298

Suture
ofArtery
bursa
12
Mutilasi
Digiti
Ekstermitas
228
179
118
326
86
30
45
33
16
6Ethmoidektomi
Suture
Rekonstruksi
Wide
Fistulektomi/Repair
Removal
Implantation
Ekstirpasi
Sistoskopi
Lumbal
Eksisi
of
of
Punksi
Corpus
Tumor
implanted
or
facial
replacement
Ganas
cleft
Alienum
Fistel
devices
Uretra
di
of
Kornea
from
spinal
bone-other
Klinik 359
17
59
Closed
reduction
(Intranasal)
of
fracture
with
internal
fixation
Refusion
of
atlas-axis
spine
CONTOH
;spinal
38
Total
gastrektomi
48
Laringoskopi
Rigid
12
Blefaroptosis
152
53
26
76
18
101
30
Elevasi
Bursectomy
Application
VP
Insertion
Operative
Excision
Shunt
Kraniotomi
of
Satu
of
of
histeroscopy/Ablasi
of
total
other
hybrid
hand
Sisi
Fraktur
lesion
external
disc
of
Impresi,Tanpa
soft
prosthesis,
fixator
endometrium
tissue
device
oflumbosacral
Robekan
hand
Repair
ekstrofia
buli
(57.8)
Herniotomi
elektif
tanpa
penyulit
Repair
Fistula
Bronkopleural
127
73
Myotomy
Other
change
in
hand
muscle
or
tendon
length
299
Refusion
of
dorsal
and
dorsolumbar
spine,
anterior
(Pelvic
neurostimulator
bone
and
lead(s)
Vertebraae)
87
Rekonstruksi
nasal
119
46
17
7
Wide
Ekstirpasi
Sistoskopi
Pain
Eksisi
Intervention
Pterygium
ODS
Tumor
Jinak
+
Graft
+
Flap/Skin
Konjungtiva
Graft
-Femur
(Including
:
MIPO,
interlocking
nail,
D. Semua Tindakan DAFTAR
Yang
Berisiko
Tinggi
:Diafragma
360
Suture
of
capsule
ligament
of ankle
and
footTEN)
Other
partial
ostectomy
(including
: Bone
curretage,
39
Repair
Laserasi
TINDAKAN
orTINDAKAN
Korpus
Alienum
Kavum
Nasi
180
1Ekstraksi
Scaling
229
31
153
54
27
60
31
Bursotomy
Arthrocentesis
Repair
Insertion
Overectomi
hernia
or
replacement
diafragma
(53.7/53.8)
of
(cement)
spacer
B. Tindakan Anestesi 18
&Sedasi
(
Sedang
dan
Dalam),
tindakan
yang
column,
anterior
technique
Herniotomi
laparoskopik
Injeksi
Triger
Myotomy
of
hand
Other
change
inpoint
muscle
or
tendon
length
258
1288
and
drainage
of (jika
palmar
thenar
space
Closed
reduction
ofTINDAKAN
fracture
withorinternal
fixation KSM/INSTALAS
KSM/INSTALASI
TINDAKAN
2 Incision
Curettage/root
planning
diperlukan
anestesi)
NO
KSM/INSTALASI/
TINDAKAN
KSM
/ 74PERLU
YANG
INFORMED
CONSENT
marginal
resection/excision)
KSM/INSTALAS
Insertion
or
replacement
of
facet
replacement
9
Injeksi
Triger
Fringer
NO memerlukan
KSM/INSTALASI/
TINDAKAN
181
No I/UNIT
230
NAMA
TINDAKAN
informed
antara
lain:
Humerus
: into
Interlocking
nail,
TEN,
NO
154 consenttersebut
Injection
of (including
anesthetic
peripheral
nerve
forMIPO)
/UNIT
NO KSM/INSTALASI
TINDAKAN
TINDAKAN
3 Neurectasis
Gingivektomi
UNIT
/UNIT
INSTALASI
KSM/INSTALAS
TINDAKAN
Other
destruction
of TINDAKAN
intervertebral
disc
I/UNIT
device(s)
KSM/INSTALASI/
KSM/INSTAL
129
TINDAKAN
KSM/INSTALAS
UNIT
10
Injeksi
CTS
NO KSM/INSTALASI
KSM/INSTALASI
KSM/INSTALASI
TINDAKAN
NO
TINDAKAN
KSM/INSTALAS
TINDAKAN
TINDAKAN
analgesia
/UNIT
NO
TINDAKAN
34
Funikokelektomi
Pasang
Double
Lumen
TINDAKAN
Hemodialisis
(HD)
(diluar
No
KSM/INSTALASI
TINDAKAN
19
4Dura
Divisi
DIVISI
Onkologi
BEDAH
44
19
761
LD
flap
Frenektomi
11
10
1anestesi
Aspirasi
Augmentasi
Abdominal
Fistulotomi
Operasi
Kista
Trauma
pull
dgn
Tulang
Mamma
through
penyulit
Ginjal
Per
Single
(sfingter
Regio
mayor
dan
(Belum
saving
Multiple
Termasuk
procedure)
KSM
Gigi dan
60
Chest
tube
I/UNIT
/UNIT
Semua
tindakan
dan
sedasi
diTINDAKAN
dalam
kamar
operasi
UNIT
Cauter
serviks
Total
pantreaktomi
NO
30
Hemi
Maksilektomi
Tanpa
Rekonstruksi
KSM/INSTALAS
ASI/UNIT
I/UNIT
NO
/UNIT
13
11
Sub
Optical
Functional
13
KSM
14 a.
KSM
1
/UNIT
I/UNIT
NO
KSM/INSTALASI/
76
Rastelli
Procedure
(right
Ventricle-Pulonary
Artery
/UNIT
/UNIT
KSM/INSTALAS
alat)
120
88
35
18
Ganti
Ekstripasi
Rekonstruksi
Sistostomi
Nefrostomy
Corpus
perkutan
Alienum
palpebra
di
Bilik
Mata
Depan
7
5
Sesuai
Undang
Undang
no
44
Bahan)
tahun
2009
tentang
rumah
sakit,
terdapat
beberapa
20
77
45
2
Le
Biopsi
Fistulotomi
Operasi
Flap
fort
Core
I
operasi
osteotomy
Urakhus/Reseksi
dgn
Lokal
(bone
penyulit
Anestesi
graft/membrance/GTR/interseptif)
minor
urakhus
KSM
BEDAH
48
Pallidotomi
(movement
Disorder)
KSM/INSTALAS
2
Tindakan
kemotherapi
1
Biopsi
Terbuka
Bronkhus
47
Operasi
Tindakan
Tertentu
KSM/INSTALAS
I/UNIT
61
Adhesiolisis
ANAK
2
NO
TINDAKAN
NO
KSM
Orthopedi
Abdominopelvic
amputation
TINDAKAN
327
Removal
Total
prokto-kolektomi
of
implanted
devices
from
bone-tarsals
and
KSM/INSTALAS
29
Fiksasi
interna
fraktur
nasal
OBGYN
TINDAKAN
KSM/INSTALAS
12
Injeksi
botox
TINDAKAN
Cordosentesis
20
Extirpasi
Tumor
Jinak
Saraf
Kulit
Kepala
13
361
Bone
rekonstruksi
facial
cleft
Mulut
Suture
of
capsule
or
ligament
of
other
lower
4
b.
Semua
tindakan
anestesi
dan
sedasi
di
ICU
NO
NO
UNIT
31
Insisi
Abses
/
Phlegmon
300
Refusion
of
dorsal
and
dorsolumbar
spine,
posterior
KSM/INSTALASI/
TINDAKAN
2.
KSM
Bedah
1
Aff
Arch
Barr
Conduit)
I/UNIT
Pasang
Implantable
Central
Venous
Access
(diluar
49
Laringoskopi
Fleksible
NO KSM/INSTALAS
89
36
19
Hidrokel
Enukleasi/Eviscerasi
Released
Sistostomi
per
Terbuka
Inguinal/Ligasi
buried
(DFG/Bonegraft)
penis
Tinggi
GIGI dan
Debriment
Mukosa
dan
Pengelolaan
Luka
Sayat
21
78
6metatarsals
46
3
Liposuction
Biopsi
Gastrostomi
Orkhidektomi
Eksisi
Lokal
THORAKS
I/UNIT
Implant
3
Pemasangan
Ventilator
2 121
Biopsi
Terbuka
Diafragma
61
32
Painless
Repair
Hernitomi
of
labor
Gastrochisis
dgn
penyulit
(54.71)
/
komplikasi
I/UNIT
Open
reduction
of
fracture
with
internal
fixationTINDAKAN
Plate
&
Screw
I/UNIT
62
I/UNIT
14
13
EMG
tindakan
kedokteran
dan
kedokteran
gigi
yang
wajib
diberikaninformed
consent.
