PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA

PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Lampiran : Surat Keputusan Pengurus Pusat Perhati-KL

Nomor : No. 008/SKEP/PP.PERHATI-KL/V/2017
Tanggal : 16 Mei 2017

Tentang

Kode ICD-9 CM dan ICD-10 di Bidang T.H.T.K.L.

KODE ICD-9 CM

1. Tindakan di Poli THT

NO TIPE TINDAKAN KODE ICD 9 CM

1. TINDAKAN MEDIK NON OPERATIF RAWAT JALAN
MIKROSKOPI TELINGA LUAR 18.19
MIKROSKOPI TELINGA TENGAH 20.39
ENDOSKOPI TELINGA 18.19
PASANG TAMPON ANTERIOR HIDUNG 21.01
PASANG TAMPON POSTERIOR HIDUNG 21.02
KAUSTIK HIDUNG EPISTAKSIS 21.03
TES FUNGSI PENGHIDU 21.29
IRIGASI SINUS 22.00
IRIGASI SINUS DARI OSTIUM ALAMIAH 22.02
NASOENDOSKOPI 22.19
NASOENDOSKOPI FLEKSIBEL 22.19
NASOFARINGOSKOPI RIGID/ FLEKSIBEL 22.19
FLEXIBLE ENDOSCOPIC EVALUATION of
29.19
SWALLOWING (FEES)
KAUSTIK FARING 29.39
TRAKEOSKOPI DENGAN BSO MELALUI
31.41
STOMA TRAKEOSTOMI
RINOLARINGOSKOPI FLEKSIBEL/
31.42
TELELARINGOSKOPI RIGID
PENUTUPAN STOMA TRAKEOSTOMI 31.72
SKIN PRICK TEST 86.19
TES FUNGSI N. VII 89.15
CANALITH REPOSITIONAL THERAPY
93.89
(CRT)
VESTIBULAR REHABILITATION THERAPY 93.89
TES PENALA/ GARPU TALA 95.42
TES BERBISIK 95.42
TES VESTIBULAR KLINIS/TES KALORI 95.44
TES DIX HALPIKE DENGAN FRENZEL 95.46
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

PASANG NGT 96.07

PASANG NGT DENGAN ENDOSKOPI 96.07
PASANG TAMPON TELINGA 96.11
EKSTRAKSI / IRIGASI SERUMEN 96.52
IRIGASI HIDUNG 96.53
CUCI KANUL TRAKEOSTOMI PADA
96.55
MUCOUS PLUG
CUCI LUKA (OPERASI HIDUNG / TELINGA) 96.59
GANTI NGT 97.01
ANGKAT NGT 97.01
GANTI VERBAN / DRAIN 97.16
GANTI TAMPON HIDUNG 97.21
ANGKAT TAMPON HIDUNG ANTERIOR 97.32
ANGKAT TAMPON HIDUNG POSTERIOR 97.32
ANGKAT KANUL TRAKEOSTOMI 97.37
ANGKAT JAHITAN OPERASI 97.38
EKSTRAKSI BENDA ASING MULUT 98.01
EKSTRAKSI BENDA ASING TELINGA 98.11
EKSTRAKSI BENDA ASING HIDUNG 98.12
EKSTRAKSI BENDA ASING TONSIL-FARING 98.13
EKSTRAKSI BENDA ASING FARING
98.13
DENGAN ENDOSKOPI
IMMUNOTHERAPY 99.12
KEMOTERAPI 99.25
TERAPI TARGET 99.25
2. TINDAKAN MEDIK OPERATIF RAWAT JALAN
TINDIK TELINGA 18.01
INSISI PSEUDOKISTA / HEMATOMA
18.09
AURIKULA
INSISI PSEUDOKISTA / HEMATOMA
18.09
AURIKULA DENGAN PASANG GIPS
BIOPSI TELINGA LUAR 18.12
INSISI ABSES PREAURIKULAR 18.21
EKSTRAKSI GRANULASI TELINGA 18.29
EKSTRAKSI KOLESTEATOMA EKSTERNA 18.29
JAHIT LUKA TELINGA LUAR 18.4
MIRINGOPLASTI LEMAK / PATCH
19.4
MIRINGOPLASTY
PEMASANGAN PIPA VENTILASI
20.01
(GROMMET)
MIRINGOTOMI / ASPIRASI TELINGA
20.09
TENGAH
PELEPASAN PIPA VENTILASI (GROMMET) 20.1
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

INSISI ABSES RETROAURIKULAR 20.21

BIOPSI TELINGA TENGAH & DALAM 20.32
INJEKSI INTRA TIMPANI 20.94
INSISI HIDUNG, INSISI SEPTUM HIDUNG 21.1
BIOPSI HIDUNG 21.22
EKSTRAKSI MASSA / POLIP INTRANASAL 21.31
EKSISI LESI HIDUNG LAINNYA (SINEKIA,
21.32
PELEBARAN OSTIUM)
REDUKSI TERTUTUP FRAKTUR OS NASAL 21.71
JAHIT LUKA HIDUNG 21.81
ANTROSTOMI 22.01
BIOPSI SINUS 22.11
BIOPSI LIDAH 25.02
INSISI ABSES WAJAH, SUBMANDIBULA,
27.0
ANGINA LUDOVICI
BIOPSI ORAL CAVITY 27.24
REVISI SINEKIA HIDUNG 21.91
JAHIT LASERASI BIBIR 27.51
JAHIT LASERASI MULUT 27.52
HECTING LASERASI PALATUM 27.61
INSISI UVULA 27.71
EKSISI UVULA 27.72
INSISI ABSES PERITONSIL 28.0
BIOPSI TONSIL & ADENOID 28.11
BIOPSI FARING (NASOFARING /
29.12
OROFARING / HIPOFARING)
KRIKOTIROTOMI 31.3
BIOPSI LARING PER ENDOSKOPIK 31.43
BIOPSI KELENJAR LIMFE 40.29
GANTI KANUL TRAKEOSTOMI 97.23
GANTI VOICE PROSTHESES 97.29
3. TINDAKAN DIAGNOSTIK ELEKTROMEDIK
ELECTROCOCHLEOGRAPHY (ECoG) 20.31
RHINOMANOMETRY 89.12
ELECTRONYSTAGMOGRAPHY 95.24
AUDIOMETRI NADA MURNI 95.41
AUDIOMETRI TES GLISEROL 95.41
TIMPANOMETRI 95.41
REFLEKS STAPEDIUS IPSILATERAL/
95.41
KONTRALATERAL
EUSTACHIAN TUBE FUNCTION TEST 95.41
SISI 95.41
ABLB 95.41
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

