Buku Kewenangan Tindak Medis Dokter Spesialis Bedah Indonesia

KEWENANGAN TINDAK MEDIK
DOKTER SPESIALIS BEDAH

INDONESIA
PENGURUS PUSAT
PERHIMPUNAN D O K T E R SPESIALIS BEDAH INDONESiA
(PP IKABI)
2013
Kewenangan Tindak Medik
Dokter Spesialis Bedah Indonesia
KEWENANGAN TINDAK MEDIK
DOKTER SPESIALIS BEDAH
INDONESIA
PENGURUS PUSAT
PERHIMPUNAN D O K T E R SPESIALIS BEDAH INDONESIA
(PP IKABI)
2013
Tim Editor dan Kontributor
Tim Editor : Paul L. Tahalele (Ketua)

Djoni Darmajaya (Sekretaris)
Fathema J. Rahmat
Audi Asadul Islam
H.N. Nazar
Henry Boyke Sitompul
Kontributor :
1. Ketua Presidium PP I K A B I : Paul Tahalele
2. Sekretaris Jenderal PP I K A B I : Djoni Darmajaya
3. Ketua PP PABI: Urip Murtedjo
4. Ketua PP I K A B D I : Nurhayat Usman
5. Ketua PP PERABOI: Sonar S. Panigoro
6. Ketua PP PESBEVI : R. Suhartono
7. Ketua PP PABOI: Rizal Pohan
8. Ketua PP l A U I : Chaidir Mochtar
9. Ketua PP PERPEBSI : Setyo Widi Nugroho
10. Ketua PP PERBANI : Purwadi
11. Ketua PP H B T K V I : Maizul Anwar
12. Ketua PP PERAPI: Asrofi S. Surachman
Saran, keluhan dan laporan pengaduan kelalaian tindak medik dapat ditujukan kepada
Pengurus Pusat I K A B I
Gedung Wisma Bhakti Mulya ~ lantai 4 - 4 0 1 - C
Jl. Kramat Raya 160 Jakarta Pusat 10430
Telp&Fax. 021 -3916774
Website : www.ikabi.org
Email, ppikabi@yahoo.com, pltahalele@yahoo.com (Ketua), kapuyux@gmail.com (Sekjen),
nazar_finacs@yahoo.co.id (Ketua Komisi Legislasi & Advokasi)
V
Kata Pengantar
Dengan semangat kebersamaan dan rasa kepemilikan serta tanggung jawab pada profesi bedah, akhimya
terbit buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia (2013) oleh PP IKABI.
Penulisan buku ini didasarkan:

1. UUD 1945 Pasal 28 H Ayat 1, Pasai 34 Ayat 3 mengenai upaya mensejahterakan masyarakat Indonesia
2. UU No. 29 Tahun 2004 Tentang Praktik Kedokteran Pasal 4 Ayat 1, Pasal 44 Ayat 1 mengenai upaya penjagaan
mutu pelayanan kedokteran
3. Standar Akreditasi Rumah Sakit versi 2012 mengenai penerbitan surat penugasan klinis
Buku ini merupakan rangkuman tindak medik yang mengacu pada standar pelayanan medis 10 organisasi
profesi kedokteran di dalam lingkungan bedah (10 OPLB) yang berada di dalam satu wadah organisasi IKABI
berdasarkan Clinical Classification of Disease 9"* Revision Clinical Modification (ICD-9-CM, 1992), sedangkan
diagnostik penyakit berdasarkan International Statistical Classification ofDisease and Related Health Problems
(ICD-10 tahun 1992 & 1994) tidak tercantum dalam buku ini tetapi mengikuti setiap tindak medik. Disamping
itu, buku ini berisi sepuluh kesepakatan yang telah ditangani oleh para ketua PP IKABI, 10 OPLB, Majelis
- Kolegium llmu Bedah Indonesia dan 10 Kolegium llmu Bedah yang terkait, dan juga berisi Tata Cara
Pembuatan Surat Penugasan Klinis serta contohnya dan disclaimer atau penyangkalan.
Terbitnya buku ini telah mendapat apresiasi, dukungan dan arahan dari Ibu Menteri Kesehatan R I ,
Ketua Umum PB IDI, Ketua Persi dan Ketua K K l , untuk itu Tim Editor menyampaikan terima kasih.
Rincian tindak medik yang tertera di dalam buku ini dapat dipakai sebagai acauan atau pedoman untuk
menerbitkan surat penugasan klinis kepada dokter spesialis bedah, staf medis yang bekerja di suatu rumah sakit
oleh Direktur Rumah Sakit atau Kepala Unit Pelaksana Kesehatan.
Semoga buku ini berguna bagi pelayanan kesehatan di Indonesia dan selanjutnya diharapkan dapat ditinjau,
dievaluasi dan diperbaharui dalam waktu 5 tahun mendatang sesuai dengan perkembangan ilmu bedah.
Selamat bekerja dan mengabdi

Jakarta, 20 Mei 2013
Tim Editor
Paul L. Tahalele (Ketua)
Daftar Isi
Tim Editor dan (Contributor v
Kata Pengantar vii
Daftar Isi ix
Sambutan Ketua Presidium PP IKABI xi
Sambutan Ketua Umum Pengurus Besar Ikatan Dokter Indonesia xii
Sambutan Ketua PERSI xiii
Sambutan Konsil Kedokteran Indonesia xiv
Sambutan Menteri Kesehatan Republik Indonesia xv
Surat Pemyataan Kesepakatan IKABI, Sepuluh OPLB, dan M-KIBI xix
Tata Cara Pembuatan Surat Penugasan Klinis dan White Paper Berdasarkan Rincian Clinical
Previlege dan Clinical Appointment Dokter Spesialis Bedah Indonesia 1
Penyangkalan atau disclaimer 4
Berita Acara PP PABI dan PP IKABI 5
Daftar Kompetensi dan Kewenangan Klinik Dokter Spesialis Bedah Umum (PABI) 7
Berita Acara PP IKABDI dan PP IKABI 17
Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Konsultan Bedah Digestif
(IKABDI) 19
Berita Acara PP PERABOI dan PP IKABI 25
Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Konsultan Bedah Onkologi
(PERABOI) 27
Berita Acara PP PESBEVI dan PP IKABI 37
Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Vaskuler dan Endovaskuler
(PESBEVI) 39
Berita Acara PP PABOI dan PP IKABI 45
Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Orthopedi & Traumatologi
(PABOI) 47
Berita Acara PP I AUi dan PP IKABI 73
Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Urologi (lAUI) 75
ix
Sambutan Ketua Presidium PP IKABI
Empat puluh lima tahun yang lalu (1967), berdiri organisasi profesi kedokteran Ikatan Ahli Bedah Indonesia
(IKABI) pada Kongres Nasional Pertama IKABI di Semarang dengan motto : Sutiksna Husada Sudarma Marga
'^Plsau untuk kebajikanûntuk perikemanusiaan". Saat itu semangat kebersamaan dan rasa kolegialitas
sesama dokter ahli bedah Indonesia ditunjukkan dalam pelayanan kesehatan kepada rakyat Indonesia dengan
menggunakan pisau kcbajikan. Dengan bcrjalannya waktu, IKABI terfragmentasi dan lahirlah 10 anak organisasi
IKABI atau OPLB (Organisasi Profesi Kedokteran dalam Lingkungan Bedah) seperti PABOI, lAUI, PERSPEBSl,
PERBANI, PESBEVI, IKABDI, PERABOI dan terakhir PABI. Dalam profesi kedokteran, potensi IKABI yang
menghimpun dokter spesialis bedah Indonesia merupakan suatu kekuatan yang besar apabila bersatu. Pada tahun
2000 muncul spirit bersatu dalam ilmu dan pengabdian bagi seluruh dokter spesialis bedah Indonesia dan 12
tahun kemudian dalam Konferensi Kerja IKABI di Jakarta, 27 Oktober 2012, spirit yang sama terwujud dalam
bentuk-bcntuk pemyataan kesepakatan bersama IKABI dan 10 OPLB bersama Majelis Kolegium llmu Bedah
Indonesia serta kolegium llmu Bedah yang terkait tentang Ciinical Previlege dan Clinical Appointment dalam
pelayanan kasus bedah dengan mengutamakan patient safety.
PP IKABI menyambut gembira dengan mengucapkan syukur kehadirat Tuhan Y M E atas terbitnya buku
KewenanganTindak Medik dan kesepakatan diantara Dokter Spesialis Bedah Indonesia yang didasari niat yang
tulus dari semua stake holder IKABI.
Mari kita semua bekerja mengabdi dan melayani penderita kasus bedah per primum non nocere dengan ber-
tanggungjawab secara ber-martabat, ber-etika dan ber-moral sesuai Sumpah Hippocrates yang pernah
diucapkan saat dilantik menjadi dokter.
Selamat mengabdi dan melayani.

Jakarta, 4 Maret 2013
Ketua Presidium PP IKABI
xi
Tanggal 19 April 2013
Sambutan Ketua Umum