Revisi
Thoraks
drain/water
sealed
drainage (WSD) (diluar
Tutup
burst
abdomen
(tanpa
alat)
49
Paravertebral
Blok
Perkutan
NO
1DAN
48
Advancement
Flap
Debulking
tumor
ovarium
UNIT
204
column,
posterior
technique
Bone
rekonstruksi
facial
cleft
14
3
Appendektomi
dgn
penyulit
KSM/INSTALAS
TINDAKAN
Achillotenotomy
extremity
Repair
(Eksisi)
Aneurisma
Jantung
77
alat:
porth-a-cath,
celsite)
Dan
30
2
Fiksasi
interna
pan-facial
40
122
90
2 MULUT
Dislokasi
Sendi
Mandibula
37
20
Hidrokel
Evakuasi
Released
Skrotoplasti
per
Silikon
syndactyly
Skrotal
Oil
kompleks
21
Fusi
Stabilisasi
Corpus
Vertebra
TINDAKAN
KSM/INSTALASI
22
79
7
Vital
pulpektomi
dan
Partial
Nekrose
47
4
Biopsi
Hemikolektomi
Lobuloplasti
Orkhidektomi
Eksisi
Narkose
extended
dengan
penyulit
mayor
19
Ekstraksi
Korpus
Alienum
Kavum
Nasi
Endoskopi
NO
Kepala
Leher
2
Aff
Arch
Barr
dan
suspensi
maksila
4
Intubasi
Endotrakea
3
Biopsi
Terbuka
Mediastinum
humerus
Simple
fracture
32
Insisional
Biopsi
Neoplasma
Jinak
I/UNIT
Removal
of
internal
limb
lengthening
device
328
Other
diagnostic
procedures
on
joint
structures
alat)
peripheral
nerve
or
ganglion
decompression
or
50
Laringoskopi
Direkta
14
Neuro
endovaskuler:
Coiling,Embolisasi,DSA
NO
63
28
231
Arthrodesis
of
elbow
55
Bursotomy
of
hand
102
62
Excision
of
semilunar
cartilage
of
knee
182
Open
biopsy
cranial
or
peripheral
nerve
or
ganglion
33
Persalinan
Hidrokolektomi
normal
RPLND
Tutup
burst
(40.59)
abdomen
dengan
penyulit
mayor
301
Refusion
of
lumbar
and
lumbosacral
spine,
anterior
I/UNIT
259
Repair
Aorta
Torakalis
(38.34)
78
Pemasangan
Central
Venous
Catheter
(CVC)
(diluar
/UNIT
Tindakan
tersebut yaitu : 450
3
123
91
38
21
Hipospadia
Fornix
Repair
Spermatokelektomi
Repair
canalis
Subkoronal
lacrimalis
(without
silicon
tube)
23
80
8Hemiglosektomi
Cauter
5
48
Biopsi
Hemikolektomi
Malarplasty
Orkhidektomi
Insisi
Lokal
Ligasi
dengan
Tinggi
penyulit
minor
KARDIOVASKULAR
Pemasangan
Traksi
Servikal
Suture
of
capsule
or
ligament
of
upper
extremity
362
5
Pemasangan
Laryngeal
mask
Biopsi
Terbuka
Paru
4
Eksisi
Epulis
Per
Rahang
49
Aspirasi
Effusi
Pleura
Eksplorasi
vagina
Open
reduction
of
fracture
with
internal
fixation205
4
Cheilonasoraphy
Appendektomi
laparoskopik
20
Ekstirpasi
Thoracal
Fistel
Symphatectomy
Pre
Aurikuler
dengan
Video
Assissted
Traumatologi
3
Adductor
tenotomy
of
hip
Insertion
or
replacement
of
interspinous
process
lysis
of
adhesions
Peripheral
nerve
neurolysis
NOS
Removal
of
pedicle
screw(s)
used
in
spinal
fusion
329
31
15
22
Graft/Transposisi
Saraf
Tepi
Tindakan
Anestesi
di
ICU
3
Biopsy
Insisional
dengan
anastesi
lokal
64
column,
anterior
technique
Other
diagnostic
procedures
on
muscle,
tendon,
fascia, and
41
33
Mandibular
Distraksi
Closed
reduction
of
fracture
with
internal
fixation
155
Repair
Atrioventricular
Septal
Defect
(35.54)
Tutup
alat)
burst
abdomen
dengan
penyulit
minor
51
183
Maksilektomi
Open
biopsy
of
Total+Rekontruksi
soft
tissue
Instalasi
124
92
22
ICCE
Repair
Tailoring
coloboma
Ureter
palpebra
(skin/mucosal
graft)
39
Holmium
YaG
Laser
(Sewa)
9
Retraksi
Gingiva
pada
prep.crown
24
81
49
6
Mamma
Biopsi
Hemikolektomi
Orkhidektomi
Narkose
aberan
Subkapsuler
tanpa
unilateral
penyulit
29
Arthrodesis
of
hip
6
Krikotirotomi
579
103
Excision
of
tendon
for
graft
Biopsi
Terbuka
Pleura
63
34
Persalinan
Intraoperatif
normal
kolangiografi
dengan
penyulit
130
Injection
anesthetic
into
spinal
canal
for
analgesia
humerus
Comminutive
or
Segmental
Separasi
Thoracoscopic
conjoined
Surgery
twin
(VATS)
(84.9)
260
75
Other
plastic
operations
on
fascia
device(s)
Removal
of
peripheral
neurostimulator
lead(s)
330
A. Semua3 Tindakan Pembedahan
dan
Tindakan
Invasive
Suture
of
cranial
and
peripheral
nerves
363
Setiap
kali
melakukan
tindakan
Hemodialisis
21
Ekstraksi
Korpus
Alienum
MAE
51
Penjahitan
Saraf
Tepi
5
Eksisi
Kelenjar
Ludah
Submandibula
232
50
Aspirasi
Paru
+
Pleurodhesis
302
Refusion
of
lumbar
and
lumbosacral
spine,
anterior
Embryotomi
-Intrarticular
Major
Bone
16
5
Chordectomy
Appendektomi
tanpa
penyulit
4
Advancement
of
tendon
56
Pemasangan
Carporadial
fusion
Intra
Aortic
Baloon
Pump
(IABP)
(diluar
65
Repair
Total
Anomalous
Pulmoanry
Venous
Connection
Hemodialisis
32
abses
dengan
anastesi
lokal
125
93
23
23
Hemisferektomi
ICCE
Repair
Transplan
&of
ductus
IOL
Resipien
(Epilepsi)
nasolacrimalis
40
Ileal
Conduit
(Bricker)
Tutup
kolostomi
/of
ileostomi
25
82
50
7
Mandibular
Breast
Hemoroid
Orkhidopeksi
Conserving
stapling
distraksi
(Torsio
(diluar
Surgery
Testis)
(BCS)
4
Deseksi
submandibula
bursa,
including
that
of
hand
7Insisi
Infus
intraosseus
Open
reduction
of
dislocation
of
ankle
- Neglected
680
Biopsi
Terbuka
Pleura
dengan
VATS
42
Thoracocentesis
Open
reduction
fracture
with
internal
fixation206
Other
plastic
operations
onofalat)
hand
261
34
Odontektomi
Per
Gigi
Insertion
or
replacement
pedicle-based
dynamic
Removal
skeletal
muscle
stimulator
331
Pemasangan
intubasi
16
ventilator
52
Mastoidektomi
Radikal
Poli
30
Arthrodesis
of
knee
184
64
104
Excision
tendon
of
hand
for
graft
35
Persalinan
Intraoperatif
pervaginam
kolangiografi
tindakan
laparoskopik
operatif
Sirkumsisi
column,
posterior
dengan
technique
general
anesthesia
(64.0)
Suture
of
muscle
or
fascia
of
hand
131
364
Injection
of
destructive
agent
into
spinal
canal
Closed
reduction
of
fracture
with
internal
fixation
Ekstirpasi
Kelenjar
Sub
Mandibula
156
alat)
(TAPVC)
(35.82)
B. Semua
Anestesi
&
Sedasi
(Intra
Sedasi
Sedang
dan
Sedasi
) graft
126
94
24
Injeksi
Repair
Transuretero-ureterostomi
fingertip
Vitreal
injury
41
dislocation
Insersi
DJ
Stent
8 Tindakan
66
Suntik
Intra
Cavernosal
Penis
26
83
51
8
Mandibular
Breast
Hemoroidektomi
Orkhidopeksi
Conserving
rekonstruksi
(UDT)
Surgery
dengan
+mayor
LD
costochondral
Flap
52
Punksi
Cairan
Otak
6
Eksisi
Kista
Odontogenik
Keratosis
+ Dalam
Ostektomi
8central
Kanulasi
vena
perifer
722
Tutup
kolostomi
/tendon
ileostomi
dengan
penyulit
mayor
Biopsi
Terbuka
Tumor
Dinding
Thoraks
43
Thymectomy
other
specified
bone
(Intraartikular
Major
Bone
)
51
Delto
Pectoral
Flap
(DP
Flap)
Extirpasi
+
kuret
polip
endoserviks
Other
plastic
operations
on
muscle
76
262
17
6
Chordectomy+urethroplasty
Biliodigesif
dengan
penyulit
stabilization
device(s)
5
Advancement
of
of
hand
Removal
of
spinal
neurostimulator
lead(s)
Pemasangan
vena
33
Insisi
flegmon
dasar
mulut
Anak332
Andrologi
Other
division
of
bone
24
Hemisferoktomi
(Epilepsi)
ORIF
Maksila
+
Zygoma
+
Mandibula
(belum
Closed
reduction
of
dislocation
-General
5
Diseksi
leher
radikal/radikal
neck
dissection
303
Refusion
of
lumbar
and
lumbosacral
spine,
posterior
233
114 KSM
-Phalang
of
foot
KSM
Repair
Pemasangan
Transposition
Peritoneal
of
Great
Dyalisis
Arteries
(PD)
(TGA)
Catheter
(35.84)
81
Excision
or
correction
of
bunionette,
That
with
53
Mini
FESS
127
95
Injection
of
locally-acting
therapeutic
substance
into
25
Injeksi
Repair
TUR
Prostat/TUIP/BNI
Periokuler
fistel
urethra
Terapetik
42
Insisi
Suture
Abses
of
tendon
Perineum
sheath
365
35
27
8
52
9
Mastopexi
Debriment
Herniotomi
Orkhidopeksi
Mamma
per
Laparoskopi
23
Ekstirpasi
Angiofibroma
Nasofaring
31
Arthrodesis
of
other
specified
joints
57
65
9
Vena
sectie
8185
67
Mediastinum
(Sternotomi)
44
36
Persalinan
Jejenostomi
Open
reduction
sungsang
/laminectomy
ileostomi
fracture
dengan
with
penyulit
internal
mayor
fixationThymectomy
dengan
VATS
Sirkumsisi
dengan
local
anesthesia
(64.0)
207
Tutup
kolostomi
/of
ileostomi
dengan
penyulit
minor
Open
reduction
of
dislocation
of
elbow
-Fresh
dislocation
263
Other
repair
of
ankle
C. Semua Tindakan
Pemberian
Produk
Darah
&
Komponen
Darah
Pemasangan
CRRT
Reopening
of
site
333
105
17
termasuk
implant)
132
Biliodigestif
anastomosis
tanpa
penyulit
atau
penyulit
7Debridement
Eksisi
Neoplasma
Jinak
Extra
Oral
Ukuran
Kecil
53
157
Insertion
Reseksi
Extra-Temporal
or
replacement
(Epilepsi)
of
skeletal
muscle
stimulator
anaesthesia
column,
posterior
technique
52
Diseksi
Axilla
Extirpasi
Closed
reduction
geboren
of
mioma
fracture
with
internal
fixation
Rehabilitasi
Elektromiografi
dan
Kecepatan
Hantar
Saraf
18
Closed
Reduction
Fr.
