/INSTALASI
/UNIT
TINDAKAN
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
NO
alat)
Repair Hernia Diafragmatika (diluar alat)
Reseksi anterior dengan penyulit mayor
Reseksi anterior dengan penyulit minor
Reseksi anterior tanpa penyulit
Reseksi esofagus-colon / ileum transposisi
Reseksi esofagus-end to end
Reseksi esofagus-esofago-gastrectomy
Reseksi hati
Second look laparoscopy
Splenektomi / splenoraphy traumatika
Splenektomi non trauma
Terminal esofagus proksimal gastrektomi (TEPG)
Total gastrektomi
KSM/INSTALASI
/UNIT
KSM BEDAH
UROLOGI
TINDAKAN
60
61
62
63
64
65
66
67
68
69
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total pantreaktomi
Total prokto-kolektomi
Tutup burst abdomen (tanpa alat)
Tutup burst abdomen dengan penyulit mayor
Tutup burst abdomen dengan penyulit minor
Tutup kolostomi / ileostomi
Tutup kolostomi / ileostomi dengan penyulit mayor
Tutup kolostomi / ileostomi dengan penyulit minor
Repair Aorta Torakalis (38.34)
Repair Atrioventricular Septal Defect (35.54)
Adrenalektomi
Adrenalektomi (Abdominotorakal)
Anastomosis end to end Ureter
Augmentasi Buli
Biopsi Ginjal perkutan
Biopsi Ginjal Terbuka
Biopsi Penis
Biopsi Prostat
Biopsi Testis
Bladder Neck Rekonstruksi
Buried Penis
Businasi/Dilatasi Uretra
Cabut DJ Stent
Defooring Kista Ginjal per Laparoskopi
Deroofing/Unroofing Kista
Diseksi Kelenjar Getah Bening Inguinal
Diseksi Kelenjar Getah Bening pelvis
Diseksi Kelenjar Getah Bening Pelvis per
Laparoskopi
Divertikulektomi Buli
Divertikulum Uretra
26
21
22
23
24
25
26
27
28
29
30
31
32
33
NO
Dorsumsisi
Drainase Periureter
Eksisi Chordae/Chordektomi
Eksisi Fibroma/Rekonstruksi Penis
Eksisi Plaque (Peyronie Disease)
Eksisi Webbed Penis
Eksplorasi testis (Microsurgery)
Ekstraksi Batu
Ekstrofi Buli Rekonstruksi
Epispadia
Evakuasi Bekuan Darah (Clot)
Extended Pyelolithotomy
Fistulektomi/Repair Fistel Uretra
KSM/INSTALASI
/UNIT
TINDAKAN
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
Funikokelektomi
Ganti Nefrostomy
Hidrokel per Inguinal/Ligasi Tinggi
Hidrokel per Skrotal
Hipospadia Subkoronal
Holmium YaG Laser (Sewa)
Ileal Conduit (Bricker)
Insersi DJ Stent
Insisi Abses Perineum
Insisi Abses Skrotum
Insisi Posterior Urethral Valve
Johanson
Johanson I
Johanson II
Kalibrasi Uretra
Kauterisasi
Koreksi Horseshoe Kidney
Koreksi Priapismus
Laparoskopi Adrenalektomi
Laparotomi Eksplorasi
Ligasi V.Spermatika Interna (Microsurgery)
Limfadenektomi Ilioinguinal
Limfadenektomi Retroperitoneal/RPLND
Litholapaksi
Lithotripsi
Masase Prostat
Meatoplasti
Meatotomi
MMK/Sling Uretra
Nefrektomi
Nefrektomi Donor Transplant
Nefrektomi Parsial
27
66
67
68
69
70
71
72
73
74
75
NO
KSM/INSTALASI
/UNIT
TINDAKAN
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
115
116
117
118
119
NO
KSM/INSTALASI
/UNIT
KSM ILMU
KESEHATAN
MATA
TINDAKAN
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
1
2
3
4
5