Pengurus Besar Ikatan Dokter Indonesia
Salam hormat,
Dalam menjalankan profesinya, setiap dokter diwajibkan tunduk kepada aturan profesi. Hal ini terkait dengan
tanggung jawab profesi untuk melindungi masyarakat yang menerima layanan serta melindungi dokter sebagai
pemberi pelayanan. Dalam hal pelayanan, berdasarkan kewenangan yang tertera dalamUndang-undang Nomor 29
Tahun 2004 Tentang Praktik Kedokteran, organisasi profesi diwajibkan menyusun Standar Profesi. Dalam standar
profesi disebutkan adanya Standar Pendidikan yang disusun oleh Kolegium, Standar Kompetensi yang disusun
oleh Perhimpunan, Standar Etik atau Kode Etik oleh Majelis Kehormatan dan Etika Kedokteran (MKEK), serta
Standar Pelayanan yang disusun oleh organisasi profesi disahkan oleh Kementerian Kesehatan.
Terkait dengan pelayanan dokter di klinis, standar kompetensi erat kaitannya dengan apa yang berhak dilakukan
oleh dokter. Untuk selanjutnya hal ini bisa disebut kewenangan klinis dimana hal ini mutlak menjadi kewenangan
dan tanggungjawab perhimpunan terkait beserta kolegiumnya untuk membuat aturan yang baku sebagai acuannya.
Untuk selanjutnya hal tersebut menjadi dasar dalam peranan profesi untuk menjaga mutu layanan anggotanya.
Dengan terbitnya Buku Kewenangan Tindak Medik Dokter Spesialis Bedah yang telah disusun oleh PP IKABI,
mutu layanan dokter spesialis bedah dapat lebih terarah serta terbina dengan baik. Peranan PP IKABI dalam
menjaga mutu layanan anggotanya sangat membantu peranan IDI sebagai induk organisasi.
Kami ucapkan terima kasih dan penghargaan yang setinggi-tingginya atas terbitnya buku ini, semoga buku ini
dapat memberikan manfaat yang sebesar-besamya bagi profesi dokter dan terutama bagi rakyat.
Salam Sehat Indonesia.
Ketua Umum
xii
Tanggal 2 April 2013
Sambutan Ketua PERSI
Terbitnya buku kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia yang diprakarsai oleh PP IKABI
patut kita sambut dengan gembira dan perasaan syukur karena merupakan prestasi sekaligus kcpedulian organisasi
profesi bedah (IKABI) dalam mengamalkan Undang-Undang RI No 29 tentang Praktik Kedokteran dalam rangka
meningkatkan mutu pelayanan medis.
Sebagaimana diketahui bahwa dalam standar akreditasi rumah sakit versi 2012 rumah sakit harus yakin bahwa
setiap'staf medis yang bekerja di rumah sakitnya, memiliki kualifikasi dan kompetensi yang sesuai dengan
kebutuhan pasien dan dalam implemcntasinya, direktur rumaii sakit diminta menerbitkan surat penugasan
Idinik dengan rincian kewenangan klinik bagi setiap staf medis yang bekerja di rumah sakitnya.
Buku ini diharapkan dapat menjadi acuan bagi direktur dan komite medis rumah sakit dalam mengatur
pemberian kewenangan klinik (ciinical previleges) dalam bentuk surat penugasan klinik dan rincian
kewenangan klinik bagi setiap staf medis di rumah sakit masing-masing, yang sudah barang tentu akan
sangat berdampak positif pada mutu pelayanan rumah sakit dan keselamatan pasien.
Perhimpunan Rumah Sakit Seluruh Indonesia (PERSI) menyampaikan rasa terima kasih kepada IKABI bersama
10 OPLB yang dengan semangat kebersamaan dapat menyatukan pendapat antar profesi bedah, dalam hal
pemberian kewenangan klinis bagi dokter bedah, PERSI juga memberikan apresiasi atas pcran yang dilakukan PP-
IKABI sebagai organisasi profesi kedokteran unmk menerbitkan buku kewenangan tindak medik ini. Semoga hal
ini dapat diikuti oleh organisasi profesi kedokteran lainnya. Sclamat berjuang demi peningkatan mutu pelayanan
medis dan rumah sakit serta keselamatan pasien
Ketua PERSI
Dr. Sutoto, dr. M.Kes
xiii
KONSIL K E D O K T E R A N INDONESIA
THE INDONESIAN MEDICAL COUNCIL
SAMBUTAN
Assalamualaikum Wr Wb
Salam Sejahtera
Pemberlakuan Undang-Undang Nomor 29 Tahun 2004 tentang Praktik Kedokteran telah memerlihatkan
kejelasan bentuk pembinaan keprofesian bidang Kedokteran.
Hal ini sejalan dengan dinamika yang terjadi dalam dunia kedokteran saat ini, termasuk dalam bidang
pendidikan dan praktik kedokteran. Pengaturan-pengaturan yang dilakukan semua bermuara pada keselamatan
pasien, melalui pembinaan keprofesian dan pemantapan kepastian hukum, baik bagi pasien maupun dokter.
Standar Pendidikan dan Standar Kompetensi sebagai acuan, ditetapkan dan disahkan oleh Konsil Kedokteran
Indonesia. Kewenangan Klinik dan ""clinical appointment merupakan bagian teknis dalam tatanan praktik.
Namun, tumpang tindih kompetensi sulit untuk dielakkan. Dibutuhkan semangat kesejawatan yang amat kental
untuk dapat membangkitkan integrasi dan sinkronisasi dalam pelayanan kedokteran. Dalam sisi inilah Konsil
Kedokteran Indonesia menilai bahwa komunitas Bedah telah menunjukkan kemampuan untuk mengatasi masalah
ini.
Buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini selain menjabarkan pembagian
kewenangan dan tanggung jawab, terlebih telah menunjukkan kearifan dalam memahami kesejawatan dan
pembinaan keprofesian.
Konsil Kedokteran Indonesia mengucapkan Selamat, kepada pengurus Pusat Perhimpunan Dokter Spesialis
Bedah Indonesia, khususnya kepada para penanggungjawab, editor serta kontributor buku dan, Mejelis Kolegium
Bedah Indonesia. Semoga langkah ini menjadi contoh bagi kita semua dan menjadi acuan bagi seluruh Dokter
Bedah di Indonesia.
Sekretariat:
Jl. Teuku Cik Ditiro No. 6 Gondangdia Menteng, Jakarta Pusat
Teip. :(021) 31923181, 31923191, 31923193, 31923197. 31923198,Fax.:(021) 31923186
xiv
via email tanggal 17 Mei 2013
MENTERI KESEHATAN
REPUBLIK INDONESIA
SAMBUTAN
MENTERI KESEHATAN R E P U B L I K INDONESIA
Undang-Undang No 36 tahun 2009 tentang Kesehatan, Pasal 5 Ayat 2, mengamanatkan bahwa kesehatan
adaiah hak setiap warga Negara. Setiap warga ncgara berhak atas pelayanan kesehatan yang aman, bermutu, dan
terjangkau yang dilayani oleh tenaga kesehatan yang kompeten.
Menurut Riset Fasilitas Kesehatan tahun 2011, dokter spesialis bedah hanya ada di 79,6% Rumah Sakit
Umum Pemerintah. Oleh karena itu, tambahan dokter spesialis bedah sangat diperlukan agar peningkatan akses
masyarakat pada pelayanan medik spesialistik yang komprehensif dan bermutu dapat terwujud. Selanjutnya,
penjelasan Undang-Undang Nomor 44 tahun 2009 tentang Rumah Sakit, Pasal 3 huruf b, menyatakan bahwa
tindakan pembedahan harus diberikan secara professional dengan mengutamakan keselamatan pasien (patient
safety), termasuk asesmen, identifikasi, dan manajemen risiko terhadap pasien dalam pelayanan medik
spesialistik.
Karena jumlah dokter spesialis bedah di Indonesia masih terbatas, maka tindakan pembedahan dapat dilakukan
oleh dokter umum yang telah dibekali kompetensi tambahan atau dokter spesialis bedah umum. Untuk maksud
tersebut dan demi keselamatan pasien, diperlukan pengaturan kewenangan tindakan medik secara bijak antara
Direktur Rumah Sakit, Komite Medik, dan para dokter spesialis bedah yang memberikan pelayanan pembedahan
di lingkungan kerja tersebut.
Saya menyambut baik terbitnya buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini
dan menyampaikan apresiasi kepada IKABI yang telah menyusun buku ini dan memberikan kewenangan kepada
dokter umum dan dokter bedah umum. Dengan demikian, keterbatasan ketersediaan dokter spesialis bedah
dapat diatasi. Untuk selanjutnya, hendaknya dilakukan pemutakhiran isi buku ini, sesuai perkembangan ilmu
dan teknologi kedokteran dalam tindakan pembedahan.
Semoga buku ini bermanfaat dan dijadikan pedoman bagi peningkatan mutu pelayanan dokter spesialis
bedah di Indonesia oleh seluruh fasilitas pelayanan kesehatan dalam memberikan pelayanan dan melaksanakan
tindakan pembedahan.
dr. NafsiahlMbUi, Sp.A., M.PH.
Jl. H.R. Rasuna Said Blok X5, Kav 4-9 Jakarta 12950 Telepon/Faksimile (021) 5201591
XV
IKATAN DOKTER INDONESIA
PERHIMPUNAN DOKTER SPESIALIS BEDAH INDONESIA
IKABI
Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C
Jl, Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774
Website: www. ikabj.org
Email • ppikabi@yahoo,com
Susunan Pengurus PP. IKABI Nomor : 50/PP-IKABI/XI/2012 Jakarta, 27 Oktober 2012

Periode 2012-2014
Lamp. : Daftar Kompetensi 10 (sepuluh) OPLB
DBwan Pertimbangan
Prof. Dr. SjacnsiibKJatat, SpB SpB-KBD Hal : Clinical Previlege & Clinical Appointment
DI. Sowarao hlartôwasA). SpB SpeTKV
dalam pelayanan kasus bedah
M^HiEmtaPwMMhit
Prol, Dr. Muchlis Rami!, SoB(Kl-Onk
K^tuiPraildlum Kepada Yth.

ProT. DR. Dr Paul Tahalele, SpB.SpBTKV
Ibu Menteri Kesehatan RI
WiltllK«>u«IKrtuiTinXllh
Df R. SuhartofW. SpBKBV Kementerian Kesehatan Republik Indonesia
WiMI mw Jin. H.R.Rasuna Said Blok X.5 Kav, 4-9
Prol. DR Df Sunaryo Hardjowidjoto, SpB SpU
Kuningan Jakarta Selatan 12950
Prof. DR Dr. Suwaryji Suganiji. SpB SpU
KituUIKlS)
Prol. Dr. EtTOI U. Hutagalung. SpB SpOT Dengan hormat.

Pwtldium Bersama ini kami PP IKABI bescrta 10 organisasi profesi dalam lingkungan bedah (OPLB),
Dr. Urip Murtedjo, SpB PGD Pal Med. ECU
Dr. Rizal Potwn, SpB SpOT yaitu Pabi, Paboi, Peraboi, lAUl, HBTKVI, Perbani, IKabdi, Perapi, Perspebsi, Pesbevi dan
DI. Sonar Soni Panigoro, SpB K.Onk
Dr. Patriot Muslim, SpU
Majelis KIBI menyampaikan surat pemyataan kesepakatan tentang clinical privilege dan
Or Poerwadi, SpB SpBA
Dr R Suhartooo. SpBKBV
clinical appointment dalam pelayanan kasus bedah dengan maksud untuk mencegah konfiik
Dr. SelyowHli Nugroho, Sp6 SpBS kepentingan profesi bedah dalam pelayanan kesehatan dan mendukung Program Pemerintah
Dr. Nuitiayal Usman, SpB KBD
Dr. Maizul Arwar. SpB TKV C/Q Kcmentrian Kesehatan RI mcnsukseskan program BPJS 2014 dan program MRA 2015
Dr. Ishandono Dacfilan, Msc, SpB, SpBP-RE(K)
SefcreUril Jtndefil serta program-program yang lain. Selanjutnya apabila Ibu Menteri Kesehatan RI berkenan
Dr. Djoni Damad)a|a. SpB MARS
dan tidak berkeberatan. kami mcmohon pemyataan sikap kami didukung penuh oleh Menteri
WlklLStllitD
Dr. Agung Prasmom, SpB SpBTKV.MARS Kesehatan Rl dan ditcruskan kepada instansi yang terkait.
Bindihira
Dr Barlian Suledja. SpB
Semoga sikap pemyataan ini dapat mensejahterakan rakyat Indonesia dan menjaga mutu
K<HTiijl OTBiniMsi. LagislMi dan Advokasi
pelayanan kasus bedah.
Dr. HN Nazar, SpB
Dr. Chandra Starts. SpB
Demikian surat ini kami sampaikan untuk dipertimbangkan tindak lanjutnya,
Atas kerjasama yang diberikan kami mengucapkan terima kasih.
Dr. Nurtia/al Usman, Sp6 K60
Dr. Erawan Wtradisiina, SpB K8D
Dr. Henry Boyke Silompul, SpB
Hormat Kami,
Dr InztaArtii, SpB
KMIIII globaHsasi & P i w B*b»i

Dr dr Falhema D Rachmal, Spfl SpBTKV
Dr. Huntal Simamora. SpBP-RE Dr. Paid Tahalele 3joni Darmadjaja, SpB
Komisi Komunikasi dan Publlkasi Ketua PP IKABI [ 3n PP IKABI
DR. Dr. Yefla Munad|al. SpB SpBP-RE(K|
Prol. DR. Dr. Sr Maliawan, SpBS (K)
Dr Iskandar Budianla. SpB SpBA
Tembusan:
Komisi Hubunqan D I I O T Ntgeri
Prof DR DrAndiAsadul Islam, SpeS - Dirjen BUK Kemenkes RI
Dr. Boyke Sumantn, SpU
Dr. Emir T Pasaribu SpB.Onk Kepala dinas Kesehatan Propinsi, Kabupaten dan kota
Homlgl Prtayanan Ambiilinc* 118 Ketua Persi Pusat dan Daerah
Dr. ZA Isma, SpB
Dr.AolSatia,Sp6KBD - Ketua KKl
ttriHilil T f i i i m - Ketua PB IDI
DR. Dr. Achrnad Hklayat, Sp6
Dr. B. Surioko, SpB Ketua Asosiasi RS Pendidikan
DR. Dr. Triwahyu Mumi, SpB SpBTKV
Direktur RS Di seluruh Indonesia
Ketua Arsada (Asosiasi RS Daerah)
Ketua ARSI (Asosiasi RS Swasta Indonesia)
Arsip
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I xvii