Nasal
(diluar
alat)
6
Amputation
above
knee
Other
excision
of
joint
Repair
Trunkus
Arteriosus
(35.83)
82
osteotomy
34
Internal
Fiksasi
fraktur
condylus
mandibula
1
Dobutamin
Stress
Ekhokardiografi
other
soft
tissue
128
96
25
Injeksi
saraf
perifer
(dengan
radiofrekuensi)
26
IOL
Replantation
TUR
Explant
Tumor
Buli
43
Insisi
Abses
Skrotum
78Eksisi
28
53
10
Mentoplasty
Diseksi
Herniotomi
Pasang
Axilla
Kateter
dgn
penyulit
mayor
6
Eksisi
gld
submandibula
10
Pengambilan
darah
intra
vena
dan
intra
arteri
9234
phalanges
of
foot
-sheath
simple
implants
(K-wire)
Pada
45
Torakoplasti
(Air
Plumbage/Muscle
Plumbage)
77
264
Suture
ofBronkhus
tendon
of
hand
366
68
Other
repair
of
elbow
24
Eksplorasi
Repair
Aorta
Abses
Torakalis
Parafaringeal
(38.34)
Pemasangan
Swan
Ganz
(Kateter
Arteri
Pulmonal)
KSM 334
Repair
of
claw
toe
54
Myocutaneus
Flap
(Pectoral
Mayor)
Open
reduction
of
dislocation
of
hand
and
finger
-Fresh
minor
32
Arthrodesis
of
shoulder
304
Refusion
of
other
cervical
spine,
anterior
column,
37
Rekanalisasi
Jejenostomi
/(41.5)
ileostomi
dengan
penyulit
minor
66
-Phalang
of
hand
Medik
36
ORIF
Maksila
Plating
(belum
termasuk
implant)
Splenektomi
D. Semua Tindakan/PENGOBATAN
Yang
Berisiko
Tinggi.
Pembedahan
Teleangiectasis
158
Revisi/Aff
Pace
Maker
Permanen
(diluar
alat)
(37.89)
Excision
or
destruction
of
intervertebral
disc,
18
83
186
Injection
of
other
agent
into
spinal
canal,
Intrathecal
2
Transophegal
Ekhokardiografi
129
97
8
27
Iridectomi
Reposisi
TVP/TMP
fraktur
nasal
sederhana
44
Insisi
Posterior
Parsial
+
Urethral
Marsupialisasi
Valve
Ranula
29
86
54
Revisi
VP
Shunt
Herniotomi
Pasang
Kateter
dgn
penyulit
dengan
minor
Mandrain
11
Eksisi
Fibroadenoma
Lokal
Anestesi
Single
Satu
Sisi
54
Amputation
Microsurgery
and
disarticulation
of
fingergeneral
Open
reduction
of
fracture
with
internal
fixation11
Pungsi
lumbal
10
Torakotomi
/
sternotomi
Eksplorasi
46
Eksisi
Pada
Paru
(Lung
Volume
Reduction)
53
Diseksi
Inguinal
Other
excision
of
soft
tissue
Extirpasi
geboren
mioma+kuiretasi
208
265
19
Comisuroplasty
repair
of
hand,
fingers
and
wrist
69
Internal
fixation
of
bone
without
fracture
reduction
Kardiologi
dislocation
Pemasangan
Intra
Arterial
Repair
Catheher
Atrioventricular
(Kateter
Intra
Septal
Arterial)
Defect
(35.54)
58
Closed
reduction
of
dislocation
of
ankle
106
Repair
of
cleft
hand
335
35
Internal
Fiksasi
fraktur
maksilofasial
3-4
tempat
235
26
Injeksi
spinal
(Pain)
25
Ekstirpasi
Tumor
Jinak
Kepala
& Leher
(Aterom
Lipoma)
Suture
of
Vein
7
Eksisi
higroma
leher
367
anterior
technique
Closed
reduction
of
fracture
with
internal
fixation
8
Biopsi
rectum
Repair
Aneurisma
(True/false)
Ekstremitas
Superior
Septostomi
Terbuka
Septum
Atrium
(35.41)
unspecified
4
injection
of
steroid,
Subarachnoid
perfusion
of
55
Myringoplasty/Timpaniplasti
133
3
Treadmill
Tes
130
98
28
Jahit
Reposisi
Ureterokutaneostomi
Kelopak
fraktur
Mata
os(39.1)
nasalis
Full
Thickness
(complicated)
& Lid implant)
Margin
45
Johanson
30
87
anaesthesia
Herniotomi
Pasang
Kateter
laparoskopik
Tenckhoff
untuk
CAPD
33
12
Arthrodesis
Eksisi
Fibroadenoma
unspecified
joint
Narkose
55
67
Torakotomi
Eksplorasi
pada
Trauma
jantung/Repair
phalanges
of
foot-Plate
&
Screws
12
Pungsiv
Pleura
11
Psycho
Analisa
38
Rekanalisasi
Jejenostomi
/shunt
ileostomi
tuba
tanpa
penyulit
Eksisi
Splenorenal
Pada
Paru
dengan
VATS
78
37
ORIF
Multiple
Mandibula
facial
fraktur
Plating
+Multiple
implant
(belum
termasuk
266
dan
Other
repair
of
joint
Pemasangan
KSM
BEDAH
Percutaneous
Dilatational
Tracheostomy
159
Adrenalektomi
19
of
hammer
toe
336
1Repair
9
Eksisi
Plunging
Ranula
55
Rhizotomi
Other
excision
Selektif
of
soft
(Spastisitas)
tissue
of
hand
187
Open
reduction
dislocation
of
hip
Fresh
dislocation
305
Refusion
of
other
cervical
spine,
posterior
column,
47
-Radius
and
ulna
(MIPO,
TEN)
54Total
Diseksi
Para
Aorta
Histeroctomy
pada
mola
/
chorio
Ca
Insersi
Elektrode
Intradural
20
Eks
mamma
aberan
bilateral
(diluar
graft)
9
Interphalangeal
fusion
236
26
Faringotomi
Koreksi
Tetralogy
of
Fallot
(TOF)
(35.81)
refrigerated
saline
Synovectomy
368
5
36
patahan
4
Exercise
Stress
Ekhokardiografi
131
99
29
Jahit
Reseksi
Ureterolisis
Kornea
mandibula
+
bone
graft
46
Johanson
I
Amputation
and
disarticulation
of
finger
-local
31
88
Laserasi
Jantung
Jejunostomi
PCNL/PNL
/
ileostomi
13
Tumor
Metastase
Loco-regional
8
Eksisi
kista
tiroglosus
107
Exploration
of
tendon
sheath
Open
reduction
of
fracture
with
internal
fixation13
Pemasangan
kateter
urine
Eksisi
Tumor
Dinding
Dada
dengan
Rekonstruksi
Dinding
209
27
Kedokteran
267
9
By
pass
usus
dengan
penyulit
mayor
/
minor
56
Pemasangan
Drain
Intra
Thorakal/Punksi
Thorax
Other
repair
of
knee
1
UROLOGI
Arthroplasty
Adrenalektomi
of
carpocarpal
(Abdominotorakal)
or
carpometacarpal
joint
Repair
of
hip,
not
elsewhere
classified
337
56
Mandibulekromi
Muskulokutaneus
flap
Transnasal
endorectal
pullthrough
laparascopic
8
59
Closed
reduction
of
dislocation
of
elbow
Psycho
Therapy
Dalam
posterior
technique
fracture
with
internal
fixation
39
Koledokotomi
Salfingektomi
unilateral
dengan
penyulit
mayor
A. Tindakan Pembedahan
dan
(Epilepsi,movement,psikiatrik)
Tindakan
Invasiveyang
memerlukan
informed
38
ORIF
Zygoma
Plating
(belum
termasuk
implant)
12
Repair
Aneurisma
Aorta
Abdominalis
(Diluar
Open
reduction
of
dislocation
of
hip
Neglected
160
Interthoracoscapular
amputation,
Forequarter
34
2
Tricuspid
Valve
Repair
(TVR)
(35.14)
10
86
68
Eksisional
Biopsi
Neoplasma
Jinak
Other
excision
or
avulsion
of
cranial
and
peripheral
nerves
132
100
30
Bedah
Keratoplasti
Rhinoplasty
Ureterolithotomi
Kardio
(Jantung)
(Corneal
Transplantation)
47
Johanson
II
anaesthesia
56
32
89
Rhizotomy
(Pain)
48
Laparotomi
Penektomi
dengan
Parsial
penyulit
minor
27
14
FESS
Eksplorasi
Duktus
Mama
phalanges
of
handPlate
&
Screws
134
55
Injection
of
therapeutic
substance
into
bursa
14
Pemasangan
keteter
rectal
Dada
Vaskular
Tarsometatarsal
fusion
237
369
79
10
Histeroctomy
radikal
188
Eksisi
Tumor
Lidah
268
21
Eksisi
neoplasma
jinak
(lipoma,
atheroma
dll)
Pemasangan237
IABP
Other
repair
of
shoulder
3 Internal
with
implant
Anastomosis
end
to
end
Ureter
20
Repair
of
macrodactyly
assisted
fiksasi
(48.42)
fraktur
maksilofasial
5flap
tempat
patahan
57
9
306
Eksisi
Refusion
luas
of
tumor
spine,
ganas
not
elsewhere
bibir
dengan
classified
rekontruksi
Myokutaneus
flap/pectoralis
mayor
108
Exploration
of
tendon
sheath
of
hand
-Tarsal
and
metatarsal
dislocation
Protesa)
10
Divertikulektomy
amputation
consentantara lain:338
Tricuspid
Valve
Repair
(TVR)
dengan
Bioprosthesis
Valve
57
Neurektomi
Saraf
Vidian
28
Kordotomi
Perkutan
133
101
31
Amputation
Aortic
Konjungtival
Rotation
Ureterolithotomi
Valve
flap
Repair
and
Flap/Amnion
disarticulation
Distal
(AVR)
Graft
of
thumb-general
48
Kalibrasi
Uretra
Pemeriksaan
Calon
Pimpinan
Publik
33
90
Open
reduction
of
fracture
with
internal
fixationLaparotomi
Penektomi
tanpa
Total/Amputasi
penyulit
Penis
49
15
Eksplorasi
Duktus
Mama+VC
Eksisi
Tumor