TONE DECAY 95.41

REFLEKS DECAY 95.41
AUDIOMETRI TUTUR (SPEECH
95.41
AUDIOMETRI)
AUDIOMETRI TUTUR DALAM BISING 95.41
OTO-ACOUSTIC EMISSION (OAE) 95.46
BEHAVIORAL OBSERVATION
95.46
AUDIOMETRY (BOA)
VISUAL REINFORCEMENT AUDIOMETRY
95.46
(VRA)
CONDITIONED ORIENTATION REFLEX
95.46
(COR)
CONDITIONED PLAY AUDIOMETRY (CPA) 95.46
BERA 95.46
ASSR 95.46
eABR 95.46
AIDED AUDIOMETRI 95.46
AIDED ASSR 95.46
AUDITORY CORTICAL TESTING (ACR) 95.46
P300 95.46
NRT 95.46
VHIT 95.46
VEMP 95.46
FITTING ALAT BANTU DENGAR 95.48
MAPPING KOKLEAR IMPLAN 95.49

2. Tindakan Bedah THT Otologi

NO TIPE TINDAKAN KODE ICD 9 CM

1. TELINGA
Eksisi neuroma akustik 04.01
Dekompresi saraf fasialis 04.42
Graft saraf kranial/perifer 04.5
Transposisi saraf kranial/perifer 04.6
Anastomosis saraf hipoglosus-fasialis 04.71
Anastomosis saraf asesorius-fasialis 04.72
Anastomosis asesorius-hipoglosus 04.73
Revisi operasi saraf kranial/perifer 04.75
Eksplorasi dan reparasi trauma saraf
04.76
kranial/perifer
Tindik telinga Dalam Narkose Umum 18.01
Insisi drenase liang telinga 18.02
Insisi pseudokista/hematoma aurikula 18.09
PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Biopsi liang telinga 18.12

Eksisi fistel/abses preaurikular 18.21
Eksisi lesi liang telinga 18.29
Eksisi luas liang telinga 18.31
Hecting laserasi telinga luar 18.4
Kanaloplasti/Meatoplasty 18.6
Ossiculoplasty 19.0
Stapedektomi 19.1
Stapedektomi revisi 19.21
Ossiculoplasy tahap II 19.3
Timpanoplasti tipe I/Miringoplasti 19.4
Timpanoplasti tipe II 19.52
Timpanoplasti tipe III 19.53
Timpanoplasti tipe IV 19.54
Timpanoplasti tipe V 19.55
Timpanoplasti revisi 19.6
Obliterasi mastoid/penutupan fistel
19.9
mastoid
Pemasangan grommet 20.01
Miringotomi 20.09
Pelepasan grommet 20.1
Insisi drenase abses
20.21
retroaurikular/mastoid
Atikotomi 20.23
Biopsi telinga tengah dan dalam 20.32
Mastoidektomi sederhana 20.41
Mastoidektomi radikal 20.42
Atticoantrostomi/Mastoidektomi
20.49
modifikasi
Eksisi lesi telinga tengah 20.51
Petrosectomy 20.59
Fenestrasi telinga dalam 20.61
Revisi fenestrasi telinga dalam 20.62
Shunt endolimfatik 20.71
Injeksi telinga dalam 20.72
Labirinectomy 20.79
Operasi tuba eustachius 20.8
Mastoidektomi revisi 20.92
Reparasi oval/round window 20.93
Pemasangan Bone Anchored Hearing Aid
20.95
(BAHA)
Implan koklea 20.96
Ekstraksi benda asing telinga 98.11
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

3. Tindakan Bedah THT Rinologi

NO TIPE TINDAKAN KODE ICD 9 CM

1. HIDUNG
Reparasi fistel kebocoran LCS 02.12
Reparasi kebocoran LCS dengan graft
02.12
abdomen
Dekompresi saraf optikus 04.42
Ganglionektomi sfenopalatina 05.21
Neurektomi posterior 05.25
Biopsi kelenjar hipofisis transsfenoid 07.14
Eksisi parsial kelenjar hipofisis
07.62
transsfenoid
Eksisi total kelenjar hipofisis transsfenoid 07.65
Dakriosistorinostomi (DCR) 09.81
Kontrol epistaksis dengan tampon anterior 21.01
Kontrol epistaksis dengan tampon
21.02
posterior dan anterior
Kontrol epistaksis dengan kauterisasi dan
21.03
tampon
Kontrol epistaksis dengan ligasi arteri
21.04
etmoid/sfenopalatina
Kontrol epistaksis dengan ligasi arteri
21.05
maksilaris transantral
Kontrol epistaksis dengan ligasi arteri
21.06
karotis eksterna
Kontrol epistaksis dengan eksisi mukosa
hidung dan graft kulit ke septum dan 21.07
dinding lateral hidung
Insisi abses hidung/septum 21.1
Insisi abses hidung/septum 21.1
Biopsi hidung 21.22
Eksisi lesi hidung 21.30
Polipektomi nasal 21.31
Reduksi konka dengan kauter/RDF 21.61
Konkotomi 21.62
Reduksi fraktur nasal tertutup 21.71
Hecting laserasi hidung 21.81
Penutupan fistel hidung 21.82
Revisi sinekia hidung 21.91
Irigasi sinus 22.00
DAWO/SAWO 22.01
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Irigasi sinus dari ostium alamiah 22.02