IKABI
Jl, Kramal R a y a 160, Jakarta P u s a l 10430, Telp & Fax. 021 - 3916774
Websjle: www ikabi.org
Email : ppikabi@yahoo com
Susunan Pengurus PP. IKABI Surat Pemyataan Kesepakatan IKABI dan 10 OPLB
Periode 2012-2014
D w a n Pertlmbanqan
bersama Majelis Kolegium llmu Bedah Indonesia
Prof. Dr. Sjamsuhidajat, SpB.SpB-KBD
Dr. Soerarso htarc^slto, Spe.SpBTKV
Tentang Clinical Previlege dan Clinical Appointment
dalam pelayanan kasus bedah
Prof. Dr. Muchlis Ramli, Sp6{K)-0nk
KttuiPfWtdlum
Prof. DR. Dr. Paul TahaWe, SpB.SpBTKV Dasar Pemikiran:
WifcllKrtuafKrtuiTarolllh Perkembangan ilmu bedah di Indonesia berjalan begitu cepat, selaras dengan itu terjadi
Dr. R. Suharlono. SpBKBV
Wakll K*tua
fragmentasi pelayanan kasus bedah dimana masing-masing disiplin ilmu bedahnya
Prof. DR Dr Surtaryo Hartôwidiolo, SpB SpU berada dibawah otoritas organisasi profesi bedah terkait dan saat ini telah mencapai
K B I U I Pumi 10 organisasi profesi dalam lingkungan bedah ( OPLB ) didalam wadah federasi
Prof. DR. Dr. Suwartdi Sugandi, SpB SpU
IKABI
KetuaJJKlfi]
Prof. Dr. Errol U. Hutagalung, SpB SpOT
Dalam pelayanan kasus bedah, pendekatan holistik seringkali diabaikan dan yang
buldium
Dr. Unp Murted)a, SpB PGD Pal Med, ECU menonjol adaiah fragmentasi tsb. yang mana tidak mcmbawa keuntungan bagi profesi
Dr. Rizal Pohan, SpB SpOT
Dr. Sorar Soni Pamgoro, SpB K.Orli bedah itu scndiri maupun bagi kesejahteraan rakyat Indonesia, bahkan sering terjadi
Or Patrol Muslim, SpU
Dr. Poemodi. SpB SpBA konflik kepentingan yang berdampak pada kesehatan dan keselamatan penderita.
Dr. R Sutiarlono, SpBKBV
Dr. Setyowkli Nugroho. SpB SpBS
Dr. Nurhayat Usman, SpB KBD
Dr Maizul Amiar SpB TKV
Dr. IsharHJono Dachlan, Msc, SpB, SpBP-RE(K)
Konfiik kepentingan yang scmpit dalam pelayanan kasus bedah juga akan merugikan
Sekretaili Jandtnl atau menghambat program pemerintah C/Q Kementrian Kesehatan RI dalam
Dr D|oni Darmadjaja, SpB MARS
mcnsukseskan Program BP.IS 2014 dan Program MRA 2015 serta mungkin juga
Wakll SaktHi
Or. Agung Prasmono, SpB SpBTKV MARS program Kementerian Kesehatan RI lainnya.
BWMMM
li
Dr. Bartian Sutedfa, SpB
Komltl Organlgatl. Lefllalagi dan Advokasi Hal ini perlu dicegah dan dicari jalan keluar demi menjaga martabat dan kehormatan
Dr HN Nazar, SpB
Dr Chandra Svaras, SpB dokter Indonesia sesuai sumpah Hippocrates.
Dr. Nurttayal Usman. SpB KBD Berdasarkan pemikiran diatas. kami para stakeholder IKABI perlu bekerjasama
Dr. Eraww Wradjsufia. SpB KBD
Or. Henry Boyke Sftompul, SpB
Dr. Inzta Arts, SpB
unmk mencapai dan mempertahankan mutu pelayanan kesehatan khususnya di bidang
KWPIJI Globalisasi S Pasar Bibas
pembedahan dalam kerangka menyediakan fasilitas dan pelayanan kesehatan yang
Dr. dr Fathema D Rachmat. SpB SpBTKV
Dr. Hunlal Sirramora, SpBP-RE
layak dalam upaya menyejahterakan masyarakat Indonesia sesuai dengan amanat
UUD'45 pasal 28 H ayat 1 dan pasal 34 ayat 3 serta upaya penjagaan mutu pelayanan
OR. Dr^Wh MuIITcliaL'spB s"paP-RE(K)
Prof. DR. Dr. Sn Maliawar, SpBS (K) kedokteran sesuai amanat UU No.29 tahun 2004 tentang praktik kedokteran pasal 4
Dr. Iskandar Bu{banla. Sp8 SpBA
ayat 1 dan pasal 44 ayat 1
Koffii»i Hubunyin Dalam Hegert
Prol DR. Dr Andi Asadul Islam, SpBS
Dr Boyke Sumanin, SpU
Dr Ermr T Pasanbu SpB Onk
Isi pemyataan kesepakatan:
Komisi Pelayanan Amtailanca 118
Dr ZA Isma, SpB Berdasarkan hal tsb.diatas, Perhimpunan Dokter Spesialis Bedah Indonesia ( I K A B I )
Or Agi Salna, Sp6 KBD
melalui Konker tanggal 27 oktober 2012 di Jakarta bersama 10 anak organisasi OPLB
KombI Trauma
OR. Dr Achmad Hidayat, SpB dan Majelis Kolegium Ilmu Bedah serta Kolegium Ilmu Bedah yang terkait Indonesia
Dr B Sunoko, SpB
DR. Dr. Trtwahyu Mumi, SpB SpBTKV menyatakan bahwa:
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I X I X

IKABI
Jl. Kramal R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774
Website: www.ikabi.org
E m a i l : ppikabi@yahoo.com
Susunan Pengurus PP. IKABI

Periode 2012-2014
1. Perlu ditegakkan ketertiban dan disiplin dalam menjalankan pelayanan kesehatan
Dewan Pertim ban flan
Prol. Df. Sjamsuhidajat, SpB.SpB-KBD disetiap tempat pelayanan kesehatan (rumah Sakit, klinik,poIiklinik ) berdasarkan
Dr. Soerarso Hardjowaslto, SpB.SpBTKV
Majelis Etik APenaselial

kompetensi yang dipunyai oleh masing-masing Dokter Spesialis Bedah sesuai
Prof. Dr. Muchlis Ramli, Sp8(K]-0nk
dengan yang digariskan oleh organisasi profesi bedah yang terkait beserta
Ketua Presldlunn
Prof. DR. Dr. Paul Tahalele, SpB SpBTKV kolegiumnya dalam bentuk clinical privilege (Kewenangan tindak medik sesuai
Wakll Katua/Kfllua Taroilih kompetensi dokter spesialis bedah) yang dipertimbangkan/diterbitkan oleh komite
Dr. R. Suhartono. SpBKBV
medik masing-masing Rumah Sakit.
Wakll Ketua
Prof DR. Df Sunaryo Hard|owidjolo, SpB SpU 2. Clinical previlege yang dimaksud dipakai sebagai pedoman pelaksanaan clinical
Ketua Puma appointment oleh masing - masing Direktur Rumah Sakit diseluruh Indonesia
Prof. DR. Dr. Suwardi Sugandi, SpB SpU
yang sesuai dengan SDM dan sarana - prasarana yang tersedia untuk kepentingan,
Ketua MKtBI
keselamatan dan keamanan penderita.
Prof. Dr Errol U. Hulagalurg, Sp8 SpOT
3. Setiap Dokter Spesialis Bedah yang bekerja di suatu RS harus taat dan mendukung
Presidium
Dr Urip Murtedjo, SpB PGD Pal Med, ECU penuh dalam memajukan pelayanan kesehatan di RS yang terkait dengan membuat
Dr. Rizal Polian, SpB SpOT
Dr Sorar Son Panigoro, SpB K.Onk komitmen berupa pemyataan kesediaan dan kesanggupan secara tertulis untuk
Df Patriot Muslim, SpU
Dr. Poerwadi, SpB SpBA melayani penderita sesuai daftar penyakit/kasus yang disepakati bersama dengan
Dr. R Suhartono, SpBKBV
Dr Setyowidi NugnDho, SpB SpBS direktur RS dalam bentuk clinical appointment dan tidak menyimpang dari daftar
Dr Maizul Anwar. SpBTKV kewenangan yang telah dibuat oleh masing-masing anak organisasi bedah (OPLB)
Dr. Ishandono Dachlan, Msc, SpB, Sp6P-RE(K)
Sakretaris Jenderal
Dr. Djoni IDarniadjaja, SpB MARS didalam Federasi IKABI, bisa lebih banyak atau bahkan mungkin lebih sedikit
Wakll Sekjen
Dr Agung Prasmono, SpB SpBTKVMARS dari jumlah dan jenis kasus yang ditetapkan oleh OPLB-OPLB .
Bendahara
Dr Bariiar Suted|a, SpB
4. Setiap Direktur RS menilai outcome / kinerja Dokter Spesialis Bedah yang bekerja
Komisi OrBanisasi. Legislasi dan Advokasi di dalam RS tsb. dan mengambil langkah2 kebijakan sesuai performance yang
Dr. HN Nazar, SpB
Dr Chandra Svaras, SpB dimnjukkan dokter yang terkait ( menegur atau bahkan melarang melakukan suatu
Komisi Profesi Bedah. Asuransi dan tindakan medis tertentu apabila terjadi penyimpangan dari standar pelayanan yang
Perpajahan
Dr Nurhayat Usman, SpB KBD berlaku atau menyebabkan terjadinya kerugian/ kecelakaan penderita .
Dr, Erawan Wiradlsuria, SpB KBD
Dr Henry Boyke Sitompul, SpB 5. Dalam menerapkan clinical appointment masing-masing disiplin ilmu bedah, para
Dr. Inzta ArCI, SpB
Komisi Globalisasi & Pasar BBIMS

Dokter Spesialis Bedah dihadapkan dengan adanya kasus tumpang tindih baik
Dr. dr Fathema D Rachmat, SpB SpBTKV
Dr. Huntal Simamora, SpBP-RE
interen ( didalam profesi bedah sendiri) maupun eksteren ( dengan disiplin ilmu
Komisi Komunikasi dan Publika?i kedokteran yang lain ). Tumpang tindih kasus bedah tidak bisa kita hindari, namun
DR. Dr Yefta fûnadjat. SpB Sp8P-RE(K)
Prof. DR. Dr Sri Maliawar. SpBS (K) kita harus menghargai dan menghormati bersama termasuk tidak dibenarkan
Dr. Iskandar Sudianta. SpB SpBA
saling melarang atau meng-klaim. Setiap tindakan bedah sehamsnya di dasari
Komisi Hubungan Dalam Neqerl
Prof DR Dr And Asadul Islam, SpBS kompetensi yang telah ditetapkan oleh masing2 organisasi profesi kedokteran
Dr. Boyke Sumanlri, SpU
Dr. Emir T Pasaribu SpB.Onk yang terkait.
Komisi Pelayanan Ambulance 11B
Dr. ZA Isma, SpB
6. Dalam menghadapi kasus tumpang tindih diharapkan ada pengaturan yang tepat
Dr. Agi Satria, SpB KBD
dan bijak dari Direktur RS misalnya dengan membangun kerjasama antar profesi
Komisi Trauma
DR. Dr. Achmad Hidayat, SpB dalam 1 unit kerja ( panitia ad hoc ) atau pengaturan kerja berdasarkan waktu
Dr. B. Suroko, SpB
DR. Dr. Tnwahyu Mumi, SpB SpBTKV setiap hari atau setiap minggu bergantian dalam menangani kasus-kasus yang
sama tetapi berbeda profesinya atau mengadakan diskusi kasus yang sama diantara
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia B XXI

IKABI
Sekretariat: Gedung Wisma Bhakti Mulya-iantai 4 - 401-C
Jl. Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax, 021 - 3916774
Websile: www.1kabi.org