Mediastinum
(Thymoma,
Teratoma,
40
15
Kolesistektomi
Salvingoovarectomi
Pemasangan
orogastrik
unilateral
tube
210
39
Osteotomi
Maksila
le
Fort
I ligaments
Pemasangan
269
Drain
Intra
Abdominal
3Repair
Closed
reduction
of
dislocation
of
foot
and toeArthroplasty
of
carpocarpal
or+knee
carpometacarpal
joint
repair
of
the
collateral
4
28
FESS
Advance
11
Augmentasi
Other
excision,
Buli
fusion
and
repair
of
toes
of
mallet
finger
339
Enukleasi
Kista
Dentigerous
Extraksi
Gigi
Impaksi
87
Tendon
graft
370
9
57
Selective
Nerve
Root
Block
238
307
Refusion
of
spine,
not
otherwise
specified
58
Open
reduction
of
dislocation
of
Neglected
135
69
Transplantasi
Injection
of
therapeutic
organ
substance
into
bursa
of
hand
Bronchoscopy/FOB
56
11
Kistektomi
Repair
Pembuluh
Darah
Regio
Servikal
(Karotis,
13
22
Nasal
Eksisi
repair
luas
+
dan
Deltopectoral
rekonstruksi
flap
Eksisi
Tumor
Sub
Mandibula/Sub
Mental
Intra-operative
neurophysiologic
monitoring
161
35
60
(35.27)
38
atau
lebih
84
Excision
ofRepair
bone
forsimple
graft
134
102
anaesthesia
Aortic
Valve
(AVR)
dengan
Bioprosthesis
Valve
32
Piggy
Sagital
Ureterolithotomi
Back
Split
IOL
osteotomi
Proksimal
mandibula
49
Kauterisasi
189
phalanges
of
handimplants
34
91
Ligasi
PER
hemoroid
(Primary
Endoscopic
(diluar
alat)
Realignment)
10
16
flap
Insisi
lokal
Absces
Mastitis
Lokal
109
Exploratory
thoracotomy
50
dsb)
16
Pemasangan
nasogastrik
tube
Pemasangan
Gemo
11
Drainase
abses
dengan
general
anasthesia
270
without
implant
Other
repair
of
the
cruciate
ligaments
5Neurogenic
Biopsi
Ginjal
perkutan
21
Repair
of
old
traumatic
injury
of
cranial
and
peripheral
340
58
Osteotomi+Septum
general
anaesthesia
koreksi
29
Kordotomi
Servikal
Open
(Pain)
dislocation
Aborsi
Provocatus
Medicinalis
29
308
Frontal
Release
Sinusotomi
of
carpal
tunnel
Enukleasi
Kista
radikuler
Per
Rahang
+spinal
Extraksi
Gigi
41
Kolesistektomi
Secound
look
surgery
laparoskopik
Ca
ovarium
Tindakan
kemotherapi
Jugular)
Other
exploration
and
decompression
of
canal,
40
Osteotomi
Maksila
le
Fort
II
-Neuromonitoring
Tendon
pulley
reconstruction
59
371
4
Tricuspid
Valve
Repair
(TVR)
dengan
Mechanical
Valve
Injection
of
therapeutic
substance
into
joint
or
Neo
vagina
Amputation
and
disarticulation
of
fingergeneral
135
103
Aortic
Valve
Repair
(AVR)
dengan
Mechanical
Valve
Simple
Ureterosigmoidostomi
bone
grafting
(Caffey)
50
33
Koreksi
Pneumoretinopexy
Horseshoe
Kidney
Open
reduction
of
fracture
with
internal
fixation58
Selective
Thalamotomi
(Movement
Disorder)
92
Pielokalikotomi
17
LD
Pankreatiko-duodenektomi
Flap
+
Eksisi
Tumor
cephalis
(Whipple)
12
Ekstraksi
Corpus
Alienum
di
Regio
Toraks
51
70
Tutup
burst
abdomen
dengan
penyulit
(54.61)
211
1Laringectomi
Pemeriksaan
Audiometri
12
Konisasi
serviks
Cardioversi
57
14
271
23
Eksisi
luas
+
Fore
head
flap
Arthroplasty
of
metacarpophalangeal
and
Insersi
Chest
Tube
Other
repair
or
plastic
operations
on
bone
6
Biopsi
Ginjal
Terbuka
nerves
16
IRNA
Jiwa
136
39
88
85
Excision
of
intervertebral
disc
10
Closed
reduction
of
dislocation
of
foot
and
toe-local
11
Eksisi
luas
tumor
ganas
dengan
rekontruksi
flap
jauh
309
110
Release
Fasciotomy
of
clubfoot,
not
elsewhere
classified
Penyebab
239
KSM/INSTALAS 190
35
Repair
Ruptur
Pembuluh
Arteri
Abdominal
Open
Thoracoscopy
reduction
of
dislocation
of
knee
Fresh dislocation
12
Drainase
abses
local
anasthesia
162
36
(35.28)
22
ligament
68
Rekontruksi
Fraktur
Maksila
Multiple
60
Operasi
bedah
mikro
30
Kordotomi
anaesthesia
Servikal
Perkutan
(Pain)
136
104
Atrial
septal
Defect
(ASD)
Simple
Ureterostomi
skin
51
Koreksi
Priapismus
tarsals
and
metatarsalsPlate
&
Screws
93
Decompression
Tendon
Tindakan
pulley
terapi
reconstruction
elektroconfusi
372
dengan
penyulit
mayor
Pielolitotomi
18
Mastectomy
+
Tram
Flap
61
Ekstraksi
Corpus
Alienum
diClosure
Regio
Toraks
dengan
VATS
34
Repair
Canalis
Lacrimalis
(Without
Silicon
Tube)
NO
TINDAKAN
52
42
Kolostomi
Seksio
sesaria
/Arch
sigmoidostomi
(46.11)
30
Fore
Head
Flap
2
Pemeriksaan
Timpanometri
Bronchoskopi-FOB
41
Pelepasan
Bar
(Intermaksila
Fiksasi)
15
272
Intervertebral
interphalangeal
chemonucleolysis
joint
with
implant
5Repair
Other
suture
ofgrafting
flexor
tendon
of
hand
7
Biopsi
Penis
of
recurrent
dislocation
of
shoulder
341
59
Simpatektomi
Open
(Pain)
310
Release
of
tarsal
tunnel
I/UNIT
71
Tutup
burst
abdomen
tanpa
penyulit
(54.61)
anaesthesia
13
Revisi
Kuret
Arteriovenous
abortus
incompletes
Shunt
Contra
Ventil/WSD
24
Eksisi
luas
+
Muskulocutan
flap
58
Ventricle
Septal
Defect
(VSD)
Closure
(35.5)
13
Extirpasi
Kista
Dermoid
23
Ismulobectomy
1
Adenotonsilektomi
89
Amputation
Excision
of
and
lesion
disarticulation
of
muscle
of
finger
-local
86
61
Orif
fraktur
zygoma
137
105
Bidirectional
Cavo
Pulmonary
Shunt
(BCPS)
Open
Skin
Ureterouretostomi
flap
reduction
of
fracture
with
internal
fixation52
Laparoskopi
Adrenalektomi
94
12
Eksisi
Peritoneal
luas
tumor
ganas
(CAPD)
kulit
dengan
rekontruksi
Pieloplasti
111
19
Modified
Fasciotomy
Radical
ofof
hand
Mastectomy
+secara
Flap/Single
Grafting
Efusi
Pleura/Empyema
Torakoskopik
137
35
Injection
Repair
Coloboma
ofdreanse
therapeutic
Palpebra
substance
(Skin/Mucosal
into
tendon
Graft)
212
TEE KSM 342
53
36
191
Open
reduction
dislocation
of
other
specified
sites
13
Arthroplasty
hygroma
of
metacarpophalangeal
colli
and
273
36Repair
Pemeriksaan
Audiometri
Tutur
163
315
.1
Other
suture
of
muscle
orpenyulit
fascia
8Evakuasi
Pemeriksaan
kandungan
zat
narkotika
Biopsi
Prostat
Tendon
of
the
transfer
anulus
or
fibrosus
transplantation
with
graft
or
prosthesis
KSM
373
69
Rekontruksi
Fraktur
Maksila
Sederhana
fasciectomy
31
Kranioplasti
dua
sisi
11
311
Removal
ofPleura
(cement)
spacer
KSM
Bedah
190
Amygdala
Hypocampectomy
(Epilepsi)
43
LADD
Seksio
Operation
sesaria
dengan
(54.95)
penyulit
240
31
Fronto
Etmoidektomi
(Ekstranasal)
1
Intubasi
Skleroterapi
Endotrakea
Vena
(Varises,
Hemangioma)
Punctie
16
Limb
lengthening
procedures
37
Amputasi
Above
Knee
(AK)
(84.17)
Closed
reduction
of
dislocation
of
hand
and
finger24
anaesthesia
DIVISI
PEDIATRI
62
Biopsi
Jantung
138
106
tarsals
and
metatarsalssimple
implants
Eksisi
luas
+
rekonstruksi
dengan
bedah
Skin
Uretroplasti
graft
>5
Hipospadia
cm
53
Laparotomi
Eksplorasi
THT-KL
60
Simpatektomi
Perkutan
95
Peritoneal
lavase
Pieloplasti
per
Laparoskopi
20
(VATS)
Modified
Radical
Mastectomy
Single
Orif
fraktur
hand
59
36
Reposisi
IOL
72
Tutup
ileostomi
dengan
penyulit
(46.5)
37
14 Anthrostomi+Sinuskopi
Kemoterapi
Lap
op:
myomektomi
Perinfus
54
interphalangeal
joint
without
implant
Pulmonologi
274
4reduction
Pemeriksaan
Sisi&Tore
2 Saraf
14
Extirpasi
Sialolith
Other
suture
of
other
tendon
hand
9
Repair
of
vertebral
fracture,
Elevation
of
spinal
bone
Biopsi
Testis
62
Injection
of
therapeutic
substance
into
tendon
of
Open
Excision
of
lesion
of
dislocation
of
muscle
of
shoulder
of
hand
-Fresh
87
343
25
2
13
flap
lokal
112
Finger
reattachment
312
Removal
of
bone
growth
stimulator
(invasive)
Tenotomy
of
hand
374
Stripping
Varises
Ekstremitas