Biopsi sinonasal dengan endoskopi 22.11
Biopsi sinonasal terbuka 22.12
Antrotomi intranasal (FESS) 22.2
Sinusektomi sinus frontal (FESS) 22.42
Trepanasi sinus frontal 22.42
Caldwell Luc 22.61
Etmoidektomi (FESS) 22.63
Sfenoidektomi (FESS) 22.64
Penutupan fistel sinus 22.71
Sleep endoscopy 89.19
Dilatasi duktus frontonasal 96.21
Penggantian tampon hidung 97.21
Pengangkatan tampon hidung 97.32
Ekstraksi benda asing hidung 98.12

4. Tindakan Bedah THT Laring Faring, Endoskopi, Head and Neck Onkologi

NO TIPE TINDAKAN KODE ICD 9 CM

1. FARING
Insisi drenase abses wajah/ submandibula/
27.0
angina ludovici
Insisi palatum 27.1
Biopsi palatum durum 27.21
Biopsi uvula/ palatum mole 27.22
Eksisi lesi palatum durum 27.31
Eksisi luas lesi palatum durum 27.32
Hecting laserasi palatum 27.61
Implan palatum 27.64
Insisi uvula 27.71
Eksisi uvula 27.72
Insisi drenase abses
28.0
tonsil/peritonsil/parafaring/ retrofaring
Biopsi tonsil dan adenoid 28.11
Biopsi tonsil dan adenoid 28.11
Tonsilektomi 28.2
Tonsilektomi dengan adenoidektomi 28.3
Eksisi tonsil lingual 28.3
Eksisi tag tonsil 28.4
Eksisi tonsil lingual 28.5
Adenoidektomi 28.6
Kontrol perdarahan pasca tonsilektomi dan
28.7
adenoidektomi
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Ekstraksi benda asing tonsil/adenoid

28.91
dengan insisi
Eksisi lesi di tonsil dan adenoid 28.92
Faringotomi 29.0
Biopsi nasofaring/orofaring/hipofaring 29.12
Eksisi kista brakial 29.2
Miotomi krikofaring 29.31
Divertikulektomi faring 29.32
Faringektomi 29.33
Eksisi lesi di faring 29.39
Nasofaringektomi 29.39
Ekstirpasi angiofibroma nasofaring 29.39
Faringoplasti 29.4
Hecting laserasi faring 29.51
Penutupan fistel celah brakial 29.52
Penutupan fistel faring 29.53
Ekstraksi benda asing faring 98.13
2. LARING-TRAKEA-ESOFAGUS-HEAD NECK
Biopsi kelenjar tiroid 06.12
Biopsi kelenjar paratiroid 06.13
Lobectomy tiroid unilateral 06.2
Hemitiroidektomi 06.2
Eksisi lesi tiroid (kista tiroid) 06.31
Tiroidektomi parsial 06.39
Near total tiroidektomi 06.39
Tiroidektomi total 06.4
Eksisi tiroid lingual 06.6
Eksisi duktus tiroglosus 06.7
Paratiroidektomi total 06.81
Ligasi pembuluh darah tiroid 06.92
Hecting kelenjar tiroid 06.93
Rhinotomi lateral 21.30
Maksilektomi medial 22.31
Frontal sinusotomi (onkologi) 22.41
Etmoidektomi eksternal (onkologi) 22.51
Sfenoidektomi eksternal (onkologi) 22.52
Pendekatan sublabial 22.61
Midfasial degloving 22.62
Glosektomi parsial/ hemiglosektomi 25.2
Glosektomi total 25.3
Glosektomi radikal 25.4
Sialendoskopi Diagnostik 26.19
Sialolithektomi 26.29
PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Ekstirpasi kelenjar sublingual/

26.31
submandibula/ parotis parsial
Parotidektomi parsial 26.31
Parotidektomi superfisial 26.31
Ekstirpasi kelenjar sublingual/
26.32
submandibula/ parotis total
Parotidektomi total 26.32
Sialendoskopi Diagnostik dan Dilatasi 26.91
Sialendoskopi Diagnostik dan Terapeutik 26.99
Radiofrekuensi Dasar Lidah 27.99
Eksplorasi Abses Multiple 28.0
Marsupialisasi kista laring 30.01
Eksisi lesi laring (papiloma, nodul) 30.09
Hemilaringektomi 30.1
Epiglotiktomi 30.21
Kordektomi 30.22
Laringektomi parsial 30.29
Laringektomi total 30.3
Laringektomi radikal 30.4
Injeksi laring 31.0
Trakeostomi temporer 31.1
Trakeostomi dengan penyulit 31.1
Trakeostomi permanen 31.29
Trakeoskopi melalui stoma trakea 31.41
Trakeoskopi melalui stoma trakea 31.41
Laringoskopi/trakeoskopi 31.42
Laringoskopi/trakeoskopi 31.42
Biopsi laring dengan endoskopi 31.43
Biopsi trakea dengan endoskopi 31.44
Biopsi terbuka laring atau trakea 31.45
Eksisi lesi trakea 31.5
Laringofisure 31.6
Hecting laserasi laring 31.61
Hecting laserasi laring 31.61
Penutupan fistel laring 31.62
Revisi laringostomi/ repair stoma 31.63
Reparasi fraktur laring 31.64
Eksisi neoplasma laring dengan laser 31.69
Penutupan fistel trakea 31.72
Revisi trakeostomi 31.74
Rekonstruksi trakea dan konstruksi laring 31.75
Lisis penyempitan trakea/laring 31.92
Penggantian stent laring/trakea 31.93
PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Pemasangan T-Tube/ganti T stent 31.93