Periode 2012-2014 para dokter yang terkait berdasarkan modul pembelajaran dan pencapaiannya
Oewan Pertimbangan seharusnya sama, dimana modul - modul tersebut telah diterbitkan oleh masing-
Prof. Dr. Siamsuhidajat, SpB.SpB-KBD
Dr Soerarso Hardjowasilo, SpB.SpBTKV masing Kolegium Ilmu Bedah.
M^lelis Ellk&Penasehat 7. Selain penanganan kasus tumpang tindih, pengaturan clinical privilege oleh Komite
Prof. Dr Muchlis Ramli, SpB(K)-Onk
Ketua Presidium
Medik dan ciinical appointment oleh Direktur Rumah Sakit juga akan berdampak
Prof. DR. Dr. Paul Tahalele, SpB SpBTKV
pada pemerataan jasa pelayanan medis yang telah ditetapkan berdasarkan
Wakll Ketua/KetuaTerpilih
Dr R. Suliartopo, SpBKBV pengaturan atau ketentuan BPJS secara adil dan proporsional
Wakll Ketua 8. Kami mendukung sepenuhnya Program Pemerintah C/Q Kemenkes RI antara lain
Prof. DR. Dr. Sunaryo Hardjowidjoto, SpB SpU
menyukseskan pelaksanaan BPJS 2014 dan MRA 2015 serta program-program
Ketua Puma
Pml OR. Dr Suwandi Sugandi. SpB SpU yang lain.
Prof. Dr. Erroi U. Hutagalung, SpB SpOT 9. Apabila terjadi permasalahan sebagai akibat diterapkannya clinical previlege &
Presidium clinical appointment, kami organisasi profesi kedokteran IKABI beserta 10 OPLB
Dr Urip Murtedjo, SpB PGD Pal Med, ECU
Dr. Rizal Pohan, SpB SpOT bersedia turut menyelesaikan sesegera mungkin setclah mendapat laporan dari
Dr. Sonar Soni Panigoro, SpB K.Oni<
Dr Patriot Muslim, SpU Direktur RS yang terkait, atau laporan dari pihak lainnya
Dr. Poenwadi, SpB SpBA
Or. R Suhartono, SpBKBV 10. Pemyataan kesepakatan ini disertai lampiran daftar kompetensi dari 10 OPLB dan
Dr Setyowidi Nugroho, SpB SpBS
Or Nurhayat Usman, SpB KBD diharapkan dapat mendukung serta mempercepat akselerasi tercapainya masyarakat
Dr. Maizul Anwar, SpB TKV
Dr Ishandono Dachlan, Msc, SpB, Sp8P-RE(K) Indonesia sehat dan sejahtera serta menjaga mutu pelayanan kesehatan.
Sekretaris Jenderal
Dr Djoni Darmadjaja, SpB MARS
Dr. Agung Prasmono, SpB SpBTKV.MARS
Dr. Barlian Suledja, Sp8

Komlil Organisasi. Legislasi dan Advokail
Or. HN Nazar. SpB
Or. Chandra Si/aras. SpB
Komisi Profesi Bedah. Asuransi dan
Peiyalakan
Dr. Erawan Wiradlsuria, SpB KBD
Dr. Henry Boyke Sitompul, SpB
Dr Inzta Arbi, SpB
Komisi Globalisasli Pasar Bebas

Or dr. Fathema D Rachmal. SpB SpBTKV
Dr Huntal Simamora, SpBP-RE
Komisi Komunikasi dan Publlkasi

OR. Dr. Yefta Munadjal, SpB SpBP-RE(K)
Pml. DR. Dr. Sri Maliawan, SpBS fK)
Dr, Iskandar Budianla, SpB SpBA
Komisi Hubungan Dalam Negerl

Prof DR Dr Andi Asadul Islam, SpBS
Dr. Boyke Sumanlri, SpU
Df Emir T Pasaribu S|^,Onk
Komisi Pelayanan Ambulance 118

Dr. ZA Isma. SpB
DrAgi Satria, SpB KBD
Komisi Trauma
DR. Dr Achmad Hidayat, SpB
Dr. B Sunoko, SpB
OR. Dr. Triwahyu Mumi, SpB SpBTKV
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I xxili

IKABI
Jl, Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774
Website, www.ikabi.org
Email ppikabi@yatioo.cam
Susunan Pengurus PP IKABI Jakarta, 27 Oktober 2012

Periode 2012-2014
Q w a n Pw1lmbMig*n
Prof Or Siamsuhidajat, SpB.SpB-KBD
Dr Soerarso Hard|Owasito, SpB.SpBTKV
Yang bertanda tangan dibawah ini adaiah Ketua PP IKABI dan para Ketua 10
Manila Ellk a Peniiehal OPLB serta Ketua Majclis Kolegium Ilmu Bedah Indonesia dan para Ketua 10
Prof. Dr Muchlis Ramli, SpB(Kl-Onli
Kolegium Ilmu Bedah Indonesia :
KmitEnttMlum
Prof. OR Or Paul Tahalele, SpB.SpBTKV
WiKIIKilutf<rtuiTtrplllh 1. Ketua PP IKABI Paul Tahalele

2. Ketua PABI Urip Murtedjo
Prof. DR. Dr. Sunaryo Hardjowidfoto, SpB SpU
3. Ketua IKABDI Nurhayat Usman
Kilua Puma
Prof. DR. Or. Suwandi Sugandi. SpB SpU 4. Ketua PERABOI Sonar Panigoro
5. Ketua PESBEVI R Suhartono
prof. Dr Errol U. Hutagalung, SpB SpOT
6. Ketua PABOI Rizal Pohan
Df. Urip Murtedjo, SpB PGD Pal Med, ECU
Dr. Rizal Ponan, SpB SpOT
7. Ketua lAUI Chaidir Mochtar
Dr Sonar Som Panigoro. SpB K Onli
Dr Patnol Muslim, SpU
8. Ketua PERSPEBSI Setyo Widi Nugroho
Dr. Poenivadi SpB SpBA
Dr. R Suhanono, SpBKBV
9. Ketua PERBANI Purwadi
Dr. SelyowHJi Nugroho, SpB SpSS
Dr. Nurhayat Usman, SpB KBD 10. Ketua PERAPI Asrofi S SUrachman
Dr. Maizul Arwar, SpB TKV
Dr. Ishandono Oachlar, Msc, SpB, SpBP-RE(K) 11. Ketua HBTKVI Maizul Anwar
Sekretirii Jendir i l 12. Ketua MKIBI Errol U Hutagalung
Dr Djoni Dam^djaja. SpB MARS
13. Ketua KIBI Aryono D Pusponegoro
WMtl<Si<()wi
Or. Agung Pravnono, SpB SpBTKV.MARS 14. Ketua Kolegium Ilmu Bedah Digestif Benny Philipi
Dr. Badiar Sutedja, SpB
15. Ketua Kolegium Ilmu Bedah Onkologi Dimyati Achmad
Komlil Organiiwl. Legislasi dan Advokisi 16. Ketua Kolegium Ilmu Bedah Vaskuler Hilman Ibrahim
Dr. HN Nazar, SpB
Dr. Chandra Svaras, SpB 17. Ketua Kolegium Ilmu Bedah Orthopaedi Errol U Hutagalung
Kwnlsl Profisi Bettah. Atunnil d m 18. Ketua Kolegium Ilmu Bedah Urologi Rayni Umbas
Perp^kin
Dr. Nurhayat Usman, SpB KBD 19. Ketua Kolegium llmu Bedah Plastik, Rekonstruksi David Perdana K
Dr. Erawan Wiradisuna, SpB KBD
Dr. Henry Boyke Silompul, SpB dan Estetika
Dr Inzta Arbi, SpB
HomliiQIolwliHtl&PiHrBttm
20. Ketua Kolegium Ilmu Bedah Saraf Padmosantjojo
Or dr. Fathema 0 Rachmat, SpB SpBTKV
Dr. Hunlal Simamora, SpBP-RE 21. Ketua Kolegium Ilmu Bedah Anak Amir Thayeb
Komisi Kamunikasi dan P u b l l k i » l 22. Ketua Kolegium llmu Bedah Toraks Kardiak dan Jusuf Rahmat
DR. Dr. Yefta Munadjat, SpB SpBP-RE(K)
Prof. OR. Or Sr Maliawar. SpBS (K) Vaskuler
Dr. Isitandar Budianla, SpB SpBA
Komlii Hubungin Dilam Htgerl

Prof DR. Dr Ardi Asadul Islam, SpBS
Or. Boyke Sumanin, SpU
Or. Emr T PasanlHj SpB.Onk
Komisi Pelayanin Amhu^•n^:^ 1 H

Dr. ZA isma, SpB
Or Agi Satra, SpB KBD
HOTIHIIIMHI
OR. Or Achmad Hidayat. SpB
Dr B. Sunoko. SpB
DR. Or. Triwahyu Mumi, SpB SpeTKV
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I XXV

IKABI
Jl. Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax, 021 - 3916774
Email ppikabi@yatioo.eom
Susunan Pengurus PP IKABI Jakarta, 27 Oktober 2012

Periode 2012-2014
Dawan Pertim banaan Demikian pemyataan ini kami buat dengan sebenamya.
Prof. Df Sjamsuhidaial. SpB SpB-KBD
Dr Soerarso Hardjowasilo, SpB SpSTKV
WajelisEtlkSPenasehat
No. OPIB KETUA
Prof. Dr Muctihs Rarrli, SpB|KJ-Onli
Ketua Preskllum
PP IKABI
Prof. OR. Dr. Paul Tatialele. SpB SpBTKV
Wakll Kelua/Ketua Terpllih

Dr. R. Suharlono, SpBKBV
PP PABI
VHMiKetm
Prof DR. Dr. Suraryo Hardjowidjolo. SpB SpU
PP IKABDI
KBtua Puma
Prof. OR. Or Suwandi Sugandi. SpB SpU
Ketua MKIBI PP PERABOI 3 JOM^ S'(fAî<î^

PKif. Dr Etrol U Hutagalung, SpB SpOT
Presidium
Dr Urip MuftedfO, SpB PGD Pal Med, ECU PP PESBEVI
Dt Rizal Potian. SpB SpOT ^ p.. SUHARTOtÔ
Or Sonar Soni Panigoro, SpB K.Orli
Df. Patriot Muslim. SpU
Dr Poenwadi, SpB SpBA
Dr R Sufiarlono, SpBKBV PP PABOI
Dr. Setyowidi tûgroho, SpB SpBS
Dr Nuftwyal Usman, SpB KBD
Dr Maizul Anwar, SpBTKV
Dr. istandono Dacfilan. Msc, SpB, Sp6P-RE(K)
PP lAUl
Or. Djoni Dwmadja)a, SpB MARS
Wakil Sekjen
Dr Agung Prasmono, SpB SpBTKVMARS PP PERSPEBSI
Dr Barlian SulBd|a. SpB
Kwnlsl Ofganlsisi. leaislaii dan Advokasi PP PERBANI

Dr. HN Nazar. SpB
Dr. Chandfa Svaras. SpB
Komisi Profeii Bedah. Asuransi dan PP HBTKVI

Perpajakan
Dr. Nurhayal Usman, SpB KBD
Or. Erawan Wiradisuria, SpB KBD
10 PP PERAPI
Or. Henry Boyke Silompul, SpB dir.
Dr Inzta ArtH, SpB
Komlil Globallsasi A Pilar Bebas

Dr. dr Falhema D Rachmal, SpB SpBTKV
Komisi Komunikasi dan Publikasi

DR Dr Yefta Munadjat, SpB SpBP-RE(K)
Prof DR. Dr Sri Maliawan, SpBS (K)
Or iskandar Budianta, SpB SpBA
Hubungan Dalam I
Prof DR DrAndiAsadul Islam, SpBS
Dr. Boyke Sumantri, SpU
Dr Emir T Pasanbu SpB.Onk
Komlil PetayafMn Ambulanca 118