Inferior
FNAB
14
Eksisi
kista
brachialis
Restraint
/(Clipp,
Fiksasi
:cm
mekanik
dan
psikotropika
164
Amputasi
Below
Knee
(BK)
(84.14)
Other
fasciectomy
of
hand
25
192
138
Anterior
Temporomesial
Lobectomi
(Epilepsi)
70
Rhinoplasti
Amputation
and
disarticulation
of
thumb-general
291
Krikotirotomi
Bedah
THT-KL
general
anaesthesia
32
Kranioplasti
satu
sisi
GAWAT
mikrovaskular
Open
reduction
of
fracture
with
internal
fixation-tibia
139
107
7
Skin
Uretroskopi/Uretrosistoskopi
graft
sedang
5
241
54
Ligasi
V.Spermatika
Interna
(Microsurgery)
Biopsi
Perikardium
96
Polipektomi
Fiksasi
Prostatektomi
Costae
Radikal
Wire)
(diluar
Clipp)
21
Quadrantectomy
/
Partial
Mastectomy
63
213
37
Reposisi
Iris
44
Sirklase
Laparoskopik
serviks
diagnostik
(61.6)
32
FOL
38
dan Ilmu17
55
275
Limb
shortening
procedures
Orif
fraktur
mandibula
Decay
fragments,
Other
suture
Reduction
ofRekonstruksi
tendon
of fracture
ofShunt,
vertebrae,
dislocation
10
Bladder
Neck
hand
Laparoskopi
(Kistektomi
Ovarium,
Salphingektomi,
12
38
Arthroscopy
61
SLTH
313
Removal
of
foreign
body
from
spinal
canal
73
Tutup
kolostomi
/ ileostomi
(46.5)
60
Latissimus
Dorsi
Flap
(LD
Flap)
Vascular
Shunting
(Splenorenal
De
Palma
Scalene
Biopsy
0DARURAT
15
Extraksi
Corpus
Alienum
dengan
Teknik
Lindorf
Arterial
Pungsi,
Kanulasi,
Sectie
(38.91)
anaesthesia
BLM
Simple
(Kista,Polip,Nodul,Granulasi)
C. Tindakan
Pemberian
Produk
Darah
dan
Komponen
Darah
tindakan
yang
Kanulasi
vena
perifer
Excision
of
lesion
of
other
soft
tissue
88
15
92
Thigh
reattachment
and
fibula
-Simple
fracture
375
140
108
Skin
Uretrotomi
grafting
Interna
kecil
(Sachse)
55
3
Closed
reduction
dislocation
of
hand
and
finger14
Eksisi
luas
tumor
ganas
rongga
mulut
dengan
97
113
Potong
Five-in-one
kolostomi
repair
of
knee
Fiksasi
Prostatektomi
Sternum
(Wire,
Retropubik
Plate)
(diluar
wire/plate)
22
Simple
Mastektomy
+
Flap/Skin
Grafting
38
Resesi
&
Reseksi
2
Otot
Kedokteran
Other
fusion
of
foot
39
sengketa/
konflik
dalam
keluarga
Limfadenektomi
Ilioinguinal
Open
reduction
of
dislocation
of
shoulder
-Neglected
18
15
Eksisi
malformasi
kista
duktus
lymphatik
tiroglossus
/
vaskuler
276
56
165
5
Pemeriksaan
Pendengaran
Pada
Anak
64
Removal
Blalock-Taussing
of
bony
spicules
Shunt
(BT
from
Shunt)
spinal
canal
tendon
transposition
11
Buried
Penis
26
3
Biopsi
Saraf
Tepi/Otot
71
Rinotomi
Lateral+Maksilektomi
Medial
242
Adhesiolisis)
33
8
Kraniotomi
Orif
fraktur
Biopsi
maxilla
otak
314
Removal
implanted
devices
from
bone
carpals
139
Insertion
of
bone
growth
stimulator
45
Seksio
Ligasihemoroid
sesaria
dengan
(49.4)
penyulit
penyulit
33
Glosektomi
Total/Parsial
63
Shunt)
193
Reposisi
Local
excision
of
lesion
or
tissue
of
bone
Arthrotomy
for
removal
of
prosthesis
without
Arteriovenous
Shuntt
(AV
Shunt)
Brakiosefalika
(39.42)
Amputation
and
disarticulation
of
thumb-local
Vena
sectie
Open
reduction
of
fracture
with
internal
fixation-tibia
ILMU
93
Extraksi
Gigi
Anak
dengan
Kelainan
Jantung
Per
141
109
Skin
URS/Lithotripsi
grafting
luas
62
Stereotactic
Ablative
Procedure
(Psichiatric)
98
Prosedur
Heller
Lobektomi
Prostatektomi
Parsial
(Reseksi
Terbuka
Paru
segmental)
23
Simple
Mastektomy
Single
Respirasi
214
dislocation
74
61
Tutup
Maksilektomi
Stoma
(46.5)
Total
39
Resesi
&
Reseksi
3keloid
Otot
local
anaesthesia
Dorsal
and
dorsolumbar
fusion
of the
anterior
40
56
19
277
39
Thumb
reattachment
of
joint
of
foot
and
toe
57
6Replacement
Pemeriksaan
Brainstem
Evoked
Response
Other
tenodesis
of
hand
12
Coronary
Artery
Bypass
Graft
(CABG)
memerlukan
informed
consenttersebut
Businasi/Dilatasi
antara
Uretra
lain:
Limfadenektomi
Retroperitoneal/RPLND
4376
Biopsi
Tumor
344
16
65
13
27
Ekstraksi
ateroma
/
Other
hand
muscle
transfer
or
transplantation
15
rekontruksi
flap
lokal
114
and
Foot
metacarpals-Plate
reattachment
&
screw
Orif
maksila
plating
Semua
injeksi
dengan
obat
risiko
tinggi
Vena
Punctie,
Kanulasi,
Sectie
89
16
Laparoskopi
Histerektomi
16
Eksisi
Pleurodesis
neoplasma
Jinak
(
lipoma,
atheroma
dll
)
replacement
166
243
Arteriovenous
Shuntt
(AV
Shunt)
Radiosefalika
(39.27)
anaesthesia
27
15KESEHATAN 4
Blok
Saraf
Perifer
Iumbilikal
72
Rekontruksi
Laring
Trakea
and
fibula
Comminutive
or
Segmental
Pungsi
lumbal
34
Laminektomi
Rahang
Eksisi
Tumor
Spinal
94
142
110
Open
reduction
of(Reseksi
dislocation
of
unspecified
site
Fresh
Skin
Varikokelektomi
grafting
sedang
(Palomo)
99
Rektopexy
Lobektomi
Prostatektomi
Parsial
Terbuka
dan
Paru
Sectio
segmental)
Alta
dengan
140
24
Tram
Insertion
Flap
of
+Reseksi
bone
Eksisi
void
Tumor
filler
46
Sirklase
Operasi
kelainan
serviks
lain
(54.3)
40
Resesi
&korpus
4 Otot
34
Glosektomi
Total/Hemiglosektomi+RND
column,
anterior
technique
41
Audiometry
278
Lower
leg
or
ankle
reattachment
KSM Patologi
58
Other
tenonectomy
13
Cabut
DJ
Stent
57
Eksisi
Cardiac
Myxoma
345
Resurfacing
hip,
partial,
acetabulum,
Hip
resurfacing
28
Ekstraksi
alienum
194
63
Subthalamotomy
(Movement
Disorder)
Litholapaksi
Toe
reattachment
378
315
Removal
of
implanted
devices
from
bone
carpals
62
66
75
Urethroplasty
/
chordectomy
(64.42)
Abdominal
pull
through
(sfingter
saving
procedure)
Mastopexy
10
AFF
WSD
Orif
mandibula
plating
Bedah
Varises
Insisi
Babcock
(38.5)
Transfusi
darah:
Amputation
of
ankle
through
malleoli
of posterior
tibia and
KSMANAK
BEDAH 20
1
5143
Bronkoskopi
Rigid
64
Other
Closed
hand
reduction
muscle
transposition
of
dislocation
of the
hip
dislocation
95
40
Aspiration
of
bursa
111
Skin
Vasektomi
grafting
(anestesi
with
complication
lokal)
16
Eksisi
parsial+marsupialisasi
Ranula
115
100
VATS
Forearm,
wrist,
or
hand
reattachment
Repair
fistel
usus
215
Psoas
Hitch/Boari
Flap
25
Operasi
Tumor
Kulit
FNAB
(Fine
Needle
Biopsy)
Dorsal
and
dorsolumbar
fusion
of
41
Extraksi
Resesi/Reseksi
Gigi
Anak
1Aspiration
Per
Otot
Rahang
244
17
Pungsiv
Laparoskopi
Pleura
steril
42
3
17
sinus/granuloma
umbilikalis
279
167
Other
tenonectomy
of
hand
59
14
Defooring
Insertion
of
Kista
catheter
Ginjal
into
per
spinal
Laparoskopi
canal
for Conduit)
infusion
of
Cingulotomy
(Psichiatric)
73
Reposisi
Fraktur
Os
Nasal
35
Laminoplasti
Fontan
Operation
(Atrium-Pulmonary
Artery
14
arthroplasty,
partial,
acetabulum
29
Elevasi
ear
rim
cartilago
and
metacarpals-simple
implants
(K-wire)
58
Open
reduction
of
fracture
without
internal
47
Supra
Orchidopexy
vaginal
(62.5)
hyterectomy
35
90
Hemiglosektomi+SOHND
Abdominoperineal
resection
(miles)
dengan
penyulit
Lithotripsi
11
Perawatan
Luka
WSD
Lower
limb
amputation,
not
otherwise
specified
Anatomi 5
67
Biopsi
Pembuluh
Darah
(Perifer)
(38.21)
fibula
Open
reduction
of
dislocation
of Ginjal
unspecified
sitefixation
Total
ankle
replacement
379
Orif
mandibula
wiring
96
112
144
64
Suturektomi
Kraniostenosis
Tendon
Vasektomi
reconstruction
(narkose)
Lumbal
Simpatektomi
101
Repair
fistel
vesicorectal
63
Punksi
dan
sklerosing
Kista
26
Biopsi
Insisi
Tumor
Kulit
Lokal
column,
posterior
technique
76
Vena
Sectie
Aksilaris
(38.94)
42
Sekunder
Implant
(Posterior
Chamber)
Modifikasi
RND
43
21
280
a.