Injeksi obat terapetik ke trakea 31.94
Fistulasasi trakeoesofagus 31.95
Bronkoskopi melalui stoma 33.21
Bronkoskopi fiber optik 33.22
Bronkoskopi 33.23
Biopsi bronkus dengan endoskopi 33.24
Ligasi arteri karotis eksterna 38.82
Biopsi eksisi kelenjar limfe leher simpel 40.29
Biopsi insisi kelenjar limfe leher simpel 40.29
Eksisi kelenjar limfe regional 40.3
Diseksi leher selektif 40.3
Diseksi leher radikal unilateral 40.41
Diseksi leher radikal modifikasi 40.41
Diseksi leher radikal bilateral 40.42
Esofagotomi 1/3 proksimal 42.0
Insisi web esofagus 42.01
Esofagostomi 42.10
Esofagostomi servikal 42.11
Esofagoskopi 42.23
Biopsi esofagus per endoskopi 42.24
Biopsi esofagus per endoskopi 42.24
Biopsi esofagus per endoskopi 42.24
Eksisi divertikulum esofagus 42.31
Tindakan esofagus kompleks (eksisi,
42.33
varises)
Reseksi esofagus 42.40
Reparasi fistel esofagus 42.84
Reparasi striktur esofagus 42.85
Dilatasi esofagus 42.92
Dilatasi esofagus 42.92
Dilatasi esofagus 42.92
Mandibulektomi parsial 76.31
Maksilektomi parsial 76.39
Maksilektomi total 76.39
Maksilektomi radikal 76.39
Mandibulektomi total 76.41
Reduksi terbuka fraktur malar dan zigoma 76.72
Reduksi terbuka fraktur maksila 76.74
Reduksi terbuka fraktur mandibula 76.76
Eksisi kulit luas 86.4
Esofageal manometri 89.32
Intubasi dengan Flexible Bronkoskopi 96.04
 PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

Pembersihan kanul trakeostomi 96.55

Cuci trakea dan bronkus 96.56
Penggantian NGT 97.01
Penggantian kanul trakeostomi 97.23
Pengangkatan kanul trakeostomi 97.37
Ekstraksi benda asing esofagus 98.02
Ekstraksi benda asing laring 98.14
Ekstraksi benda asing trakea 98.15
Ekstraksi benda asing bronkus 98.15
3. BIBIR MULUT
Biopsi sinonasal app gingivobuccal 22.61
Biopsi Lidah 25.02
Hecting laserasi lidah 25.51
Frenektomi lingual 25.92
Insisi drenase kelenjar liur 26.0
Biopsi kelenjar liur 26.12
Marsupialisasi kista kelenjar liur 26.21
Hecting laserasi kelenjar liur 26.41
Probing saluran liur 26.91
Insisi drenase abses wajah, submandibula,
27.0
angina ludovici
Biopsi bibir 27.23
Biopsi mulut/ basis lidah 27.24
Biopsi eksisi rongga mulut 27.29
Frenektomi labial 27.41
Hecting laserasi bibir 27.51
Hecting laserasi mulut 27.52
Penutupan fistel mulut 27.53
Ekstraksi benda asing mulut 98.01

5. Tindakan Bedah THT Plastik Rekonstruksi

NO TIPE TINDAKAN KODE ICD 9 CM

Blefaroplasty 08.70
Rekonstruksi palpebra superior 08.89
Rekonstruksi palpebra inferior 08.89
Otoplasti pada makrotia 18.5
Aurikuloplasti mikrotia tahap 1 18.71
Aurikuloplasti mikrotia tahap 2 18.71
Aurikuloplasti mikrotia tahap 3 18.71
Aurikuloplasti rekonstruksi 18.71
Rekonstruksi daun telinga putus 18.72
Reseksi hidung 21.4
PERHIMPUNAN DOKTER SPESIALIS TELINGA HIDUNG TENGGOROK BEDAH KEPALA LEHER INDONESIA
PERHATI - KL
The Indonesian Otorhinolaryngological Head and Neck Surgery Society
INDO HNS
PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
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Submukosa reseksi septum (SMR) 21.5