Or ZA Isma. SpB
DrAgi Satra, SpB KBD
Komlil Trauma
DR. Dr. Achmad fWayal. SpB
Dr. B. Sunoko, SpB
DR Dr Tnwahyu Mumi, SpB SpBTKV
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I XXVII

IKABI
Sekretariat: Gedung Wisma Bhakti Mulya-iantai 4 - 401-C
Jl Kramat R a y s 160, Jakarta P y s s t 10430. Telp & Fax. 021 - 3916774
Website: www.iKabi.org
Susunan Pengurus PP IKABI

Periode 2012-2014 MAJELIS KOLEGIUM ILMU
\)v*t*n Partlmbangan Kelua
Prof. Dr Sjamsufiidaiat, SpB.SpB-KSD
Dr. Soerarso Hardiowasito, SpB SpBTKV
BEOAH UMUM INDONESIA
Mi|ill» EHk a Penaaehel
Prof. Dr. Muchlis Ramli. SpB(K)-Onk
Ketua PrtBldlum
Prol. DR. Dr. Paul Tahalele, SpB.SpBTKV
Wakll KetuafKatuaTaroiilh KOLEGIUM ILMU

Dr. R. Suhartono, SpBKBV
BED AH INDONESIA
Prof, DR, Or Sunaryo Hardjowidjolo. SpB SpU a. Koi^fum Ihrni »- fHiUpri
Katui Puf ni Bedah D«Mt»f
Prof. OR. Or. Suwandi Sugandi, SpB SpU
b. Kot^him llmu
Prof. Or, Errol U, Hutagalung, SpB SpOT Bedah Onkologi
l^miJlum c Kolegium flmu
Dr. Urip Muftfldjo, SpB PGD Pal Med. ECU
Dr. Rizal Pohan. SpB SpOT Bedah Vaskuler &
Dr. Sonar Soni Panigoro, SpB K.Onk
Dr Patnol Muslim, SpU Endovaskuler
Dr. Poerwadi, SpB SpBA
Dr. R Suharlono, SpBKBV Kolegkim llmu
Or. Setyowidi Nugroho, SpB SpBS
Or Nurhayal Usman, SpB KBD
Orthopaedi
Dr Ishandono Dachlan, Msc, SpB. SpBP-RE(Kj
Kolegium llmu
SekretirliJendenl
Urologi
Dr Djoni Damiadjaja. SpB MARS
WiUIMbm
Kolegium flmu Bedah
Or Agung Prasmono, SpB SpBTKV MARS
Ptastik, Rekonstruksi
Buulitiiri dan Estetika
Dr Barlian Suledja, SpB
Komisi OfganNfsl. Iêglslasl dan Advokail Kolegium llmu Bedah
Dr. HN Nazar, SpB
Dr Chandra Svaras, SpB
Saraf
Vkm\l>\ PnM Asuransi dan Ktriegium Iknu Bedah ^ i>r hworWt^cW 9y^1fM
Perpajakan
Or, Nurtieyat Usman, SpB KBD Anak
Dr. Erawan Wiradisuria, SpB KBD
Dr Henry Boyke Sitompul, SpB Kolegium Ibmi Bedah
Or Inzta Arbi, SpB
Toraks Kardiak dan
Komisi Globallsasi A Pasar Bebis
Or df. Fathema D Rachmat. SpB SpBTKV Vaskuler
Dr, Huntal Simamora. SpBP-RE
Komisi KomunlliMt din Publlhisl

DR. Dr YeflB Munadjat. SpB SpBP-RE(K]
Prof. OR, Dr Sri Maliawan, SpBS (K)
Dr. Iskandar Budianla, SpB SpBA
Komlii Hulmngan Dalam Hufirl

Prof DR, Df, Andi Asadul Islam, SpBS
Dr Boyke Sumanin. SpU
Dr. Emir T Pasaribu SpB.Onk
Kwnlil P t l i y n i n AmbulMHina
Or ZA Isma, SpB
Dr Agi Satria. SpB KBD
Komisi Trauma
DR. Dr Achmad Hidayat, SpB
Dr. B. Sunoko, SpB
OR. Or Tnwahyu Mumi, SpB SpBTKV
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I xxlx

Tata Cara Pembuatan Surat Penugasan Klinis dan
White Paper Berdasarkan Rincian Clinical Previlege dan
Clinical Appointment Dokter Spesialis Bedah Indonesia
1. Kerangka Dasar Pembuatan Surat Penugasan Klinis

1.1 Kewenangan tindak medik dalam pelayanan kesehatan yang tertera didalam undang-undang No. 29
tahun 2004 tentang Praktek Kedokteran berdasarkan amanat UUD.45 pasal 28 H ayat 1 dan pasal 34
ayat 3 tentang upaya mensejahterakan masyarakat Indonesia
1.2 Profesi yang mengacu pada standar pendidikan dan modul pembelajaran yang diterbitkan oleh Kolegium
Ilmu Bedah masing-masing Organisasi Profesi Kedokteran dalam Lingkungan Bedah (OPLB) yang
disyahkan oleh K K l
1.3 Standar Kompetensi dan Standar Pelayanan yang disusun oleh Organisasi Profesi Kedokteran OPLB
1.4 Standar Etik atau Kode Etik yang dikeluarkan oleh Majelis Kehormatan dan Etika Kedokteran
(MKEK)
1.5 Standar akreditasi Rumah Sakit Versi 2012
1.6 Visi,Misi,Azas dan Tujuan IKABI 2012
1.7 Sepuluh kesepakatan (10) OPLB dan Kolegium Ilmu Bedah yang terkait pada KOnker IKABI 27
Oktober 2012
2. Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia diberikan kepada dokter masing-masing
sebagai staf medis di rumah sakit yang terkait dengan rincian kewenangan klinik yang meliputi:
1.1 Penegakkan diagnosis penyakit bedah sesuai klasifikasi ICD 10 (anamnesis dan pemeriksaan klinik yang
terarah,dilengkapi dengan pemeriksaan penunjang seperti laboratorium,pencitraan USG, ekokardiografi,
ecg, endoskopik,biopsy/FNAB,dll).
1.2 Memberikan terapi dalam bentuk tindakan bedah dan non bedah (kasus bedah tanpa operasi seperti
tetanus,trauma capitis, trauma toraks, trauma abdomen, kolik abdomen, dll), termasuk terapi penunjang
yang lain (pemberian antibiotika rasional, analgesik, nutrisi, cairan elektrolit, terapi kemo, dll).
1.3 Melakukan perawatan kasus bedah akut dan elektif serta kasus bedah kronik
1.4 Mendeteksi dan menangani komplikasi durante dan pasca operatif
1.5 Melakukan terapi rehabilitasi kasus bedah dan follow upnya.
1.6 Member! konsultasi, informasi,edukasi (KIE) pada pasien maupun keluargannya
1.7 Mencatat semua proses asuhan medis pada semua kasus bedah dalam dokumen rekam medis.
1.8 Sebelum melakukan semua tindakan bedah invasif & non invasif harus membuat informed consent yang
ditandatangani bersama dokter & penderita/keluarganya.
1.9 Dalam melaksanakan setiap prosedur tindakan bedah harus mengikuti standar patient safety, misalnya:
time out sebelum melakukan tindakan medis.
1
3. Bagan Alur Pengajuan Pembuatan Surat Penugasan Klinis (White Paper)
3.1 Dokter yang telah bekerja disuatu rumah sakit
Dokter,Staf medis ybs. Membuat secara tertuHs rincian kewenangan tindak medis
sesuai acuan Organisasi Profesi Kedokteran OPLB dan
Kolegium llmu Bedah yang terkait
Rincian tertulis tsb. diajukan kepada Ketua SMF llmu
Bedah
V
Ketua SMF l.Bedah Melakukan penelitian kebenaran dokumen yang berisi
kompetensi dokter ybs. serta menyepakati tindak medis yang
dapat dilakukan dokter ybs. di SMF I. Bedah
Semua dokumen diajukan kepada Komite Medis Rumah
Sakit
V
Komite Medis RS Melakukan verifikasi dan validasi serta evaluasi akhir semua
Sub Komite Kredensial dokumen dokter ybs.
Memberi rekomendasi kepada Direktur Rumah Sakit
V
Direktur Rumah Sakit Bersama dokter ybs. menandatangani berita acara yang berisi
rincian kewenangan klinik yang telah disepakati berdasarkan
rekomendasi Komite Medis
Menerbitkan surat Penugasan Klinis kepada dokter ybs.
V
Dokter,Staf Medis ybs. Menyerahkan surat Penugasan Klinis kepada Ketua SMF
1. bedah
2 I Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

3.2 Dokter Baru yang akan melamar bekerja disuatu rumah sakit
Dokter ybs. Melamar ke Direktur RS dengan tembusan ketua SMF

l.Bedah
Membawa surat penempatan
Membuat secara tertulis rincian kewenangan tindak medis
sesuai acuan Organisasi Profesi Kedokteran OPLB dan
Kolegium Ilmu Bedah yang terkait
V
Direktur R.S. Menyerahkan semua dokumen lamaran dan surat
penempatan serta dat\ar rincian kewenangan tindakan
medis kepada Komite Medis RS
V
Komite Medis R S Melakukan verivikasi dan validasi
Memberi rekomendasi kepada Direktur RS
Panitia Kredensial
V
Bersama dokter ybs.menandatangani berita acara yang
Direktur Rumah Sakit
berisi rincian kewenangan klinik yang telah disepakati
berdasarkan rekomendasi Komite Medis
Menerbitkan surat Penugasan Klinis kepada dokter ybs.
V
Dokter, ybs. Menyerahkan surat penugasan klinis kepada Ketua SMF
Lbedah
1 - Tata Cara Pembuatan Surat Penugasan Klinis I

Penyangkalan atau disclaimer
Buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini adaiah merupakan rangkuman dari
sejumlah tindakan medis yang dapat dilakukan oleh dokter spesialis bedah Indonesia yang mengacu pada standar
pelayanan medis 10 organisasi Profesi Kedokteran dalam Lingkungan Bedah (OPLB), yang dapat dijadikan
acuan atau pedoman oleh rumah sakit dalam hal ini adaiah Direktur rumah sakit bersama Komite Medis rumah
sakit dalam menerbitkan surat penugasan klinis pada setiap dokter spesialis bedah, staf medis yang ada di rumah
sakit tersebut.
Buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini tidak berisi informasi rincian secara
lengkap tentang setiap tindakan bedah seorang dokter spesialis bedah Indonesia. Setiap kasus/penyakit bedah yang
ditangani memerlukan ketersediaan sarana/fasilitas kesehatan maupun alat kesehatan pendukung, hal tersebut
sangat bervariasi termasuk ketidaklengkapannya atau ketidaksempumaannya.
Buku ini tidak menghilangkan hak Direktur rumah sakit untuk memberikan penugasan klinis yang melebihi
ataupun mengurangi dari daftar yang ada kepada staf medis rumah sakit, tergantung situasi yang dihadapi rumah
sakit dalam pengadaan SDM medis, termasuk pemberian kewenangan klinis tindakan pembedahan kepada dokter
spesialis bedah umum atau dokter umum yang telah dilatih dan diberi kompetensi tambahan (setelah melalui
konsultasi dan koordinasi dengan Komite Medis rumah sakit).
Buku ini tidak memberikan jaminan atas keberhasilan suatu tindakan operasi dengan hasil yang baik, sempuma
dan memuaskan bagi penderita karena tingkat kesulitan penanganan diagnostik maupun terapi bedah setiap
kasus bedah terutama kasus yang sulit sangat bervariasi, maka disarankan di antara para dokter yang terlibat
pada penanganan suatu kasus bedah untuk bekerja sama secara tim dan atau melakukan konsultasi dan rujukan
(mjukan pasien, rujukan ilmu dan rujukan dokter ahli), apabila dokter yang bersangkutan merasa tidak menguasai
atau ragu dalam menegakkan diagnostik maupun terapi bedah. Untuk melengkapi dan menyempumakan mutu
pelayanan kesehatan kepada penderita bedah diperlukan juga buku Pedoman Nasional Praktek Kedokteran
(PNPK), Standar Pelayanan Medis, Panduan Praktek klinik (PPK), Clinical Pathway, Clinical Guidelines, standar
prosedur operasional (SPO), dan Iain-lain.
Apabila terjadi suatu kejadian akibat tindakan dokter hal itu, mempakan tanggungjawab dokter yang bersangkutan
dan Direktur Rumah Sakit.

