9N

DIAGNOSA
O
1. Bronchopneumonia, unspecified

KODE
ICD
J.18./J.1
3
J44.9

KLS I

KLS II

KLS III

4.922.600,00

4.219.400,00

3.397.900,00

2.912.200,00

2.909.000,00

2.493.500,00

4. Acute cystitis/ ISK

N20.0/N
23
N30.0

2.196.400,00

1.882.600,00

5. Typhoid fever

A01.0

3.930.600,00

3.368.700,00

6. Dispepsia

K30

3.937.800,00

3.375.000,00

7. Dengue haemorrhagic fever

A91

2.752.600,00

2.359.400,00

8. Fever, unspecified

R50.9

2.205.500,00

1.890.400,00

9. Viral infection, unspecified

B34.9

2.752.600,00

2.359.400,00

Headache
10.
11.Secondary hypertension,

R51

2.202.700,00

1.888.000,00

6.113.700,00

5.240.300,00

3.516.500,0
0
2.426.800,0
0
2.078.100,0
0
1.568.900,0
0
2.807.300,0
0
2.812.700,0
0
1.966.100,0
0
1.575.500,0
0
1.966.100,0
0
1.573.500,0
0
4.367.400,0
0

2. Chronic obstructive pulmonary

disease
3. Calculus of kidney/ Colic renal

unspecified I15.9
Non-insulin-dependent diabetes
mellitus with renal
+

complications E11
or (Noninsulin-dependent diabetes mellitus

dr. MIRNAWATI

KET.

with multiple complications E11.7

Secondary hypertension,

4.509.800,00

3.865.900,0
0

3.221.300,0
0

4.509.800,0
0

3.865.900,00

3.221.300,0
0

13.
Hypertensive heart disease with

5.402.400,00

4.630.400,00

14.(congestive) heart failure I11.0

Hypertension secondary to

4.501.900,0
0

4.509.800,00

3.865.900,00

15.endocrine disorders I15.2

Essential (primary)

3.221.300,0
0

4.509.800,00

3.865.900,00

3.221.300,0
0

6.113.700,00

5.240.300,00

4.367.400,0
0

4.509.800,00

3.865.900,0
0

3.221.300,0
0

2.752.500,00

2.359.300,00

1.965.900,0

unspecified I15.9
+ Non-insulin-dependent diabetes
mellitus without
12.complications E11.9
Hypertensive heart disease without
(congestive) heart failure I11.9

16.hypertension I10
Essential (primary)
hypertension I10 Transient cerebral
ischaemic attack,
17.unspecified G45.9
Essential (primary)
hypertension I10
+ Non-insulindependent diabetes mellitus
18.without complications E11.9
19.Non-insulin-dependent diabetes

dr. MIRNAWATI

mellitus without/ with

complications E11.9 + Essential
(primary) hypertension I10 or
secondary
Non-insulin-dependent diabetes

2.752.500,00

2.359.300,00

1.965.900,0
0

5.908.600,00

5.064.000,00

4.220.400,0
0

4.922.600,0
0

4.219.400,00

3.516.500,0
0

5.908.600,0
0

5.064.000,00

4.220.400,0
0

5.908.600,0
0

5.064.000,00

4.220.400,0
0

9.380.300,00

8.040.200,0
0

6.699.500,0
0

mellitus with coma E11.0 OR WITH

20.KETOASIDOSIS
Tuberculosis of lung, confirmed by
sputum microscopy with or without
21.culture A15.0
Bronchopneumonia,
unspecified J18.0
+ Tuberculosis of lung, confirmed
by sputum microscopy with or
22.without culture A15.0
Tuberculosis of lung, confirmed by
sputum microscopy with or without
23.culture A15.0
Tuberculosis of lung, confirmed by
sputum microscopy with or without
culture A15.0
+ Bronchopneumonia,
24.unspecified J18.0
25.Primary respiratory tuberculosis,
confirmed bacteriologically and

dr. MIRNAWATI

histologically A15.7 +
Bronchopneumonia,
unspecified J18.0
Primary respiratory tuberculosis,
confirmed bacteriologically and
26.histologically A15.7
Insulin-dependent diabetes mellitus
with peripheral circulatory
complications E10.5 OR
Non-insulin-dependent diabetes
mellitus with peripheral circulatory
27.complications E11.5
Non-insulin-dependent diabetes
mellitus with peripheral circulatory

