KASUS RAWAT INAP

No Diagnosa Kode Deskripsi Kode INA‐CBG

1 Bayi lahir SC P‐8‐17‐I NEONATAL, BBL > 2499 GR TANPA PROSEDUR MAYOR (RINGAN)
2 SC O‐6‐10‐I OPERASI PEMBEDAHAN CAESAR (RINGAN)
3 GEA K‐4‐17‐I NYERI ABDOMEN & GASTROENTERITIS LAIN‐LAIN (RINGAN)
4 Partus spontan O‐6‐13‐I PERSALINAN VAGINAL (RINGAN)
5 DHF A‐4‐13‐I INFEKSI VIRAL & NON‐BAKTERIAL LAIN (RINGAN)
6 Thyfoid Fever A‐4‐14‐I PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN‐LAIN (RINGAN)
7 BP J‐4‐16‐I SIMPLE PNEUMONIA & WHOOPING COUGH (RINGAN)
8 Fever
9 Neonatal Hiperbilirubin B‐4‐13‐I GANGGUAN HATI SELAIN TUMOR, SIROSIS ATAU HEPATITIS ALKOHOLIK
10 Dyspepsia K‐4‐18‐I GANGGUAN SISTEM PENCERNAAN LAIN‐LAIN (RINGAN)
11 Kejang Demam G‐4‐22‐I SERANGAN KEJANG RINGAN
12 Morbili A‐4‐13‐I INFEKSI VIRAL & NON‐BAKTERIAL LAIN (RINGAN)
13 Appendisitis
14 BO
15 Anemia
16 Hipertensi
17 Abortus
18 Bacterial infection
19 Vomitus
20 UTI
21 TB J‐4‐15‐I PERADANGAN DAN INFEKSI PERNAFASAN (RINGAN)
PENYAKIT KENCING MANIS & GANGGUAN NUTRISI/ METABOLIK
22 DM E‐4‐10‐I RINGAN

OPERATIF
Appendiktomi K‐1‐13‐I PROSEDUR APPENDIK (RINGAN)
App+Adhesiolisis
Ulcus DM I‐4‐15‐I GANGUAN PEMBULUH DARAH PERIFER LAIN‐LAIN (RINGAN)
Kuretase (Abortus/BO/IU W‐1‐10‐I PROSEDUR ABORSI RINGAN
Kuretase (tidak hamil) W‐1‐11‐I PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK RINGAN
SC O‐6‐10‐I OPERASI PEMBEDAHAN CAESAR (RINGAN)
Tonsilektomi (Turbinektom
U‐1‐20‐I PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN TELINGA LAIN‐LAIN
P
Tarif Lama Tipe B Tarif Baru Tipe C Tarif Baru Tipe B
Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1 Kelas 3
1,829,500 2,195,400 2,561,300 3 ,777,400 4 ,532,900 5 ,288,300 3 ,838,500
4,424,300 5,309,200 6,194,100 4 ,975,200 5 ,970,200 6 ,965,200 4 ,986,800
2,605,600 2,680,000 3,126,900 1 ,448,400 1 ,738,100 2 ,027,700 1 ,717,900
2,215,000 2,658,000 3,101,000 1 ,591,200 1 ,909,500 2 ,227,700 1 ,675,000
2,517,800 2,589,700 3,021,400 1 ,554,500 1 ,865,400 2 ,176,300 2 ,090,000
3,051,900 3,662,300 4,272,700 2 ,155,300 2 ,586,300 3 ,017,400 2 ,268,700
3,822,600 4,587,100 5,351,600 3 ,784,400 4 ,541,300 5 ,298,200 3 ,793,900

2,941,000 3,529,200 4,117,500 3,545,300 4,254,400 4,963,500 4,414,500

3,057,600 3,669,100 4,280,600 1,279,900 1,535,800 1,791,800 1,452,800
1,956,300 2,347,600 2,738,900 2,867,700 3,441,300 4,014,800 2,788,700
2,517,800 2,589,700 3,021,400 1 ,554,500 1 ,865,400 2 ,176,300 2 ,090,000

4,587,800 5,505,300 6,422,900 4 ,541,900 5 ,450,300 6 ,358,700 4 ,553,300

3,782,100 4,538,600 5,295,000 3,677,900
3,059,500 3,671,400 4,283,200

3,729,000 4,474,800 5,220,600 3,169,100 3,802,900 4,436,800 4,068,100

3,918,900 4,702,700 5,486,500 4,390,000 5,268,000 6,145,900 4,482,400

2,574,100 3,088,900 3,603,700 1,800,400 2,160,500 2,520,500 2,311,100
3,005,800 3,607,000 4,208,200 1,881,800 2,258,200 2,634,500 2,415,600
4,424,300 5,309,200 6,194,100 4 ,975,200 5 ,970,200 6 ,965,200 4 ,986,800
5,951,800 7,142,200 8,332,500 5,062,900 6,075,500 7,088,100 6,499,200
Tarif Baru Tipe B
Kelas 2 Kelas 1
4 ,606,200 5 ,373,900
5 ,984,100 6 ,981,500
2 ,061,500 2 ,405,100
2 ,010,000 2 ,345,000
2 ,508,000 2 ,926,000
2 ,722,400 3 ,176,100
4 ,552,700 5 ,311,400

5,297,400 6,180,300
1,743,400 2,033,900
3,346,400 3,904,100
2 ,508,000 2 ,926,000

5 ,464,000 6 ,374,700
4,413,400 5,149,000

4,881,800 5,695,400

5,378,800 6,275,300
2,773,300 3,235,600
2,898,700 3,381,900
5 ,984,100 6 ,981,500
7,799,000 9,098,900
Kasus Rawat Jalan
No Diagnosa Kode

1 Supervision of normal pregnancy

Acute upper respiratory infection,
2 unspecified

3 Supervision of normal first pregnancy

4 Fever, unspecified
5 Other general examinations
6 Extracorporeal dialysis
Diarrhoea and gastroenteritis of
7 presumed infectious origin
8 Dyspepsia
Tuberculosis of lung, confirmed by
9 culture only
10 Presence of intraocular lens
11 Unspecified diabetes mellitus
12 Essential (primary) hypertension
13 Postpartum care and examination
14 Routine child health examination
Stroke, not specified as haemorrhage or
15 infarction
16
17
18
19
20
21

Z34
J06.9
Z34.0
R50.9
Z00.8
Z49.1
A09
K30
A15.1
Z96.1
E14
 I10
Z39
Z00.1
I64
Deskripsi Kode INA‐CBG Tarif Lama Tipe B Tarif Baru Tipe C
Tarif Baru Tipe B