IKABI
Jl. Kfamat Raya 160. Jakarta Pusat I M S O , Telp & Fax. 021 - 3916774
E m a i l : ppikabi@yatioo.com

Periode 2012-2014
BERITA ACARA
Dewan Pertimbangan
Prof Dr. Sjamsutiidaial, SpB SpB-KBD
Dr. Soerarso Hardjowasilo. SpB.SpBTKV
Yang bertanda tangan dibawah ini
Majelit Ellk t Panatahat Nama : Dr Urip Murtedjo, SpB.PGD Pa! Med, ECU
Prof Dr. Muchlis Ramli, SpB(K|-Onk
Jabatan : Ketua PABI
Ketua PfeakMum
Prof DR Dr Paul Tahalele. SpB.SpBTKV Periode 2010-2014
Dr R. Suhartono, SpSKBV
Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PABI

Prof. DR. Dr Sunaryo Hardjowidioto, SpB SpU
kepada :
Katua Puma
Prof. DR. Dr. Suwandi Sugandi, SpB SpU

Nama : Dr Djoni Darmadjaja, SpB.MARS
KatuLMKIBI
Jabatan : Sekretaris Jenderal IKABI
Prof. DI. Emol U. Hutagalung. SpB SpOT
Periode 2012-2014
Dr Urip Murtedjo. SpB PGD Pal kted. ECU
Dr Rizal Pohan. SpB SpOT
Or Sonar Sara Panigoro, SpB K.Onk
Dr Patriot Mu5lim, SpU Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr R Suhartono. SpBKBV Bedah Indonesia.
D' Setyowidi Nugroho. SpB SpBS
Dr Nurtiayat Usman. SpB KBD
Dr M a « u l Anwar. SpB TKV
Dr. Ishandono Dachlan. Msc. SpB, SpBP-RE{K}
Jakarta,
Seltfttiris Jenderal 11 Februari 2013
Dr. Djoni Darmadj^, Sp8 MARS
Wakil Stktan
Bendahara
Dr Barlian Sutedja, SpB
Komiti Organitaal. Leglilail dan Advokasi Dr. Urip Murtedjo, SpB.PGD Pal Med, ECU Dr. Djoril Darmadjaja, SpB.MARS
Dr HN Nazar. SpB
Dr Charxlra Svaras SpB Ketua PABI Sekjen IHABI
Komlal Profeei Bedah. Aauransi dan
Pefp^lakan
Or. Nurhayat Usman, SpB KBD
Dr Erawan Wiradisuna. SpB KBD
Or Henry Boyke Sitompul, SpB
Dr Inzta Arbi, SpB
Komlil Globallwl t, Paaar Bebai

Dr dr Fathema D Rachmal. SpB SpBTKV
Dr Huntal Simamora. SpBP-RE
Konrtil ttoimintoil dan PuMikaU

DR. Dr. Yalta MunadjaL Sp6 SpBP-RE(K)
Prof. OK. Dr. Sn Maliawan, SpBS (K)
Dr Iskandar Budianta, SpB SpBA
Komlil Hnt)tjpajp Dalam Nageri

Prot DR Dr Andi Asadul Islam, SpBS
Df. Boyke Sumantri, SpU
Dr. Emir T Pasanbu SpB.Onk
Komlil Palavanan Amtwlance 118

Dr. ZA Isma. SpB
Dr.AgiSalha.SpB KBD
Komtei Trauma
OR. Or Achmad Hidayat, SpB
Dr B. Sunoko. SpB
DR Dr. Tnwahyu Mumi, SpB SpBTKV
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I 5

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIK
DOKTER SPESIALIS BEDAH UMUM

(PABI)
DAN TUMPANG TINDIH TINDAKAN
DENGAN DOKTER SPESIALIS BEDAH
YANG LAIN
DAFTAR KOMPETENSI & KEWENANGAN K L I N I K
D O K T E R SPESIALIS BEDAH UMUM (PABI)
DAN TUMPANG TINDIH TINDAKAN
DENGAN D O K T E R SPESIALIS BEDAH YANG LAIN
Jenis Tindakan Dokter Spesialis Bedah Umum

NO ICD.9 C M
Bidang Bedah Digestif
t Laparotomi 54.1
2 Torako-laparotomi (darurat) 34.02 + 54.11
3 Penutupan perforasi usus kecil & besar 46.73,46.75
4 Pembuatan stoma (gastrostomi, ileostomi, sigmoidostomi, 43.19, 46.21,46.10, 46.41
jejunostomi)
5 Rektoskopi/Anuskopi 48.29,49.21
6 Laparoskopik diagnostik. (darurat) 54.2!
7 Reseksi dan anastomosis usus kecil & besar 45.3,45.8,45.90
8 Penanggulangan trauma hepar (darurat): hepatorafi & hepatektomi 50.61,50.4, 50.22
9 ' Splenektomi (total & parsial) 41.5,41.43
10 Drenase pankreatitis (darurat) 52.01
11 Pankreatektomi (partial & darurat) 52.6, 52.59, 52.7
12 Eksleriorisasi usus kecil & besar 46.01,46.03
13 Appendektomi terbuka 47.0
14 Appendektomi laparoskopik 47.01
15 Kolesistektomi terbuka 51.22
16 Kotesistektomi laparoskopik 51.23
17 Gastroenterostom i 43.7,44.39
18 Gastrektomi (partial) 43.89
19 Hemikolektomi (kiri & kanan) 45.73,45.75
20 Hemiotomi (Inguinal, Femoralis, Umbilikal) 53, 53.0, 53.1,53.2, 53.3,53.4
21 Hemoroidektomi 49.4, 49.46
22 Fistulektomi, fistulotomi (Fisura ani) 49.12,49.11
23 Operasi Miles 48.5
24 Operasi Hartmann 45.75
25 Reseksi Anterior sigmoid 45.76
26 Pasang *'T" tube saluran empedu 51.43
27 RouxenY anatomosis usus kecil 45.91
28 Bypass enterotomi (usus kecil & besar) 45.02,45.03

NO ICD-9CM
Bidang Bedah Anak
29 Laparotomi 54.1
30 Toraks - laparotomi 34.02 & 54.11
31 Penutupan perforasi usus kecil & besar 46.73,46.75
32 Pembuatan stoma (gastrostomi, ileostomi, sigmoidostomi. 43.19,46.21,46.10, 46.41
jejunostomi)
33 Operasi hernia diafragmatika traumatik (abdominal approach, thoracic 53.7, 53.8
approach)
34 Selioplasti 54.71
35 Hemiotomi (Inguinal, Femoralis, Umbilikal) 53, 53.0, 53.1,53.2, 53.3, 53.4
36 Ligasi tinggi hidrokel (round ligament, spermatic cord, tunica 56.19,63.1,61.2
vaginalis)
2 - Berita Acara PP PABI dan PP IKABI I 9

Jenis Tindaltan Dokter Spesialis Bedali Umum
ICD-9 C M
Bidang Bedah Anak
37 Operasi invaginasi (laparotomi, millcing, reseksi usus, 54.11, 46.80, 45.62/45.79, 47.0
appendectomy)
38 Operasi tumor retroperitoneal 54.4
39 Operasi PSARP lerbatas 49.79
40 Operasi omfalokel - siloplasti 53.49, 53.41 (dengan prostesis)
41 Operasi kriptorkhismus - orchidopexy 62.5
42 Operasi hipospadia 58.45
43 Repair Hernia diafragmatika kongenital/kel. Diafragma kongenital 53.7, 53.8
44 Operasi Willems tumor - nefrektomi 55,51 (unilat), 55.54 (bilat)
45 Anoplasti sederhana (cut back) 49.79
46 Circumsisi 64.0 (pria), 71.4 (wanita)
47 Operasi piloromiotomi 43.3
48 Spleenektomi (total & parsial) 41.5,41.43
49 Detorsi torsi testis & orkidopeksi 62.5
50 Anastomosis tarik trobos 48.65
51 Operasi kelainan umbilikus - hernia umbilikus 53.4
52 Eksisi higroma 40.29
53 Eksisi limpangioma 40.29
54 Appendektomi 47.0,47.01 (laparoskopik)

NO ICD-9 C M
Bidang Bedah Onkologi
55 Biopsy insisional/biopsy of breast 85.1! (close), 85.12 (open)
56 Ekstirpasi tumor jinak mamma 85.41
57 Ekstirpasi tumor jinak kulit/jaringan lunak lainnya 86.3
58 Ekstirpasi tumor jinak parotis 26.30
59 Salphingo oophorektomi bilat pada kanker payudara 65.61
60 Mastektomi simpleks 85.4! (unilat), 85.42 (bilat)
61 Mastektomi subkutaneus 85.34
62 Mastektomi radikal 85.45 (unilat),85.46 (bilat)
63 Modifikasi mastektomi radikal 85.43
64 Strumektomi (lobectomy & thyroidectomy) 06.2 (L-total), 06.4 (T-total),
06.39 (LAT-parsial) '
65 Tiroidektomi pada Ca 06.4 (total), 06.39 (parsial)
66 Radikal neck dissection (RND) (classical) 40.40
67 Parotidektomi 26.30, 26.32 (complete-radical),
26.31 (parsial)
68 Operasi tumor jaringan lunak 83.49
69 Eksisi luas dan rekonstruksi sederhana (breast) 85.2 &85.7/85.8 (breast)
70 Flap-rekonstruksi kulit/otot 86.89 (kulit),3.83 (tendon)
71 Kemoterapi dan terapi paliatif yang lain 99.25
72 Pemasangan kemoport 38.93

NO. ICD-9 C M
Bidang Bedah Kepala-Leher
86.28, 86.5, 86.6-8
73 Tindakan pada trauma jaringan lunak wajah (debridement, jahit,
rekonstruksi) 31.1
74 Trakheostomi 76.75, 76.76
75 Repair fraktur mandibula .h;r;> -j-tsi'sxi^ 76.73, 76.74
76 Repair fraktur maksila 76.71,76.72
77 Repair fraktur zigoma