5.908.600,00

5.064.000,0
0

4.220.400,0
0

4.397.800,00

3.769.500,00

3.141.300,
00

6.303.000,0
0

5.402.000,00

4.501.700,
00

5.950.700,00

5.100.600,00

4.250.100,0
0

4.394.300,00

3.766.500,00

3.138.500,0
0

complications E11.5
Gangrene, not elsewhere
28.classified R02
Malignant neoplasm of liver,
unspecified C22.9 Chronic
obstructive pulmonary disease,
unspecified J44.9 Hypertensive
heart disease without (congestive)
29.heart failure I11.9
30.Non-insulin-dependent diabetes
mellitus with renal

dr. MIRNAWATI

complications E11.2
Urinary tract infection, site not
specified N39.0
Essential (primary)
hypertension I10

6.113.700,00

5.240.300,0
0

4.367.400,0
0

3.970.000,00

3.402.800,00

2.835.400,0
0

5.950.700,00

5.100.600,00

4.250.100,0
0

33.disease, unspecified J44.9

Fetus and newborn affected by
chorioamnionitis P02.7

6.125.300,0
0

5.250.800,00

4.375.200,0
0

Single spontaneous delivery,

34.unspecified O80.9
Thyrotoxicosis with diffuse

2.962.100,00

2.539.200,00

2.116.000,0
0

8.935.000,00

7.658.600,00

6.382.200,0

Chronic obstructive pulmonary

disease, unspecified J44.9
OR -- Urinary tract infection, site
31.not specified N39.0
Liver cell carcinoma C22.0
OR PLUS Essential (primary)
hypertension I10
32.OR HHD
Liver cell carcinoma C22.0
Chronic obstructive pulmonary

goitre E05.0
35.OR WITH HT
36.Senile cataract, unspecified H25.9

dr. MIRNAWATI

0
4.069.700,0
0

Maternal care for disproportion,

5.698.100,00

4.883.600,00

37.unspecified O33.9
Delivery by emergency caesarean

5.698.100,00

4.883.600,00

38.section O82.1
Delivery by emergency caesarean

4.069.700,0
0

6.287.900,00

5.389.600,00

4.491.300,0
0

39.membranes O75.6
Single spontaneous delivery,

2.852.700,00

2.445.200,00

40.unspecified O80.9
Pneumonia,

2.037.600,0
0

6.917.600,00

5.929.400,00

4.941.600,0
0

41.unspecified J44.9
Dyspepsia K30 Urinary tract

5.906.700,00

5.062.300,00

42.infection, site not specified N39.0

Mild and moderate birth

4.218.600,0
0

4.947.100,00

4.240.400,00

3.533.600,0
0

section O82.1 Delayed delivery

after spontaneous or unspecified
rupture of

unspecified J18.9 Chronic

obstructive pulmonary disease,

asphyxia P21.1 Fetus and newborn

affected by caesarean
43.delivery P03.4
44.Dizziness and giddiness R42
45.Hydrocele, unspecified N43.3

dr. MIRNAWATI

1.880.600,00
5.425.500,00

4.650.000,00

3.875.400,00

Non-insulin-dependent diabetes
mellitus with peripheral circulatory

4.397.800,00

3.769.500,00

3.141.300,00

10.312.900,00

8.839.600,00

7.365.600,00

2.860.800,00

2.452.000,00

2.383.700,00

3.871.200,00

3.317.900,00

2.765.200,00

46.complications E11.5
OPERASI Non-insulin-dependent
diabetes mellitus with peripheral

47.circulatory complications E11.5

Diarrhoea and gastroenteritis of

48.presumed infectious origin A09

Blighted ovum and nonhydatidiform

curettage 69.09

49.mole O02.0

368.100( RAWT JALAN)

Acute myocardial infarction,

50.unspecified I21.9
Delivery by emergency caesarean

6.287.900,00

5.389.600,00

4.491.300,00

3.397.900,00

2.912.200,00

2.426.800,00

8.935.000,00

7.658.600,00

6.382.200,00

2.939.800,00

2.520.100,00

2.099.900,00

section O82.1 Delayed delivery after

spontaneous or unspecified rupture of
membranes O75.6 Maternal care due
to uterine scar from previous

51.surgery O34.2
Chronic obstructive pulmonary

52.disease, unspecified J44.9

Ocular laceration and rupture with
prolapse or loss of intraocular

53.tissue S05.2/H21.8
Other specified arthritis, unspecified

54.site M13.89

dr. MIRNAWATI

Other dilation and

Zoster with other complications B02.8

3.296.100,00

Scabies B86 Unspecified

adverse effect of drug or
medicament T88.7

55.
Diarrhoea and gastroenteritis of
presumed infectious

56.origin A09 Dyspepsia K30

dr. MIRNAWATI

2.860.800,00

2.452.000,00

2.383.700,00