Plasma
sel
Other
hand
tendon
transfer
or
transplantation
tenoplasty
of
hand
195
therapeutic
or
palliative
substances,
Insertion
of
60
15
Deroofing/Unroofing
Kista
DIGESTIVE
6
2
BLM
Advance
(Stenosis,
Subjektif/Trakea,
Papiloma
346
Resurfacing
hip,
partial,
femoral
head
41
Aspiration
of
bursa
of
Internal
Resusitasi/Cardiac
Massage
(Operasi
30
Excise
hemangioma
+hand
rekonstruksi
245
316
Removal
of
implanted
devices
from
bone
- Terbuka)
External
17
Eksisi
tumor
ganas
kulit
dengan
flap
local
atau
graft
116
Fusion
or
refusion
2-3
vertebrae
16
216
18
118Debriment-Nekrotomi
Diagnostik
Extraksi
Gigi
Kateterisasi
Dewasa
Per
Jantung
Rahang
mayor
Laparoskopik
Diagnostik
Neglected
dislocation
soft
tissue
tumor
dengan
penyulit
59
12
USG
Thorax
Marker
Lumbar
and
lumbosacral
fusion
of
the
anterior
168
Luka
Gangren
(86.22)
KSM PENYAKIT
6
Corpus
Callosotomi
(Epilepsi)
74
Reposisi
Masase
&
Prostat
Fiksasi
Fraktur
Mandibula
36
Laminotomi
Biopsi
Mielum
68
Orif
orbital
wall
113
97
145
Tendon
Vasoepididimostomi
transfer
Mediastinostomy
Open
reduction
of
separated
epiphysis
102
Repair
Railroading
hernia
Rupture
cicatricalis
Uretra
27
Biopsi
Eksisi
Tumor
Kulit
Narcose
65
48
Surgical
Orchidopexy
Total
Closed
elbow
staging
reduction
laparoskopik
replacement
of
dislocation
(62.5
+
of
61.6)
knee
36
Insisi
Abses
Leher
Dalam
380
43
Sekunder
Implant
Claw
Lens
/
Fiksasi
Sulcus
15
Amputation
of
toe-general
anaesthesia
44
281
Inst. 347
22
141
catheter
Other
tenotomy
into
epidural,
subarachnoid,
or
subdural
16
61
Diseksi
Kelenjar
Getah
Bening
Inguinal
91
Excision
of
bone
for
graft
Revision
of
total
knee
replacement,
tibial
insert
(liner),
31
Excise
intra
keloid
fixator
device
(invasive)
(Otot(miles)
65
Thalomotomy
(Pain)
Ligasi
Patent
Ductus
Arteriosus
(PDA)
64Disartikulasi
77
Vena
sectie
Femoralis
/tissue
saphena
magna
(38.94)
Abdominoperineal
resection
dengan
penyulit
Other
hand
tendon
transposition
Operasi
Compartement
b. PRC
column,
Tindakan
anterior
Radiologi
technique
Injectee
contrast
2
PTMC
Laring/Trakea)
Sendi
Ekstremitas
60
Meatoplasti
246
196
69
Open
Orif
orbital
reduction
wall
of
dislocation
of (84.13)
wrist
-Fresh
dislocation
42
Aspiration
of
other
soft
114
146
98
Tendon
Vasografi
transfer
with
complication
18
19
kulit
Fissure
Sealant
pada
Autis
Pemasangan
thorak
drain/water
sealed
drainage
(WSD)
117
Fusion
or
refusion
of
48dgn
vertebrae
217
103
Tindakan
Reimplantasi
Radiotherapi
Ureter
Bilateral
Repair
hernia
cicatricalis
penyulit
mayor
(diluar
44
19
Laparotomi
SICS
dengan
penyulit
mayor
4JANTUNG &
soft
tissue
tumor
tanpa
penyulit
282
space
of
spine
with
intermittent
or
continuous
28
Eksisi
Tumor
Jinak

3cm
Other
total
shoulder
replacement
17
3
Diseksi
Kelenjar
Getah
Bening
pelvis
7
Debrimen
Rekonstruksi
Vulnus
Kulit
Kepala
75
Septum
Koreksi+Konkotomi
Other
Repair
of
Abdominal
Wall
(Repair
Omphacele)
62
37
Laminotomi
Diskektomi
HNP/Stenosis>1
level
Replacement
of
tibial
insert(liner)
Total
ostectomy
381
32
Excise
polydactyly
317
Removal
of
implanted
devices
from
bone
femur
Osteoclasis
(correction
of
bone
deformity)
Mitral
valve
repair
(MVr)
minor
49
TAH+BSO
dengan
Penyulit
37
Inversi
Grommet
16
Amputation
of
toe-local
anaesthesia
Lumbar
and
lumbosacral
fusion
of
the
anterior
169
23
45
Radiotherapi
Transposisi
kraniostenosis,dengan
orbital
Tindakan
Radiologi
pada
pasien
dengan
kelainan
Eksisi
Closed
Tumor
reduction
Pembuluh
of
Darah
dislocation
Perifer
of
(Hemangioma)
other
specified
3
PTCA/Stenting
PEMBULUH
49
92
Excision
of
intervertebral
disc
61
Meatotomi
6 c. Eksisi
178
115
70
Orif
zygoma
wiring
BiopsiCell
Other
incision
of
bone
without
division
Tennoraphy
Vasovasostomi
alat)
alat)
Reimplantasi
Ureter
65(diluar
Wound
repair
(86.8)
45
SICS
&
IOL
Whole Blood
Open
Ovariectomy
reduction
of
Bilateral
fracture
with
internal
fixationradius
283
66
infusion
of
drug
(with
of
any
reservoir)
247
29
Eksisi
Tumor
Jinak
+ penyulit
Flap/Skin
Graft
Partial
hip
replacement
7147
Cald
Well
Luc
Diseksi
Kelenjar
Getah
Bening
Pelvis
perdisc
(954.72)
66
348
Revision
or
replacement
of
artificial
spinal
63
43
Aspiration
of
other
soft
tissue
of
hand
20
Fraktur
Dento
alveolar
Dengan
arch
Bar
33
Excise
reduksi
lymedema
318
Removal
of
implanted
devices
from
bone
-penyulit
humerus
19
Eksisi
tumor
ganas
kulit
dengan
flap
local
jauh
118
Fusion
refusion
of
9creation
or
more
vertebrae
218
Abdominoperineal
resection
(miles)
tanpa
197
20
Laparotomi
dengan
minor
column,
Mitral
Valve
posterior
Repair
technique
(MVR)
dengan
Bioprosthesis
Valve
20
teratoma
dengan
penyulit
dan
rekonstruksi
Total
wrist
replacement
382
advancement
104
cardiovaskuler
4
Pacemaker
Temporer&Permanen
DARAH
4
8
Dekompresi
Saraf
Tepi
76
Stapedektomi
TAH+BSO
dengan
Penyulit
Pemasangan
Tampon
62
38
Laminotomi
Diskektomi
HNP/Stenosis
1minor
level
sites-general
anaesthesia
Tumor
116
71
Osteotomy
craniosynostosis
reconstruction
KSM
ILMU
18
1
Pleural
window
(Eloeser
Flap)
Tennoraphy
Angkat
Jahitan
with
complication
Repair
hernia
cicatricalis
dgn
penyulit
(diluar
MMK/Sling
Uretra
Unilateral/Ureteroneosistostomi
Other
and
ulna-Simple
fracture
38
Insisi
Perikondritis
46
Simpel
Vitrektomi
17
Amputation
through
foot
1
Cerebral
Angiografi
284
24
30
Eksisi
Tumor
Jinak
Kulit
>3cm
Partial
shoulder
replacement
Laparoskopi
50
Other
incision
of
soft
tissue
93
Excision
of
lesion
of
muscle
prosthesis,
cervical
12 d. Trombosite
KSM BEDAH
1
Abdominoplasty
2
Eksplorasi
Vaskular
(Trauma/Non
trauma)
142
34
Facial
Insertion
sling
of
dengan
interbody
allograft
spinal
fusion
device
319
Removal
implanted
devices
from
bone
radius
Abdominoplasty
50
Polipektomi
Mitral
Valve
Replacement
(48.36)
(MVR)
dengan
Mechanical
248
66
Lumbar
and
lumbosacral
fusion
ofof
the
posterior
170
46
Transposisi
Reseksi
Mandibula
kraniostenosis,tanpa
orbital
Fraktur
Dento
alveolar
Dengan
Bracket
(belum
Tindakan
Radiologi
pada
pasien
dengan
alergi and
864
Cochlear
Implant/Implan
Baha
5
Abdomen
Pembuluh 349
117
44
Atlas-axis
spinal
fusion
72
Osteotomy
facial
rekonstruksi
Open
reduction
oftanpa
fracture
with
internal
fixationKESEHATAN
2Pleurektomi
383
alat)
20
Eksisi
TMJ
Angkat
tumor
arthroplasty
Jahitan
ganas
dengan
kulit
tanpa
GA
rekontruksi
119
Graft
Rekontruksi
of
muscle
Renovaskuler
or
fascia
63
219
Closed
reduction
of
dislocation
other
specified
5
IABP
21
Laparotomi
tanpa
penyulit
47
Skleral
Transplant
Buckle
from
cadaver
2
AVM&Embolisasi
21
teratoma
penyulit
285