Reduksi fraktur nasal terbuka 21.72
Fistulektomi
21.82
nasolabial/nasofaringeal/oronasal
Rekonstruksi ala nasi 21.83
ekstirpasi silikonoma 21.83
Ekstirpasi & rekonstruksi silikonoma 21.83
Rinoplasti rekonstruksi 21.83
Rinoplasti revisi 21.84
Rinoplasti augmentasi 21.85
Open septorhinoplasty 21.88
Septoplasti 21.88
Repair perforasi septum hidung 21.88
pemasangan Arch bar 24.7
Revisi Arch bar 24.7
Buka Arch bar 24.8
Labioplasti pada celah bibir 27.54
Full-thickness skin graft pada bibir dan
27.55
mulut
Lokal flap pada wajah 27.57
Attachment of pedicle or flap graft pada
27.57
bibir dan mulut
Palatoplasty 27.6
Palatoplasti pada celah palatum 27.62
Revisi palatoplasti pada celah palatum 27.63
Uvuloplasty 27.73
Faringoplasti 29.4
Osteotomi medialis 76.09
Osteotomi paramedial 76.09
Osteotomi percutaneus 76.09
Rekonstruksi fraktur ramus mandibula 76.62
Augmentasi mental 76.68
Reduksi terbuka fraktur malar dan zigoma 76.72
Rekonstruksi fraktur zygoma 76.72
Rekonstruksi malar 76.72
Reduksi terbuka fraktur maksila 76.74
Reposisi fraktur os maksila le Fort 1 76.74
Intermaksilari fixation 76.74
Reposisi fraktur os maksila le Fort 2 76.74
Reduksi terbuka fraktur mandibula 76.76
Rekonstruksi fraktur sympisis mandibula 76.76
Rekonstruksi fraktur condylus 76.76
Rekonstruksi tripod fraktur 76.79
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Rekonstruksi panfacial fraktur 76.79

Rekonstruksi fraktur palatum durum 76.79
Costal graft 76.91
Insersi implan sintetik di tulang wajah 76.92
STSG 86.60
conchal graft 86.60
FTSG 86.63
Ritidectomy 86.82
Pengangkatan alat fiksasi mandibula 97.36
Hecting luka kepala leher 97.38
Pengangkatan alat terapetik di kepala leher 97.39

KODE ICD-10

NO TELINGA KODE DIAGNOSIS ICD 10

1 SERUMEN PROP H612 Impacted cerumen
2 BENDA ASING TELINGA T16 Foreign body in ear
3 H600 Abscess of external ear
OE SIRKUMSKRIP
H601 Cellulitis of external ear
4 Diffuse otitis externa, Swimmer
OE DIFUSA H603
ear, Hemorragic
5 B372 Candidiasis
OTOMIKOSIS
B448 Aspergillosis
6 KOLESTEATOMA EKSTERNA H604 Cholesteatoma of external ear
7 OE MALIGNA H602 Malignant otitis externa
8 OTALGIA H920 Otalgia
9 Acquired stenosis of secondary
STENOSIS LIANG TELINGA H613
trauma, inflammation, infection
10 EKSOTOSIS LIANG TELINGA H618 Exostosis of external canal
11 PERIKONDRITIS H610 Pericondritis of external ear
12 PSEUDOKISTA/HEMATOMA H611 Noninfective disorders of pinna
13 H680 Eustachian salpingitis
OKLUSI TUBA Obstruction of Eustachius tube:
H681
compression, stenosis, stricture
14 TUBA PATOULUS H690 Patulous Eustachian tube
15 OMA H660 Acute suppurative otitis media
16 H650 Acute serous otitis media
OME AKUT Acute and subacute allergic otitis
H651
media (mucoid) (serous)
17 H652 Chronic serous otitis media
OME KRONIK Chronic mucoid otitis media
H653
(Glue Ear)
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H654 Chronic allergic otitis media

18 Chronic tubotympanic
OMSK BENIGNA AKTIF H661
suppurative otitis media
19 Central perforation of tympanic
OMSK BENIGNA TENANG H720
membrane
20 Chronic atticoantral suppurative
H662
otitis media
H71 Cholesteatoma of middle ear
Attic perforation of tympanic
H721
membrane
OMSK MALIGNA
Other marginal perforations of
H722
tympanic membrane
Total & multiple perforations of
H728
tympanic membrane
H744 Polyp of middle ear
21 BAROTRAUMA T700 Otitic Barotrauma
22 Tuberculosis of (inner) (middle)
OMSK TBC A186
ear
23 Disorder of facial nerve,
PARESIS FASIALIS H519
unspecified
24 Acute mastoiditis: abcess of
H700
ABSES/FISTEL mastoid
RETROAURIKULAR Chronic mastoiditis: Fistula of
H701
mastoid
25 H811 Benign paroxysmal vertigo
Labyrinthine dysfunction :
H832
paresis kanal
H810 Meniere's disease
GANGGUAN KESEIMBANGAN H812 Vestibular neuronitis
H813 Other peripheral vertigo
H814 Vertigo of central origin
H830 Labyrinthitis
H831 Labyrinthine fistula
26 Developmental disorder of
DELAYED SPEECH F809 speech and language,
unspecified
27 TINITUS H931 Tinnitus
28 Conductive hearing loss,
H900
bilateral
Conductive hearing loss,
GANGGUAN PENDENGARAN H901 unilateral, normal on
contralateral
Sensorineural hearing loss,
H903
bilateral
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Sensorineural hearing loss,