Jenis Tindakan Dokter Spesialis Bedah ITmum
ICD-9 C M
Bidang Bedah Kepala-Leher
78 Repair fraktur nasal 21.71,21.72
79 Biopsi insisional/biopsi cubit (soft tissue) 83.21
80 Biopsi kelenjar getah bening 40.11
81 Ekstirpasi kista duktus tireoglosus : ;•i 06.7
82 Ekstirpasi tumor jinak parotis 26.30
83 Strumektomi (lobectomy & thyroidectomy) 06.2 (L-total), 06.4 (T-total),
06.39 (L/T-parsiai)
84 Tiroidektomi pada Ca 06.4 (total), 06.39 (parsial)
85 Radikal neck dissection (RND) (classical) 40.40
86 Parotidektomi 26.30, 26.32 (complete-radical),
26.31 (parsial)
87 Operasi tumor jaringan lunak (kista dermoid, higroma leher, dll) 83.49 -
88 Eksisi luas dan rekonstruksi sederhana (skin/subcutaneous tissue) 86.2 & 86.5-86.8 (skin/
subcutaneous tissue)
89 Hemiglossektomi 25.2
90 Reseksi mandibula 76.31 (parsial), 76.42 (total),
76.4! (dengan rekonstruksi)
91 Eksisi tumor jinak rongga mulut 27.49
92 Eksisi & marsupialisasi ranula 26.2,26.21
93 Eksisi kista bronkiogenik 32.09,32.01 (endoskopik)
94 Mandibuiektomi marginalis 76.3! (parsial), 76.42 (total),
76.41 (dengan rekonstruksi)
95 Ekskokleasi kista rahang 22.62
96 Flap rekonstruksi kulit/otot 86.89 (kulit), 3.83 (tendon)
97 Labioplasti 27.54
98 Palatoplasti 27.6
99 Insisi abses maksilofasial 86.04
! 00 Insisi flegmon dasar mulut 27.0
101 Eksisi Makroglosia 25.1
102 Prenolektomi pada tongue tie 25
103 Release tortikolis (Reseksi M . Stemocleidomastoideus) 83.45
104 Kemoterapi 99.25
ICD-9 C M
Bidang Bedah Toraks Kardiak Dan Vaskular
105 Torakotomi (darurat) 34.02,34.11
106 Fiksasi internal iga . 79.39
107 Pemasangan WSD/drainase toraks 34.04
108 Perawatan trauma toraks konservatif
109 Rekonstruksi vaskular perifer (trauma) 39.59
110 Perikardiosenlesis terbuka (darurat) 37.0
111 Reseksi iga 77.91
112 Simpatektomi torakal 05.2
113 Simpatektomi lumbal/simpatektomi periarterial 05.23
114 Stripping varises, eksisi varises, ligasi - komunikan 38.5
115 Operasi A-V shunt (Brecia - Cimino) 39.27
116 Operasi jendela toraks 39.59
117 Perawatan varises non bedah (injeksi skleroterapi) 39.92
118 Operasi aneurisma perifer 39.52
119 Debridement, amputasit gangren diabetik atau penyakit y.I. 84.91
120 Eksisi hemangioma 38.6
121 Embolektomi perifer darurat 38.0

Jenis Tindaltan Dokter Spesialis Bedali Umum
ICD-9 C M
Bidang Urologi
122 Punksi buli - buli/sistostomi 57.1
123 Kateterisasi/businasi 57.94
124 Nefrektomi 55.51 (unilat), 55.54 (bilat)
125 Repair urehtra, ureter, ginjal (trauma) 56.82 (ureter), 58.41 (urethra),
55.89 (ginjal)
126 Orkhidektomi 62.3, 62.41
127 Ureterostomi ekstema (darurat) 56.61
128 Repair ruptur buli - buli 57.81
129 Vasektomi 63.73
130 Sistoskopik, endoskopik diagnostik 57.33
131 Section alta 57.19
132 Hidrokelektomi 63.1 (spermatic cord), 69.19 (round
ligament), 61.2 (tunica vaginalis)
133 Insisi Infiltrat urin 86.04
134 Insisi perirenal abses 59.09
135 Drenase pionefrosis 55.01,54.19, 54.91
136 Nefrostomi 55.02
137 Prostatektomi terbuka 60.2 ( t r a n s u r e t r a l ) , 60.3
(suprapubic), 60.4 (retropubic),
60.5 (radical), 60.6 (other)
138 Ligasi tinggi Varikokel 63.1
139 Nefrolitotomi 55.01
140 Pielolitotomi 55.01
141 Operasi Hipospodia 58.45
142 Repair Kriptorkhismus (orkhidopeksi) 62.5
143 Ureterolitotomi 1/3 tengah & proximal 56.2
144 Urethralitotomi 58.0
145 Urethrostomi ekstema 56.61
146 Uretero-ileo shunt 56.7!

ICD-9 C M
Bidang Bedab Plastik, Rekonstruksi dan Estetika
147 Debridement luka bakar 86.28
148 Repair fraktur tulang hidung 21.7,21.71 (closed), 21.72 (open)
149 Repair fi^tur tulang mandibula 76.75.76.76
150 Repair fraktur tulang maksila 76.73, 76.74
151 Tandur alih kulit 86.6
152 Release kontraklur 86.84
153 Eksisi keloid 86.3
154 Labioplasti 27.54
155 Palatoplasti 27.62
156 Operasi hipospadi 58.45
157 Flap kulit/otot 86.70

ICD-9 C M
Bidang Bedah Orthopaedi
158 Tindakan Reposisi tertutup dan immobilisasi 93.59 V
159 Debridement fraktur terbuka gr M i - I I I 79.60
160 Fiksasi ekstemal 93.59
161 Amputasi ekstrimitas 84.0 (upper limb), 84.1 (lower
limb)
12 I Kewenangan Tindak Medik Dokler Spesialis Bedah Indonesia

Jenis Tindalon Dokter Spesialis Bedah Umum
NO. ICD-9 C M
Bidang Bedah Orthopaedi
162 Disartikulasi sendi kecil dan sedang 84.13 (ankle), 84.06 (elbow)^
84.01 (finger), 84.02 (thumb),
84.11 (toe), 84.04 (wrist)
163 Pemasangan traksi (skeletal, skin, Glisson) 93.44
164 Tendon repair 83.88
165 Disartikulasi sendi besar: panggul, bahu, lutut 84.18 (hip), 84.08 (shoulder),
84.16 (knee)
166 Reduksi Terbuka dan fiksasi interna (ORIF): 79.3
167 - Nailing: Femur, Tibia 79.35, 79.36
168 - Plate & Screw: Femiu^, Tibia, Radius, Ulna, Humerus, Ciavicula 79.35, 79.36, 79.32, 79.32, 79.31,
79.33
169 - K. Wire: Tangan dan Kaki (Carpalia, Tarsalia, Phalanx) 79.03, 79.06
170 Tension band wiring (tbw): Olecranon, Patella, Ankle 93.56
171 Biopsi Tulang 77.40
172 Perawatan CTEV konservatif (serial gips) 93.53
173 Sekwesterektom i/guttering 77.60

NO. ICD-9 C M
Bidang Bedah Saraf Pusat dan Perifer
174 Boor hole 77.10
175 Trepanasi trauma (fraktur cranium, EDH) 01.24
176 Reposisi fraktur impresi 02.02
177 Repair saraf perifer 04.79
178 Eksisi meningokel & mielokel (sederhana) 01.59

NO. ICD-9 C M
Bidang Traumatologi
179 Laparotomi 54.1
180 Torako-laparotomi 34.02 & 54.11
181 Penutupan perforasi sederhana 46.73, 46.75
182 Pembuatan stoma (gastrostomi, ileostomi, kolostomi, sigmoidostomi, 43.19, 46.21,46.10, 46.41
jejunostomi)
183 Rektoskop i/anuskop i 48.29, 49.21
184 Laparoskopik diagnostik 54.21
185 Reseksi dan anastomosis usus 45.79, 45.90
186 Penanggulangan trauma hepar (darurat) 50.69
187 Splenektomi 41.5
188 Drenase pankreatitis (darurat) 52.01
189 Pankreasektomi (partial & darurat) 52.59
190 Eksteriorisasi 46.03
191 Tindakan reposisi tertutup dan immobilisasi 93.5
192 Debridement fraktur terbuka gr I-Il-III 79.6
193 Fiksasi ekstemal 93.59
194 Amputasi ekstrimitas 84.0 (upper limb), 84.1 (lower
limb)
195 Disartikulasi sendi kecil dan sedang 84.13 (ankle), 84.06 (elbow),
84.01 (finger), 84.02 (thumb).
84.11 (toe), 84.04 (wrist)
196 Reduksi terbuka dan fiksasi intema 79.3
197 - Nailing: femiu^, tibia 79.35, 79.36

Jenis Tindakan Dokter Spesialis Bedah Umum 4
Bidang Traumatologi
198 - Plate & Screw: femur, tibia, radius, ulna, humerus, ciavicula 79.35, 79.36, 79.32, 79.32,
79.31,79.33
199 - K. Wire: tangan dan kaki (carpalia, tarsalia, phalanx) 79.03, 79.06
200 Tension band wiring (tbw): olecranon, patella, ankle 79.36, 79.06
201 Disartikulasi sendi besar: panggul, bahu, lutut 84.18 (hip), 84.08 (shoulder),
84.16 (knee)
202 Tendon repair 83.88
203 Pemasangan traksi (skeletal, skin, glisson) 93.44
204 Tindakan pada trauma jaringan lunak wajah (debridement, jahit, 86.28, 86.5, 86.6-8
rekonstruksi)
205 Trakheostomi 31.1
206 Repair fraktur mandibula 76.75, 76.76
207 Repair fraktur maksila 76.73, 76.74
208 Repair fraktur zigoma 76.71, 76.72
209 Repair fraktur nasa! 21.71, 21.72
210 Torakotomi 34.02
211 Fiksasi internal iga 78.51
212 Pemasangan WSD/drainase toraks 34.04
213 Perawatan trauma toraks konservatif 86.59
214 Rekonstruksi vaskular perifer 39.59
215 Perikardiosentesis terbuka 37.0
216 Debridement luka bakar 86.28
217 Operasi Hernia diafragmatika traumatik (abdominal approach, 53.7,53.8
thoracic approach)
218 Boor hole 77.10
219 Trepanasi trauma (Fraktur cranium, EDH) 01.24
220 Fraktur reposisi impresi 02.02
221 Repair saraf perifer 04.79
222 Eksisi meningokel & mielokel (sederhana) 01.59
223 Kateterisasi/businasi 57.94
224 Nefrektomi 55.51 (unilat), 55.54 (bilat)
225 Repair urehtra, ureter, ginjal 56.82 (ureter), 58.41 (urethra),
55.89 (ginjal)
226 Orkhidektomi 62.3 (unilat), 62.41 (bilat)
227 Ureterostomi ekstema 56.61
228 Repair ruptur buli - buli 57.81
229 Sistostomi 57.1

NO. ICD-9 C M
Bidang Bedah Yang Lain
230 Pemasangan akses vena (antara lain C VP, cut down incision, kanulasi 38.95, 89.62, 38.94, 39.93
vena)
231 Pemasangan akses arteri (antara lain: kanulasi untuk hemodialisis. 38.91
monitor tekanan arteri)
232 Insisi abses (termasuk submandibular abses, dll) 86.0
234 Perawatan selulitis, infeksi jaringan lunak 86.0
235 Penangganan gigitan ular & binatang yang lain 86.0
236 Perawatan luka(steril, kontaminasi, infeksi, gangren) pada umumnya 86.27, 86.22
(toilet, debridement, necrotomy, irigasi, vacuum, jahit)
237 Penangganan tetanus

Jenis Tindakan Dokter Spesialis Bedah Umum ^
NO. ICD-y CIVI
Bidang Bedah Yang Lain
238 Pemberian nutrisi, elektrolit, dll 96.6
239 Penangganan kasus bedah akut, kritis, life saving
240 Operasi Trigger Finger 82.11
241 Operasi Finger Tip Injury (Rhinoplasty tip) 21.86
242 Penangganan kasus bedah dengan anestesi lokal atau anestesi blok
berikut terapi nyeri

IKABI
Jl. Ktamal R a y a 160, Jakarta Pusat 10430, Telp & Fax, 021 - 3916774
Website www.ikabi.org
Email . ppikabi@yahoo.com
Susunan Pengurus PP. (KABI

Periode 2012-2014
BERITA ACARA
Dtwan Pitimbinqan
Pnl Dr Sfamsuhidaiat, SpB.SpB-KBO
Dt. Soerarso Hardiowasito, Spe.SpBTKV Yang bertanda tangan dibawah ini
Nama : Dr Nurhayat Usman, SpB.KBD
Prof Dr. v!^^^^S^^^
Jabatan : Ketua IKABDI
KttuaPfwklkim
Prof. DR. Dr. Paul TahaWe, SpB.SpBTKV Periode 2012-2015
WahllKatuiftlrtuaTafrillh
Dr. R. Suharloflo. SpBKBV
Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi IKABDI

Prof. DR. Dr. Sunaryo Hardjowidjolo, SpB SpU
kepada:
Katua Puma
Prof. DR. Dr. Suwandi Sugandi. SpB SpU