Sistostomi perkutan
Sistostomi Terbuka
Skrotoplasti
Spermatokelektomi
Tailoring Ureter
Transplan Resipien
Transuretero-ureterostomi
TUR Prostat/TUIP/BNI
TUR Tumor Buli
TVP/TMP
Ureterokutaneostomi
Ureterolisis
Ureterolithotomi
Ureterolithotomi Distal
Ureterolithotomi Proksimal
Ureterosigmoidostomi (Caffey)
Ureterostomi
Ureterouretostomi
Uretroplasti Hipospadia
Uretroskopi/Uretrosistoskopi
Uretrotomi Interna (Sachse)
URS/Lithotripsi
Varikokelektomi (Palomo)
Vasektomi (anestesi lokal)
Vasektomi (narkose)
Vasoepididimostomi
Vasografi
Vasovasostomi
Angkat Jahitan
Angkat Jahitan dengan GA
Anterior Chamber Tap/Parasintesis
Aspirasi Massa Lensa
Blefaroplasty (2 Kelopak Mata)
29
6
7
8
9
10
11
12
13
14
15
16
17
NO
Claw Lens
Cryopexy Kornea
Cyclo Cryo
Dacryocystorinostomi (Without Silicon Tube)
Dekompresi Orbital/Lateral Orbitotomi
Disisi Aspirasi & IOL
ECCE
ECCE & IOL
Eksenterasi
Eksisi Hordeolum / Chalazion
Ekstirpasi Corpus Alienum di Kornea
Ekstirpasi Pterygium + Graft Konjungtiva
KSM/INSTALASI
/UNIT
TINDAKAN
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
NO
10
KSM/INSTALASI
/UNIT
Divisi Onkologi
TINDAKAN
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
NO
KSM/INSTALASI
/UNIT
TINDAKAN
47
48
Advancement Flap
49
50
51
52
Diseksi Axilla
53
Diseksi Inguinal
54
55
56
57
58
Ismulobectomy
59
Kemoterapi Perinfus
60
61
Maksilektomi Total
62
Mastopexy
63
Modifikasi RND
64
65
Ovariectomy Bilateral
66
Reseksi Mandibula
67
Rotation Flap
68
Skin Grafting
69
NO
11
KSM/INSTALASI
/UNIT
DIVISI BEDAH
ANAK
70
Superficial Parotidectomy
71
72
Total Parotidectomy
73
Total Thyyroidectomy
74
TINDAKAN
1
2
Appendektomi laparoskopik
10
Divertikulektomy
11
12
13
14
15
16
17
18
19
20
21
22
23
Eksisi urachus
24
33
NO
25
Ekstirpasiranula
26
Endoskopik diagnostik
27
28
Endoskopik terapeutik
29
Hemikolektomi
30
31
Herniotomi laparoskopik
Gastrostomi
KSM/INSTALASI
/UNIT
TINDAKAN
32
33
Hidrokolektomi
34
Intraoperatif kolangiografi
35
36
37
38
39
40
Kolesistektomi
41
Kolesistektomi laparoskopik
42
43
44
45
Ligasihemoroid (49.4)
46
47
Orchidopexy (62.5)
48
49
50
51
52
53
34
NO
54
55
56
57
58
59
60
KSM/INSTALASI
/UNIT
TINDAKAN
61
62
RPLND (40.59)
63
64
65
66
Splenektomi (41.5)
67
69
70
71
72
73
74
68
KSM BEDAH
PLASTIK
78
1
2
3
Abdominoplasty
Aff archbar, Lokal Anastesi
Aff Suspensi, Lokal Anastesi
35
NO
Amputasi digital
Augmentasi mamae
10
11
12
Blefaroptosis
KSM/INSTALASI
/UNIT
TINDAKAN
13
14
15
Cheilonasoraphy
16
Chordectomy
17
Chordectomy+urethroplasty
18
19
Comisuroplasty
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
36
40
41
42
43
NO
KSM/INSTALASI
/UNIT
TINDAKAN
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
LD flap
Le fort I osteotomy
Liposuction
Lobuloplasti
Malarplasty
Mamma aberan unilateral
Mandibular distraksi
Mandibular rekonstruksi dengan costochondral graft
Mastopexi
Mentoplasty
Microsurgery
Multiple facial fraktur + implant