Nefrektomi
25
67
105
31
Wide
Patellar
Eksisi
stabilization
+
Diseksi
KGB
Divertikulektomi
Buli
9
Revision
Dekompresi
or
replacement
Tulang
Durameter
of
artificial
spinal
disc
77
Skin
Pricle
Test
PLASTIK
39
Lesionectomy
(Epilepsi)
2
Aff
archbar,
Lokal
Anastesi
198
ulna
35
Fasciotomy
Valve
burn
injury
19
Other
(peripheral)
vascular
shunt
or bypass
Apendektomi
39
Irigasi
Sinus
Maksila
67
column,
posterior
technique
18
Amputation
through
forearm
advancement
termasuk
bahan)
Other
incision
of
soft
tissue
ofMajor
hand
berat
63Pleurodesis
94
Excision
of
lesion
of
muscle
of
hand
unspecified
site
(Periarticular
Bone
) salfingektomi
Darah
3118
Aorta
73
Osteotomy
genioplasti
tanpa
tarif
bahan
143
Insertion
of
other
spinal
devices
Repair
Hernia
Diafragmatika
(diluar
alat)
MATA
249
(Pleurosklerosis)
TMJ
Anterior
arthrostomy
Chamber
Tap/Parasintesis
Repair
Fistel
Enterovesika
e. Albumin
51
Total
Posterosagital
abdominal
anorectoplasty
hysterectomy+bilateral
(49.79)
48
Socket
Repair
(Contracted
Socket)
3Embolektomi/Trombektomi
sites-local
Aneurisma
anaesthesia
Coiling
47
26
286
67
64
106
32
Wide
Percutaneous
Eksisi
Tumor
denervation
Ganas
of
Kulit
facet
Rotation
Flap
9
Dekompresi
Nervus
Fasialis
Divertikulum
Uretra
prosthesis,
lumbosacral
Nefrektomi
Donor
Transplant
384
Transposition
of
cranial
and
peripheral
nerves
65
45
320
Biopsy
Removal
of
bone
of
implanted
devices
from
bone
- scapula,
36
20
Fasciotomy
with
complication
21
Eksisi
tumor
jinak
dengan
anastesi
lokal
120
Hip
bearing
surface,
ceramic-on-ceramic
220
6
Perikardiosintesis
Operasi
Redo
Open
Heart
(Valve
Replacement)
Apendektomi
dgn
penyulit
major
22
LEEP
3
Aff
Suspensi,
Lokal
Anastesi
171
22
wajah
KSM 10
Tindakan
Radiologi
pada
pasien
dengan
KU
yang
Open
reduction
of
fracture
with
internal
fixation-carpals
7
Dekortikasi
Sinus
Frontalis
78
Tiroidektomi
Sub-Total
40
Lobektomi
(Epilepsi)
Amputation
through
hand,
Amputation
through
22
fraktur
Dento
Alveolar
dengan
Eyelet
4119
Embolektomi/Trombektomi
Pembuluh
Darah
Arteri
Abdominal
68
Trepanasi
Cedera
Kepala
(<4jam)
74
Osteotomy
maksila
Le
fort
I soft
Reseksi
anterior
dengan
penyulit
mayor
4Plikase
Tram
flap
Bulae
/
Bleb
Emfisematous
Aspirasi
Massa
Lensa
Repair
Fistel
Vesikokutan
Other
amputation
below
knee
40
Insisi
Abses
Peritonsil
49
Trabekulektomi
Other
injection
of
locally-acting
therapeutic
substance
into
Lysis
of
adhesions
of
hand
4
Embolisasi
pre
operasi
27
287
48
107
Percutaneous
vertebral
augmentation
33
Wide
Eksisi
Tumor
Ganas
Kulit+Flap
/
Skin
Graft
350
Revision
or
replacement
of
artificial
spinal
disc
Dorsumsisi
Posterosagital
anorectoplasty
urethro
vaginoplasty
95
Excision
of
lesion
of
other
tissue
19
65
Closed
reduction
of
dislocation
of
other
specified
clavicle,
and
thorax
(ribs
and
sternum)
144
21
Operasi
Insertion
Reopen
of
partial
oleh
spinal
Karena
disc
sebab
prosthesis,
Perdarahan,
cervical
37
Flap
lokal
sederhana
f. lain

lain
Nefrektomi
Parsial
52
Tubektomi
klinik
Apendektomi
dgn
penyulit
minor
and
metacarpals
plate
&
screws
1
Radiologi10
199
-Nerve
transplantation
menurun
68
Hip
Skin
bearing
Grafting
surface,
ceramic-on-polyethylene,
Hip
8
DCR
52
carpals
Embolektomi/Trombektomi
Pembuluh
Darah
Arteri and
66
120
46
Biopsy
of
joint
structure
68
75
Osteotomy
maksila
Le
fort
II
Wound
Dressing
5
Reseksi
anterior
dengan
penyulit
minor
Plikasi
diafragma
22
Ekskokleasi
epulis
Blefaroplasty
(2
Kelopak
Mata)
Repair
Fistel
Vesikorektal
250
221
7
Pemasangan
Swan
Ganz
Kateter
4
Amputasi
above
elbow
23
Micro
kuretase
DUB
50
Trabekuletomi
&
Ollogen
Lysis
of
adhesions
of
muscle,
tendon,
fascia,
172
23
5
Eksisi
Diagnosis
urachus
DSA
28
288
108
49
prosthesis,
Percutaneous
not
otherwise
vertebroplasty
specified
34
Operasi
Soft
Tissue
Tumor
(70.79)
Drainase
Periureter
11
Denervasi
Facet
79
Tonsilektomi/Adenoidektomi
23
Fraktur
Maksila
dengan
Suspensi
Wiring
5121
Tamponade
Jantung
41
Mesencephalectomy
(Pain)
sites-local
anaesthesia
321
Removal
of
implanted
devices
from
boneFNAB
-unspecified
69
Trepanasi
Cedera
Kepala
(>4jam)
22
38
Fr.
Condylus
mandibula
open
red
soft
tissue
ofper
hand
Hand
Other
NOS
anastomosis
-Plate
&oxidized
Screw
of
cranial
or
peripheral
nerve
66
Apendektomi
laparoskopik
41
Imunoterapi
Tindakan
Radiologi
yang
memerlukan
Nefrektomi
Laparoskopi
Insertion
of
partial
spinal
disc
prosthesis,
bearing
surface,
zirconium-on-polyethylene
969
Ekstremitas
Bawah
96
Excision
of
lesion
of
tendon
sheath
Amputation
through
humerus,
Upper
arm
121
Wound
Repair
389
76
Palatoplasti
Triad
knee
bilateral
repair
komplit
6Pneumonectomy
Reseksi
anterior
tanpa
penyulit
Claw
Lens
Repair
Fistel
Vesikovagina
53
Tutup
burst
abdomen
Sub
Total
Thyroidectomy
bursa
Trabulektomi
&
Goniotomi
pada
Pediatric
29
6
Lumbal
Punksi
289
145
109
KSM 351
Revision
or
replacement
of
artificial
spinal
disc
11
Eksisi
Peripheral
Ekstostosis
nerve
injection,
not
otherwise
specified
35
Amputasi
+
Diseksi
KGB
67
50
Eksisi
Chordae/Chordektomi
20
site
(Phalanges
(of
foot)
(oftanpa
hand))
-fixation-carpals
Plate
& Screw
47
Biopsy
of
spinal
cord
or
spinal
meninges
Pemasangan
IABP
23
Open
reduction
ofpre
fracture
with
internal
39
Fr.
Maksila
suspensi
(IOID)
23
Ekskokleasi
kista
folikuler
222
8
Pemasangan
Amplatzer/ADO/Coilling
53
5
Amputasi
Potong
kolostomi
bellow
elbow
(46.14)
Bilio-difgestif
anastomosis
penyulit
24
Mikrokuret
Guiding
MSCT
pada
pasien
kelainan
yang
24
Ekstirpasi
fistel
aurikulae
Embolektomi/Trombektomi
Pembuluh
Darah
Ekstremitas
lumbosacral
67
51
10
amputation
Fraktur
Nasal
close
Reduksi
12
DREZ
Lession
(Pain)
80
Tracheostomi
Other
local
excision
or
destruction
of
lesion
of joint
42
Mikrodisekktomi
HNP
Nefrektomi
Radial
70
Trepanasi
CVA
Bleeding
7Pneumonectomy
77
Palatoplasti
bilateral
tak
komplit
Reseksi
esofagus-colon
/with
ileum
transposisi
122
Hip
bearing
surface,
dengan
metal-on-metal
VATS
Other
Cryopexy
and
unspecified
Kornea
repair
ofdengan
the
anulus
fibrosus
Repair
Fistel
Vesikovagina
Kompleks
251
42
Konka
Reduksi
Excision
of
lesion
of
tendon
sheath
of hand,
Glaucoma
173
30
69
Closed
reduction
of
dislocation
of
shoulder
7
Pain
Intervention
6110
290
5
prosthesis,
thoracic
Plastic
operation
on
hand
graft
of
muscle
or
fascia
390
Triple
arthrodesis
36
Amputasi
Jari
+
Flap
/
Skin
Graft
Eksisi
Fibroma/Rekonstruksi
Penis
68
and
metacarpals
plate
&
screws
322
51
Removal
of
implanted
devices
from
bone
200
24
Pemasangan
Pace
Maker
Permanen
(diluar
alat)
40
Fr.