H904 unilateral normal on
contralateral
H906 Mixed hearing loss, bilateral
Mixed hearing loss, unilateral,
H907
normal on the contralateral
H911 Presbycusis
H912 Sudden idiopathic hearing loss
Noise effects on inner ear :
H833
acoustic trauma, NIHL
H910 Ototoxic hearing loss
29 MIRINGITIS AKUT H730 Acute myringitis
30 MIRINGITIS KRONIK H731 Chronic myringitis
31 OTITIS MEDIA ADHESIVE H741 Adhesive middle ear disease
32 TIMPANOSKLEROSIS H740 Tympanosclerosis
33 Otosclerosis involving oval
H800
window, nonobliterative
OTOSLEROSIS Otosclerosis involving oval
H801
window, obliterative
H802 Cochlear otosclerosis
34 Discontinuity and dislocation of
H742
GANGGUAN TULANG ear ossicles
PENDENGARAN Ankylosis and partial loss of ear
H743
ossicles
35 S004 Superficial injury of ear
S013 Open wound of ear
S021 Fracture of Base of Skull
TRAUMA TELINGA
S045 Injury of facial nerve
S046 Injury of acoustic nerve
S092 Traumatic rupture of ear drum
36 B001 Herpes simpleks infection
HERPES
B028 Zoster with other complications
37 Recurrent cholesteatoma of
H950
postmastoidectomy cavity
PASCA OPERASI MASTOID Chronic inflam, granulation,
H951 mucosal cyst of
postmastoidectomy
38 DEFORMITAS TELINGA M951 Cauliflower ear
39 Congenital absence of ear auricle
Q160
(anotia)
KELAINAN KONGENITAL
Congenital absence, atresia and
TELINGA Q161
stricture of auditory canal
Q162 Absence of eustachian tube
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Congenital malformation of ear

Q163
ossicles
Other congenital malformations
Q164
of middle ear
Congenital malformation of
Q165
inner ear
Congenital malformation of ear
Q169
causing impairment of hearing
Q170 Accessory auricle
Q171 Macrotia
Q172 Microtia
Q175 Prominent ear
Q181 Preauricular sinus and cyst
Other branchial cleft
Q182
malformations

NO HIDUNG KODE DIAGNOSIS ICD 10

1 J01 Acute sinusitis
J010 Acute maxillary sinusitis
J011 Acute frontal sinusitis
J012 Acute ethmoidal sinusitis
SINUSITIS AKUT Acute sphenoidal sinusitis,
J013
unspecified
J014 Acute pansinusitis, unspecified
Other acute sinusitis, more than
J018
one sinus, not pansinusitis
2 Chronic rhinitis : atropic,
J310
granulomatous
J320 Chronic maxillary sinusitis
J321 Chronic frontal sinusitis
J322 Chronic ethmoidal sinusitis
J323 Chronic sphenoidal sinusitis
J324 Chronic pansinusitis
Other chronic sinusitis, more
J328
RINOSINUSITIS KRONIK than one sinus, not pansinusitis
J329 Chronic sinusitis, unspecified
Polyp of nasal cavity: choanal,
J330
nasopharyngeal
Polypoid sinus degeneration:
J331
Woakes' Syndrome
Other polyp of sinus: polyp of
J338
ethmoidal, maxillary, spenoidal
J339 Nasal polyp, unspecified
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3 RINITIS VASOMOTOR J300 Vasomotor rhinitis

4 J304 Allergic rhinitis, unspecified
RINITIS ALERGI
J450 Allergic rhinits with asthma
5 SEPTUM DEVIASI J342 Deviated nasal septum
6 HIPERTROFI KONKA J343 Hypertrophy of nasal turbinates
7 RINOLITH/PERFORASI Perforation of nasal septum,
J348
SEPTUM rinolith
8 EPISTAKSIS R040 Epistaxis
9 Abscess, furuncle and carbuncle
ABSES/FURUNKEL J340
of nose
10 Cyst and mucocele of nose and
KISTA/ MUKOSIL SINUS J341 nasal sinus
11 DEFORMITAS HIDUNG M950 Acquired deformity of nose
12 S003 Superficial injury of nose
S012 Open wound of nose
S021 Fracture of Base of Skull
S022 Fracture of Nasal Bones
TRAUMA HIDUNG
Dislocation of Septal Cartilage of
S031
Nose
Injury of optic nerve and
S040
pathwayas
13 T170 Foreign Body in nasal sinus
BENDA ASING
T171 Foreign Body in nostril
14 Obstructive sleep apnea (adult)
OSAS G4733
(pediatric)
15 LCS LEAKAGE G960 Cerebrospinal fluid leak
16 SELULITIS ORBITA H050 Cellulitis of orbit
17 ATRESIA KOANA Q300 Choanal Atresia

NO LARING FARING KODE DIAGNOSIS ICD 10

1 J030 Acute streptococcal tonsillitis
Acute tonsillitis due to other
TONSILITIS AKUT J038
specified organisms
J039 Acute tonsillitis, unspecified
2 TONSILITIS KRONIK J350 Chronic tonsillitis
3 HIPERTROFI TONSIL J351 Hypertrophy of tonsils
4 HIPERTROFI ADENOID J352 Hypertrophy of adenoids
5 Hypertrophy of tonsils with
HIPERTROFI TONSIL ADENOID J353
hypertrophy of adenoids
6 B302 Viral pharyngoconjunctivitis
Acute nasopharyngitis [common
FARINGITIS AKUT J00
cold]
J020 Streptococcal pharyngitis
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Acute pharyngitis due to other