Muskulokutaneus flap
Myokutaneus flap/pectoralis mayor flap
Nasal repair dan rekonstruksi
Neo vagina
Operasi bedah mikro
Orif fraktur zygoma
Orif fraktur hand
Orif fraktur mandibula
Orif fraktur maxilla
Orif maksila plating
Orif mandibula plating
Orif mandibula wiring
Orif orbital wall
Orif orbital wall
Orif zygoma wiring
Osteotomy craniosynostosis reconstruction
Osteotomy facial rekonstruksi
Osteotomy genioplasti tanpa tarif bahan
Osteotomy maksila Le fort I
Osteotomy maksila Le fort II
Palatoplasti bilateral komplit
Palatoplasti bilateral tak komplit
Palatoplasti unilateral komplit
37
79
80
81
82
83
84
85
86
87
NO
KSM/INSTALASI
/UNIT
TINDAKAN
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
Rekonstruksi palpebra
Released buried penis
Released syndactyly kompleks
Repair canalis lacrimalis (without silicon tube)
Repair coloboma palpebra (skin/mucosal graft)
Repair ductus nasolacrimalis
Repair fingertip injury
Repair fistel urethra
Replantation
Reposisi fraktur nasal sederhana
Reposisi fraktur os nasalis (complicated)
Reseksi mandibula + bone graft
Rhinoplasty
Rotation flap
Sagital Split osteotomi mandibula
Simple bone grafting
Simple skin grafting
Skin flap
Skin graft >5 cm
Skin graft sedang 5 cm
Skin grafting kecil
Skin grafting luas
Skin grafting sedang
Skin grafting with complication
Tendon reconstruction
Tendon transfer
Tendon transfer with complication
Tennoraphy
Tennoraphy with complication
TMJ arthroplasty
TMJ arthrostomy
Tram flap
Wound Dressing
Wound Repair
38
NO
13
KSM/INSTALASI/
UNIT
KSM
OBGYN
TINDAKAN
1
2
3
Cauter serviks
Cordosentesis
Debulking tumor ovarium
Eksplorasi vagina
Embryotomi
10
Histeroctomy radikal
11
Kistektomi
12
Konisasi serviks
13
14
16
17
Laparoskopi steril
18
Laparoskopik Diagnostik
19
20
21
22
LEEP
23
24
Mikrokuret
25
Miomectomy
15
39
NO
26
Neovagina
27
Operasi Ca vagina
28
29
30
31
Overectomi
KSM/INSTALASI
/UNIT
TINDAKAN
32
Painless labor
33
Persalinan normal
34
35
36
Persalinan sungsang
37
Rekanalisasi
38
Rekanalisasi tuba
39
Salfingektomi unilateral
40
Salvingoovarectomi unilateral
41
42
Seksio sesaria
43
44
Sirklase serviks
45
46
Sirklase serviks
47
48
Surgical staging
49
51
52
Tubektomi klinik
53
50
40
NO
KSM/INSTALASI
/UNIT
TINDAKAN
14
KSM
GIGI dan
MULUT
2
3
4
10
11
13
14
Extirpasi Sialolith
15
17
18
19
20
22
23
24
25
26
12
16
21
41
NO
27
Intermaksila Fiksasi
Frenektomi Per Rahang
28
Genioplasty
29
KSM/INSTALASI
/UNIT
TINDAKAN
30
31
32
33
Mandibular Distraksi
34
36
37
38
39
40
41
DIVISI PEDIATRI
GAWAT
DARURAT
ILMU
KESEHATAN
ANAK
Intubasi Endotrakea
Krikotirotomi
Kanulasi vena perifer
Vena sectie
Pungsi lumbal
Pungsiv Pleura
KSM PENYAKIT
JANTUNG &
PEMBULUH
DARAH
1
2
3
4
5
Perikardiosintesis
Pemasangan Amplatzer/ADO/Coilling
CVC
10
35
15
16
2
3
4
5
42
17
KSM PENYAKIT
DALAM
Endoscopy
43
No
KSM /
INSTALASI
NAMA TINDAKAN
44
KSM Anak
3
4
6
7
THT-KL
KSM Patologi
Anatomi
Inst.