Nasal
open
reduction
berdekatan
dengan
organ
vital
Biliodigestif
dengan
mayor
70
Atas
Superficial
(diluar
alat)
Parotidectomy
Lysis
of
adhesions
ofpenyulit
spinal
cord
and(wrist)-General
nerve roots
Insertion
of
recombinant
bone
morphogenetic
11
Neurologi
12
Kista
Branchial
68
Nefropeksi/Renopeksi
48
Bone
graft
8Pulmonary
78
Palatoplasti
unilateral
komplit
24
Ekskokleasi
Reseksi
esofagus-end
kista
radikuler
toDisease)
end
6
Amputasi
digital
Decortication
Cyclo
Cryo
223
Reparasi
Penis
9
CVC
54
Potong
Stump
(84.3)
97
Ganglionectomy
of
tendon
sheath
21
25
Amputation,
Miomectomy
not
otherwise
specified
Tube
Shunt
(Express)
31
Ekstirpasiranula
8Ekstirpasi
Injeksi
Triger
point
146
291
111
Plastic
operation
on
hand
with
other
graft
orEkstremitas
implant
352
Rotator
Other
muscle
cuff
repair
transposition
52
Hand
NOS
-Plate
&
Screw
25
Fraktur
Nasal
Open
Reduksi
37
Amputasi
Tungkai
/
Lengan
13
Eksisi
Eksisi
Ensefalokel/Mielokel
Plaque
(Peyronie
81
Turbinektomi
-unspecified
site
(Phalanges
(of
foot)
hand))
69
43
MVD
(Microvascular
Decompression)
52
25
71
Trepanasi
kelainan
Saraf
Kranial
Pericardiocentesis
252
Embolektomi/Trombektomi
Fraktur
Prosesus
alveolaris
Pembuluh
dengan
Darah
inter
dental
123
Hip
bearing
surface,
metal-on-polyethylene
Other
arthrotomy
391
Unspecified
operation
on
bone
injury
Biliodigestif
dengan
penyulit
minor
43
Kaustik
Konka
Inferior
174
protein
Tindakan
RadiologiFlap
pada
Ibu
hamil(of
yang
12
69
Nefrostomi
Perkutan/Temporer
9
79
Palatoplasti
unilateral
tak
komplit
Reseksi
esofagus-esofago-gastrectomy
7
Pulmonary
Decortication
dengan
VATS
Dacryocystorinostomi
(Without
Silicon
Tube)
Reseksi-anastomosis
Uretra
anaesthesia
41
71
Thoraco
Abdominal
(TA
Flap)
Viscocanulostomy
Metacarpocarpal
fusion
32
Open
reduction
of
fracture
with
internal
fixation-carpals
Bone
Pollicization
marrow
operation
or
hematopoietic
carrying
over
stem
nerves
cell
transplant
and
blood
9
Injeksi
Triger
Fringer
112
292
353
Separation
ofArch
equal
conjoined
twins
Ekstirpasi/eksisi
tumor
jinak
jaringan
lunak
ukuran
13
53
Ekstirpasi
Kista
Ductus
Tiroglosus
38
Biopsi
Core
soft
Tissue
-simple
implants
(K-wire)
Eksisi
Webbed
Penis
70
70
Bawah(diluar
Closed
reduction
alat)
of(Intermaksila
dislocation
ofFiksasi)
wrist
26
53
Perikardiektomi
7
Amputasi
jari
>1
wiring
(IDW)
(per
rahang)
Fraktur
Rahang
Reduksi
Tertutup
dengan
55
224
10
Pelepasan
Bar
Prosedur
Heller
(44.6)
Biopsi
Other
myectomy
insisional,
local
anastesi
22
26
Ankle
Neovagina
fusion
Insertion
of
spinal
disc
prosthesis,
not
otherwise
26
Endoskopik
diagnostik
49
memerlukan
foto
25
13
Implantation
of
internal
limb
lengthening
device
with
14
Eksisi
Kista
Jinak
Kulit
Kepala
82
Tiroidektomi
Total+ND
253
44
Neurektomi/Neurolise
392
70
Nefrostomi
Upper
arm
Terbuka/Permanen
reattachment
72
Trepanasi
Kelainan
Vascular
Otak
10
80
Palatoraphy
Reseksi
hati
26
Pulmonary
Other
Excision
bunionectomy
Lobectomy/Bilobectomy
of
lesion
of
tendon
sheath
of
hand,
Dekompresi
Orbital/Lateral
Orbitotomi
RPG
and
metacarpals
- (Microsurgery)
simple
implants
(K-wire)
44
Laringektomi
Vitrektomi
+++
201
supply
33
175
(all
procedures
included
in this
class
147
113
10
Injeksi
CTS
<2cm
354
124
Separation
unequal
conjoined
twins
323
Removal
of
implanted
devices
from
bone
-patella
Embolektomi/Trombektomi
Pembuluh
Darah
Regio
servikal
39
Biopsi
Insisi
Tumor
Sof
Tissue
dengan
Narcose
54
Eksplorasi
testis
71
27
Fraktur
Prosesus
alveolaris
luas
dengan
IDW
(per
54
Intermaksila
Fiksasi
Perikardiotomi/Pericardial
Window
72
Total
Parotidectomy
Biopsi
rectum
specified,
Replacement
of
disc,
NOS
Metacarpophalangeal
fusion
1Ekstraksi
Cerebral
Angiografi
14
kinetic
distraction
14
granulasi
MAE/Kolesteatosis
8Endoscopy
71
Nefroureterektomi
393
Upper
limb
amputation,
notspinal
otherwise
specified
11
Hand
NOS
-implant
sederhana
(K-wire)
8
Amputasi
jari
single
81
Pasang
archbar
56
Other
Ganglionectomy
myectomy
ofIOL
of
hand
tendon
sheath
(wrist)-Local
Pulmonary
Lobectomy/Bilobectomy
dengan
VATS
98
225
Disisi
Aspirasi
&
Sectio
Alta/Vesikolithotomi
Prosedur
Kasai
(51.37)
42
27
Operasi
Ca
vagina
23
Application
Quadricepsplasty
of
external
fixator
device
34
Bunionectomy
with
soft
tissue
correction
and
27
Endoskopik
terapeutik
114
11
Sub
Optical
Functional
(Karotis,
Jugular)
(diluar
alat)
254
KSM PENYAKIT355
Sequestrectomy
324
Removal
of
implanted
devices
from
bonetarsals and
71
Closed
reduction
of
dislocation-Local
anaesthesia
40
Biopsi
Insisi
Tumor
Soft
Tissue
Lokal
Anestesi
15
293
Eksisi
Osteoma/Osteositosis
83
Temporal
Ekstraksi
Bone
Batu
Resection
45
Neuroendoskopi
(Otak,Spinal)
55
Vitrektomi
Lengkap
&
Skleral
Buckle
28
Second
look
laparoscopy
73
72
Trepanasi
Tumor
Otak
rahang)
26
Ekstirpasi
kista
dermoid
Other
bunionectomy
with
soft
tissue
correction
55
Pulmonal
Valve
Repair
(PVR)
45
Laringektomi+ND
Eksisi
hemoroid
eksterna
176
50
2
AVM&Embolisasi
17
27
Frenektomi
Per
Rahang
KSM 35
Implantation
of
other
internal
limb
lengthening
15
Open
reduction
of
fracture
with
internal
fixation-femur72
Neobladder
394
Wedge
osteotomy
148
Insertion
of
spinal
disc
prosthesis,
thoracic
12
Anaestesi
82
Pasang
back
slab/fore
slab
Redo
Torakotomi
ECCE
Sirkumsisi
73
Total
Thyyroidectomy
Evakuasi
Hematom
di
Ekstremitas
(Pasca
Pungsi
HD/
Reattachment
of
muscle
arthrodesis
Metatarsophalangeal
fusion
DALAM
115
12
Injeksi
botox
125
356
Spinal
fusion,
not
otherwise
specified
metatarsalssimple
implants
(K-wire)
15
Ekstraksi
Polip
41
Eksisi
Tumor
>Kelopak
3cm
294
Ekstrofi
Buli
Rekonstruksi
Application
Other
neuroplasty
of
external
device,
monoplanar
202
29
56
9283Elevasi
Augmentasi
mamae
28
Fraktur
rahang
reduksi
terbuka
& inter
oseus
wiring
57
Pulmonal
Valve
Repair
(PVR)
dengan
Bioprosthesis
Other
cervical
fusion
offixator
the
anterior
column,
anterior
226
Repair
atresia
esofagus
(42.5)
Wide
Eksisi
Tumor
Mata
56
Splenektomi
/Jinak
splenoraphy
traumatika
255
Operasi
kanker
corpus
uteri
Eksplorasi
duktus
bilier
&
cholangiografi
intra
operatif
973
Gastrostomi
Aneurisma
Coiling
device
16
27
Endoscopic
thyroidectomy
Closed
reduction
of
fracture
with
internal
fixation
Comminutive
or
Segmental
16
Kraniotomi
Fraktur
Impresi,Dengan
Robekan
84
Terapi
Wicara
pada
Anak-Anak
dan
dewasa
24
46
Neuroplasti
Operasi
Priapismus
(prosedur
Winter)
13
74
VA
Shunt
83
Pasang
cast/gips
tanpa
reposisi
Rekonstruksi
Traumatik)
Sternum&Dinding
Dada
43
ECCE
&
IOL
Sistektomi
Parsial/Sistoplasti
Reduksi
46
Laringo
Fisur/Eksplorasi
Laring
Bunionectomy
Reattachment
of
with
muscle
soft
of
tissue
hand
correction
and
36
177
115
28
Genioplasty
2
Neurologi
13
EMG
357
Subtalar
fusion
99
Excision
of
muscle
or
fascia
for
graft
325
Removal
implanted
devices
from
bonetibia
and
72
295
42
Eksisi
Tumor
Jinak
<3cm
system
Epispadia
(IOW)
Valve
30
149
Insertion
of
sternal
fixation
device
with
rigid
plates
technique
57
74
Transversus-Rectus
Abdominis
Flap
(Tram
Flap)
57
Esofagotomi
Midtarsal
fusion
51
4
Open
Embolisasi
reduction
pre
of
fracture
operasi
with
internal
fixation-femurImplantation
Wide
Eksisi
or
Tumor
replacement
Kelopak
of
Mata
peripheral
+
Flap
+
graft
17
Splenektomi
non
trauma
Other
operations
on
tendon, fascia,
and bursa
Fiksasi
interna
fraktur
maksilofasial
1-2 tempat
16
Esofagoskopi
Rigid
&muscle,
Fleksibel
10
Blefaroplasty
(2
kelopak
mata)
Carpal
and
metacarpal
74
29
Operasi
Repair
Buli
Trauma
14
58
Fasciotomy
256
repair
deformitas
Pectus
84
Recheiloraphy
Sistektomi
Per
Laparoskopi
Repair
Eksenterasi
defek
diafragma
(53.8)
10
osteotomy
of+
the
first
metatarsal
29
Operasi
tumor
ganas
ovarium
Reattachment
of
tendon
37
116
Hemikolektomi
fibula
126
203
28
17
Dura
85
Terapi
Wicara
Tuna
Laring
296
43
Wide
Evakuasi
Eksisi
Bekuan
Compartement
Darah
(Clot)
Procedure
47
74
Omaya
drain
31
75
VP
Shunt
Multiple
Pulmonal
Valve
Repair
(PVR)
dengan
Mechanical
Valve
Other
cervical
fusion
of
the
posterior
column,
227
Simple
fracture
6
47
Phlebotomi
Ligasi
A.
Karotis
Eksternal
25
Application
of
external
fixator
device,
ring
system
Fistulotomi
29
Gingivektomi
Per
Rahang
178
neurostimulator
lead
(s)
5
Diagnosis
DSA
patahan
358
Subtalar
joint
arthroereisis
18
58
KSM Patologi
100
Excision
of
muscle
or
fascia
of
hand
for
graft
Terminal
esofagus
proksimal
gastrektomi
(TEPG)
15 Ligasi
75
Operasi
Sistokel
150
Insertion
of
total
spinal
disc
prosthesis,
cervical
Vaskular
Ekstremitas
85
Rekonstruksi
Sistektomi
Total/Radikal
dengan
alloplastic
material
Eksisi
Hordeolum
/
Chalazion
11
Other
operations
on
muscle,
tendon,
fascia,
and
bursa,
Reattachment
of
tendon
of
hand
transfer
or
transplantation
117
Extended
Pyelolithotomy
297
11
Blefaroplasty
pada
kasus
sulit
257
44
Wide
Eksisi
+
Diseksi
KGB
52
32
Bursectomy
75 Muscle
posterior technique
Pulmonary
Artery Banding (PA)

4
3
2
1
9
8
7
6
5
4
3
2
1
0