J028
specified organisms
J029 Acute pharyngitis, unspecified
7 J311 Chronic nasopharyngitis
FARINGITIS KRONIK Chronic pharyngitis : atrophi,
J312
granular, hipertrophic
8 J040 Acute laryngitis
Acute obstructive laryngitis
J050
LARINGITIS AKUT [croup]
J051 Acute epiglotitis
J060 Acute laryngopharyngitis
9 LARINGITIS KRONIK J370 Chronic laryngitis
10 Paralysis of vocal cords and
J380
larynx
J381 Polyp of vocal cord and larynx
J382 Nodules of vocal cords
J383 Other diseases of vocal cords
KELAINAN LARING
J384 Edema of larynx
J385 Laryngeal spasm
J386 Stenosis of larynx
Other diseases of larynx :
J387
abscess, cellulitis, perichondritis
11 Tuberculosis of larynx, trachea
A155
and bronchus
TBC LARING/KELENJAR LEHER
Tuberculosis of perypheral
A182
lymphadenopathy
12 REFLUKS LARING-FARING K210 Gastro-esophageal reflux disease
13 DISFAGIA R13 Dysphagia
14 OBSTRUKSI JALAN NAFAS J960 Acute respiratory failure
ATAS J961 Chronic respiratory failure
15 Emphysema (subcutaneous)
T818
resulting from procedure
KOMPLIKASI TRAKEOSTROMI Tracheostomy malfunction :
J950 haemorrhage, obstruction,
fistula
16 J36 Peritonsillar abscess
Retropharyngeal and
J390
ABSES LEHER DALAM parapharyngeal abscess
Cellulitis and abscess of mouth
K122
(submandibular abscess)
17 T172 Foreign body in pharynx
BENDA ASING T173 Foreign body in larynx
T174 Foreign body in trachea
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T175 Foreign body in bronchus

T180 Foreign body in mouth
T181 Foreign body in esophagus
18 B370 Cadidal stomatitis
Recurrent oral aphthae : aphthos
K120 stomatitis
KELAINAN ORAL CAVITY
Leukoplakia of oral mucosa,
K132 including tongue
K121 Other forms of stomatitis
19 Q310 Web of larynx
Q311 Congenital subglottic stenosis
Q312 Laryngeal hypoplasia
Q313 Laryngocele
KELAINAN KONGENITAL
Q315 Congenital laryngomalacia
LARING FARING
Q320 Congenital tracheomalacia
Q387 Congenital pharyngeal pouch
Sinus, fistula and cyst of
Q180
branchial cleft
20 PAROTITIS B26 Mumps
21 E040 Nontoxic diffuse goiter
E041 Nontoxic single thyroid nodule
E042 Nontoxic multinodular goiter
Thyrotoxicosis with diffuse
E050
KELAINAN TIROID goiter
Thyrotoxicosis with toxic single
E051
thyroid nodule
Thyrotoxicosis with toxic
E052
multinodular goiter
22 Temporomandibular joint
KELAINAN TMJ M266
disorder
23 Q35 Cleft palate
CELAH BIBIR & LANGIT-
Q36 Cleft lip
LANGIT
Q37 Cleft palate with cleft lip
24 Superficial injury of lip and oral
S005 cavity
Open wound of cheek and
S014 temporomandibular area
Open wound of lip and oral
TRAUMA
S015 cavity
Superficial injury of neck,
S100 contusion of throat
Open wound of larynx and
S110 trachea
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S111 Open wound of thyroid gland

Open wound of pharynx and
S112 cervical esophagus
S026
25 A360 Pharyngeal diphtheria
DIFTERI A361 Nasopharyngeal diphtheria
A362 Laryngeal diphtheria
26 DISFONIA R490 Disfonia
27 Upper respiratory tract
ANAFILAKSIS SALURAN NAPAS J393 hypersensitivity reaction, site
unspecified
28 K220 Achalasia of cardia
K223 Perforation of esophagus
KELAINAN ESOFAGUS
Diverticulum of esophagus,
K225 acquired
29 K110 Atrophy of salivary gland
K111 Hypertrophy of salivary gland
K112 Sialoadenitis
KELAINAN KELENJAR LIUR K113 Abscess of salivary gland
K114 Fistula of salivary gland
K115 Sialolithiasis
K116 Mucocele of salivary gland

NO TUMOR KODE DIAGNOSIS ICD 10

1 Malignant neoplasm of superior
C110
wall of nasopharynx
Malignant neoplasm of posterior
C111
wall of nasopharynx
Malignant neoplasm of lateral
C112
wall of nasopharynx
TUMOR GANAS NASOFARING Malignant neoplasm of anterior
C113
wall of nasopharynx
Malignant neoplasm of
C118 overlapping sites of
nasopharynx
Malignant neoplasm of
C119
nasopharynx, unspecified
2 C320 Malignant neoplasm of glottis
Malignant neoplasm of
C321
supraglottis
TUMOR GANAS LARING
C322 Malignant neoplasm of subglottis
Malignant neoplasm of laryngeal
C323
cartilage
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Malignant neoplasm of
C328
overlapping sites of larynx
Malignant neoplasm of larynx,
C329
unspecified
3 Malignant neoplasm of nasal
TUMOR GANAS HIDUNG C300
cavity
4 Malignant neoplasm of maxillary
C310
sinus
Malignant neoplasm of
C311
ethmoidal sinus
Malignant neoplasm of frontal
C312
sinus
TUMOR GANAS SINUS Malignant neoplasm of sphenoid
C313
sinus
Malignant neoplasm of
C318 overlapping sites of accessory
sinuses
Malignant neoplasm of accessory
C319
sinus, unspecified
5 Malignant neoplasm of tonsillar
C090
fossa
Malignant neoplasm of tonsillar
C091
pillar (anterior) (posterior)
TUMOR GANAS TONSIL
Malignant neoplasm of
C098
overlapping sites of tonsil
Malignant neoplasm of tonsil,
C099
unspecified
6 C100 Malignant neoplasm of vallecula
Malignant neoplasm of anterior
C101
surface of epiglottis
Malignant neoplasm of lateral
C102
wall of oropharynx
Malignant neoplasm of posterior
C103
TUMOR GANAS OROFARING wall of oropharynx
Malignant neoplasm of branchial
C104
cleft
Malignant neoplasm of
C108
overlapping sites of oropharynx
Malignant neoplasm of
C109
oropharynx, unspecified
7 Malignant neoplasm of pyriform
C12
sinus
TUMOR GANAS HIPOFARING
Malignant neoplasm of
C130
postcricoid region
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Malignant neoplasm of
C131 aryepiglottic fold,
hypopharyngeal aspect
Malignant neoplasm of posterior
C132
wall of hypopharynx
Malignant neoplasm of
C138 overlapping sites of
hypopharynx
Malignant neoplasm of
C139
hypopharynx, unspecified
8 Basal cell carcinoma skin of ear
C4421
and external auricular canal
TUMOR GANAS LIANG TELINGA
Squamous cell carcinoma of skin
C4422
of ear and external canal
9 TUMOR GANAS TELINGA Malignant neoplasm of middle
C301
TENGAH ear
10 C81 Hodgkin's lymphoma
LIMFOMA Other and unspecifiedof non-
C85
Hodgin's Lymphoma
11 Malignant neoplasm of external
C000
upper lip
Malignant neoplasm of external
C001
lower lip
Malignant neoplasm of external
C002
lip, unspecified
Malignant neoplasm of upper lip,
C003
inner aspect
Malignant neoplasm of lower lip,
TUMOR GANAS BIBIR C004
inner aspect
Malignant neoplasm of lip,
C005
unspecified, inner aspect
Malignant neoplasm of
C006
commissure of lip, unspecified
Malignant neoplasm of
C008
overlapping sites of lip
Malignant neoplasm of lip,
C009
unspecified
12 Malignant neoplasm of base of
C01
tongue
Malignant neoplasm of dorsal
TUMOR GANAS LIDAH C020
surface of tongue
Malignant neoplasm of border of
C021
tongue
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Malignant neoplasm of ventral