Radiotherapi
KSM
Neurologi
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
1
2
3
4
5
6
Chest tube
Tindakan kemotherapi
Pemasangan Ventilator
Intubasi Endotrakea
Pemasangan Laryngeal mask
Krikotirotomi
Infus intraosseus
Kanulasi vena perifer
Vena sectie
Pengambilan darah intra vena dan intra arteri
Pungsi lumbal
Pungsiv Pleura
Pemasangan kateter urine
Pemasangan keteter rectal
Pemasangan orogastrik tube
Pemasangan nasogastrik tube
Pemeriksaan Audiometri
Pemeriksaan Timpanometri
Pemeriksaan Audiometri Tutur
Pemeriksaan Sisi&Tore Decay
Pemeriksaan Pendengaran Pada Anak
Pemeriksaan Brainstem Evoked Response
Audiometry
Cerebral Angiografi
AVM&Embolisasi
Aneurisma Coiling
Embolisasi pre operasi
Diagnosis DSA
Lumbal Punksi
Pain Intervention
Injeksi Triger point
Injeksi Triger Fringer
Injeksi CTS
Sub Optical Functional
Injeksi botox
EMG
KSM Patologi
Phlebotomi
Klinik
KSM Gigi dan 1
2
Mulut
3
4
Scaling
Curettage/root planning (jika diperlukan anestesi)
Gingivektomi
Frenektomi
45
5
6
7
8
9
8
10
11
Poli
Andrologi
KSM
Kardiologi
dan
Kedokteran
Vaskular
KSM
Pulmonologi
dan Ilmu
Kedokteran
Respirasi
KSM
Radiologi
KSM
12
Neurologi
1
2
3
4
5
6
7
8
9
10
11
12
1
2
Bronchoscopy/FOB
Tindakan kemotherapi
Thoracoscopy
Contra Ventil/WSD
Punctie Pleura
FNAB
Scalene Biopsy
Reposisi
Pleurodesis
AFF WSD
Perawatan Luka WSD
USG Thorax Marker
Tindakan Radiologi Injectee contrast
Tindakan Radiologi pada pasien dengan kelainan
cardiovaskuler
3 Tindakan Radiologi pada pasien dengan alergi
berat
4 Tindakan Radiologi pada pasien dengan KU yang
menurun
5 Tindakan Radiologi yang memerlukan FNAB
Guiding MSCT pada pasien dengan kelainan yang
berdekatan dengan organ vital
6 Tindakan Radiologi pada Ibu hamil yang
memerlukan foto
1 Cerebral Angiografi
2 AVM&Embolisasi
3 Aneurisma Coiling
4 Embolisasi pre operasi
5 Diagnosis DSA
6 Lumbal Punksi
7 Pain Intervention
8 Injeksi Triger point
9 Injeksi Triger Fringer
10 Injeksi CTS
11 Sub Optical Functional
46
12 Injeksi botox
13 EMG
14 Neuro endovaskuler: Coiling,Embolisasi,DSA
13
14
16
15
Instalasi
Hemodialisis
KSM
Rehabilitasi
Medik
IRNA Jiwa
Psycho Analisa
47