C022
surface of tongue
Malignant neoplasm of anterior
C023
two-thirds of tongue
Malignant neoplasm of lingual
C024
tonsil
Malignant neoplasm of
C028
overlapping sites of tongue
Malignant neoplasm of tongue,
C029
unspecified
13 Malignant neoplasm of upper
C030
gum
Malignant neoplasm of lower
TUMOR GANAS GUSI C031
gum
Malignant neoplasm of gum,
C039
unspecified
14 Malignant neoplasm of anterior
C040
floor of mouth
Malignant neoplasm of lateral
C041
floor of mouth
TUMOR GANAS DASAR MULUT Malignant neoplasm of
C048 overlapping sites of floor of
mouth
Malignant neoplasm of floor of
C049
mouth, unspecified
15 Malignant neoplasm of hard
C050
palate
Malignant neoplasm of soft
C051
palate
TUMOR GANAS PALATUM &
C052 Malignant neoplasm of uvula
UVULA
Malignant neoplasm of
C058
overlapping sites of palate
Malignant neoplasm of palate,
C059
unspecified
16 Malignant neoplasm of cheek
C060
mucosa
Malignant neoplasm of vestibule
C061
TUMOR GANAS MUKOSA of mouth
MULUT Malignant neoplasm of
C062
retromolar area
Malignant neoplasm of
C0680
overlapping sites of mouth
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Malignant neoplasm of
C0689 overlapping sites of other parts
of mouth
Malignant neoplasm of mouth,
C069
unspecified
17 TUMOR GANAS MANDIBULA C411 Malignant neoplasm of mandible
18 Malignant neoplasm of thyroid
TUMOR GANAS TIROID C73
gland
19 Malignant neoplasm of
TUMOR GANAS ESOFAGUS C159
esophagus, unspecified
20 Malignant neoplasm of thyroid
TUMOR GANAS TIROID C73
gland
21 Malignant neoplasm of parotid
C07
gland
Malignant neoplasm of
C080
submandibular gland
TUMOR GANAS KELENJAR LIUR
Malignant neoplasm of
C081
sublingual gland
Malignant neoplasm of major
C089
salivary gland, unspecified
22 C81 Hodgkin lymphoma
C82 Follicular lymphoma
LIMFOMA C83 Non Follicular lymphoma
C84 Mature T/NK-cell lymphoma
C85 Non Hodgin Lymphoma
23 D100 lip
D101 tongue
D102 floor of mouth
D103 unspecified part of mouth
D104 tonsil
D105 oropharynx
D106 nasopharynx
D107 hypopharynx
TUMOR JINAK (1) D110 parotid gland
sublingual, submandibular
D117
glands
middle ear, nasal cavity and
D140
accesory sinus
D141 larynx
D150 thymus
D170 lipomatous
D180 hemangioma
24 TUMOR JINAK (2) D181 lymphangioma
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PENGURUS PUSAT
Sekretariat: Apartemen The Baile Jl. Kimia No. 4, Jakarta Pusat 10320 Indonesia
Telepon/Fax (021) 3912144 E-mail: perhatikl_pusat@yahoo.com

D232 skin and external auricular canal

D315 lacrimal gland and duct
D333 cranial nerves
D34 thyroid gland
D351 parathyroid gland
D352 pituitary gland
D353 craniopharyngeal duct
D354 pineal gland
D360 lymph nodes
peripheral & autonom nerves
D3611
head neck face

NO FRAKTUR WAJAH KODE DIAGNOSIS ICD 10

1 DISLOKASI RAHANG S030 Dislocation of jaw
2 Fracture of malar and maxillary
S024
bones
S026 Fracture of mandible
Multiple fractures involving skull
S027
and facial bones
FRAKTUR WAJAH Fractures of other skull and
S028
facial bones
Fractures of skull and facial
S029
bones, part unspecified
S022 Fracture of nasal bones
S023 Fracture of orbital floor