Kitua MKIBI Jabatan : Sekretaris Jenderal IKABI
Prof. Dr. Enol U. Hutagalung, SpB SpOT Periode 2012-2014
Pf«*l<lium
Dr. Unp Murtedjo, SpB PGD Pal Med. ECU
Dt. Rizal Pohan. SpB SpOT Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr. Sonar Soni Panigoro, SpB K.Onk
Dr. Patnol Muslim, SpU Bedah Indonesia.
Or. Poerwadi. SpB SpBA
Dr. Selyowkli Nugroho, SpB SpBS
Dr. Nurhayat Usman, SpB KBD Jakarta,
Dr. Ishandono Dachlan, Msc, SpB, SpBP-RE(K) 11 Februari 2013
gtKretwItJtntft'ai
Or Djoni Darmadjaia. SpB MARS
B«fw>ahara
Dr Barlian Suledja. SpB
Komisi Organiaaii. Lagitlaii dan Advokasi Dr Nurhayat Usman, SpB.KBD Dr. Djoni 1 >armadjaja, SpB.MARS
Dr. HN Nazar, SpB
Dt. Chandra Svaras, SpB Ketua IKABDI Sekjen IKABI
Kotnlal Profetl Sedah. Aturanal dan
Perpafakan
Dr Nurhayat Usman, SpB KBD
Dr. Erawan Wiradisuna, SpB KBD
Dr Inzta Arbi, SpB
Komiil Globalliait S Paiar Bebas

Dr. dr Fathema D Rachmal, SpB SpBTKV
Dr Huntal Srmamora, SpBP-RE
Komlil KommUfcil dan PuMkMl

DR. Dr Yefla Munad|at, SpB SpBP-ft£(K)
Prof DR. Dr. Sri Maliawan, SpBS (K)
Dr. Iskandar Budianla. SpB SpBA
KonWai Huburtgan Dalam I

Prof. DR. Dr. Andi Asadul Islam, SpBS
Dr Boyke Sumanlri. SpU
Komlal Palayanan Ambulance 118

Dr ZA Isma, SpB
Dr Agi Satna. SpB KBD
Komlal Trauma
DR Dr Achmad Hidayal, SpB
Dr B Sunoko, SpB
DR Dr Triwahyu Mum, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH KONSULTAN

BEDAH DIGESTIF
(IKABDI)
19
DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS
D O K T E R SPESIALIS BEDAH KONSULTAN BEDAH D I G E S T I F
(IKABDI)
NO. JENIS TINDAKAN ICD 9-CM

UPPER GASTROINTESTINAL
Oesophageal Surgery 42.4: other (42.40), partial (42.41), total (42.42)
1 Oesophagectomy,gastric interposition
2 Oesophagectomy, colonic interposition 42.55
3 Oesophagectomy, free jejunal graft
4 Heller procedur (Oesophageal myotomy) 42.7
Oesophageal (Retlux/moti lity)
5 Fundoplication 44.66
6 Para-oesophageal Hernia Repair Abd. approach (53.7), thoracic/thoracoabdominal
approach (53.80)
7 Epiphrenic diverticulectomy Diverticulectomy esophagus (42.31), endoscopic
(42.33)
8 Oesophageal myotomy + fiindoplasty 42.7
9 Zenker's diverticulectomy (Open)
Gastric Surgery
10 Total Gastrectomy (D I node dissection) 43.9
11 Total Gastrectomy (D2 node dissection) 43.9
12 Distal Gastrectomy (DI node dissection) 43.6
13 Distal Gastrectomy (D2 node dissection) 43.6
14 Proximal Gastrectomy (D 1 node dissection) 43.5
15 Proximal Gastrectomy (D2 node dissection) 43.5
16 Gastric tumour, Local excision 43.42
Laparoscopy
17 Oesophagectomy 42.40
18 Gastrectomy 43.5-9
19 Fundoplication 44.65/44.66
20 Oesophageal myotomy + fundoplasty 42.7
Endoscopy
21 Diagnostic Upper Gl endoscopy Gaster (44.13), duodenum (45.13), esophagus
(42.23)
22 Endoscopy with biopsy Bile duct (51.14), bronchus (33.24), cardioesophagel
junction/gaster (44.14), large intest/caecum/sigmoid/
colon (45.25), small intest /duodenum/jejunum
(45.14), endometrium (63.16), esophagus (42.24),
gallbladder (51.14), ileum (45.15), larynx (31.43),
pancreas (52.11), pancreatic duct (52.14), rectum
(48.24),
23 Therapeutic Upper GI endoscopy
3 - Berita Acara PP IKABDI dan PP I K A B I I 21

NO. JENIS TINDAKAN I C D 9.CM
Bariatric Surgery and Other
24 Gastric Band (Laparoscopic)
25 Gastric Band (Removal)
26 Gastric Band (Revision)
27 Tube Gastrectomy (Laparoscopic or Open) Open - for decompression intestine (96.07), for
feeding (96.6/96.35)
28 Roux en Y Gastric Bypass (laparoscopic)
29 Roux en Y Gastric Bypass (open) 44.39, high (44.31)
30 Roux en Y Gastric Bypass (revisional) 44.5
31 Splenectomy Total (41.5), partial (41.43)
32 Jejunostomy/Gastrostrostomy 46.41,43.19 - endoscopy (43.11)
Adjimctive Thoracic Operations
33 Thoracoscopy 34.21
34 Thoracotomy for gut interposition 34.02
35 Conventional right thoracotomy
COLORECTAL
36 Procedures for Haemorrhoids
37 Excisional haemorrhoidectomy, open or closed Reduction (49.41), injection (49.42), cauterization
and variant (49.43), destruction by cryotherapy (49.44), ligation
(49.45), excisi (49.46)
38 Stapled haemorrhoidopexy (PPH) 49.45
Anal abscess/Fistula
39 Incision and drainage of abscess 49.93/49.11
40 Anal fistulotomy or fistulectomy 49.11/49.12
41 Seton treatment of fistula
42 Endorectal/endoanal flap repair of fistula Anal (49.73), rectum (48.73)
43 Repair of recto-vaginal fistula (other than flap 70.73
repair)
Other proctological procedures
44 Lateral internal sphincterotomy 49.6
45 Injection of botulinum toxin to anal sphincter
46 Excision perianal lesion (skin tag, haematoma, Perianal tissue (49.04), skin tags (49.03)
viral warts etc)
47 Excision/lay open/flap repair Pilonidal sinus 86.21
disease
48 Excision lexteriorisation hidradenitis
suppurativa
49 Transanal procedures
50 Transanal excision of tumour
51 Transanal endoscopic microsurgery (TEM)
52 Anoplasty for stricture or ectropion 49.79
53 Transanal repair of rectocoel 70.52
54 Stapled Transanal Rectal Resection (STARR)
Surgical procedures for incontinence
55 Sphincter repair 49.79, suture laceration (49.71)
56 Graciloplasty
57 Sacral nerve stimulation insertion Neurostimulator (03.93)
58 Artificial bowel sphincter

fSO. JENIS TINDAKAN I C D 9-CM
Prolapse procedures
59 Perineal repair of rectal prolapse (Delorme, Wanita: 71.79, suture laceration (71.71)
Altemeier) Laki-laki: 86.89, suture laceration (86.59)
60 Transabdominal resection or fixation of rectal
prolapse
Colonoscopy/flexible sigmoidoscopy
61 Diagnostic colonoscopy 45.23
62 Colonoscopy and Sigmoidoscopy polypectomy
63 Colonoscopic decompression of volvulus or
pseudobstrucfion
64 Colonoscopic dilatation and/or metal stent
insertion
Colonoscopic endomucosal resection of tumour
Segmental colonic or ileo-colic resection
65 Ileocolic resection Reseksi ileum (45.62), ileocolectomy (45.73)
66 Right hemi colectomy 45.73
67 ' Transverse colectomy 45.74
68 Wedge colon resectio Partial (45.79), total (45.8)
69 Left hemi colectomy 45.75
70 Sigmoid colectomy 45.76
71 Hartmann's resection 45.75
Anterior Resection
72 Anterior resection of rectum for benign and 48.63
neoplastic disease
73 Rectal resection as part of abdomino-perineal 48.5
resection of rectum
Perineal rectal resection
74 As part of abdomino perineal resecfion
75 As part of proctectomy for inflammatory bowel
disease
Total colectomy
76 Whole of abdominal colon, with or without 45.8
anastomosis
77 Excludes colectomy as part of ileo-anal pouch
procedure
Rectal resection with colo-anal /ileoanal
anastomosis
78 Low anterior resection with colo-anal 48.63
anastomosis
79 Hand sewn to anal canal +/- colonic pouch
80 Stapled to anal canal +/- colonic pouch
81 Rectal resection +/- total colectomy with ileo
pouch-anal anastomosis
Stoma procedure
82 Creation, revision or closure of colostomy 46.10,46.43,46.52
83 Creation, revision or closure of ileostomy 46.21-46.22,46.41,46.51
Laparoscopic Procedure
84 Colectomy
85 Rectal Resection
3 - BeritaAcaraPP IKABDI dan PP IKABI I

NO. JENIS TINDAKAN I C D 9-CM
86 Rectal Prolapse
Tracheostomy
87 Cricothyroidostomy (needle/surgical) Temporary/percutant (31.1), permanent (31.2)
HPB (HEPATOPANCREATICO BILIARY)
Liver Procedure
88 Wedge excision OrSegmentectomy Partial (50.22), total (50.4)
89 Right Hepatectomy 50.22
90 Left lateral Hepatectomy (segments 2,3,4) 50.22
91 Left Hepatectomy (segments 2,3) 50.22
92 Unroofing Liver Cyst open 1 Laparoscopic 50.0
93 MelastatectomylNon anatomical resection 50.29
94 Ablative treatment (eg RFA) for liver tumour 50.29
95 Laparoscopic Hepatectomy
96 Liver Transplantation Auxiliary (50.51), other (50.59)
Gallbladder Surgery
97 Open Cholecystectomy 51.22
98 Open Cholecystectomy + IOC 51.22+87.54
99 Open Cholecystectomy + CBD Exploration 51.22+51.51 /endoscopy (51.11)
100 Laparoscopic Cholecystectomy 51.23
101 Laparsocopic Cholecystectomy + CBD 51.23+51.51 /endoscopy (51.11)
exploration
102 Choledochoscopy 51.11
103 Transduodenal sphincteroplasty Anal (49.79), bladder neck (57.85), pancreas (51.83),
sphincter of oddi (51.83)
104 Bilio-Enteric Bypass
105 Resection of Choledocal Cyst
Pancreas and Duodenum
106 Transduodenal resection Partial (45.62), total (45.63)
107 Pancreatic duct sphincteroplasty
108 Pancreaticoduodenectomy Total (52.6), partial: proximal (52.51), radical (52.7),
radical subtotal (52.53)
109 Retroperitoneal node dissection 59.0
110 Distal pancreatectomy 52.52
111 Central pancreatectomy
112 Enucleation of pancreatic endocrine tumour 52.22, endoscopic (52.21)
113 Total pancreatectomy 52.6
114 Duodenal preserving pancreatectomy (Begers)
115 Freys procedure
116 Pancreaticojejunostomy 52.96
117 Pseudocyst gastrostomy/Enterostomy 43.19/endoscopic (43.11), 46.39, loop (46.01), 43.0
118 External drainage pseudocyst 52.3, by anastomosis (52.4)
119 Pancreatic necrosectomy (Open/Percutaneous)
120 Local excision duodenal tumour Partial (45.62), total (45.63)
121 Duodenal exclusion procedures
122 Pancreatic Duct sphincteroplasty 51.83
123 Laparoscopic Pancreatectomy

IKABI
Jl. Kramal R a y a 160. Jakarta P u s a l 10430, Telp & Fax. 021 - 3916774
Website www ikabi.org
Email ppikabi@yahoo.com
Susunan Pengurus PP IKABI

Periode 2012-2014
BERITA ACARA
DtWM Partimbanqan
Prof. Dr. Sjainsuhklâl, SpB.SpB-KBD
Dr Soerarso Hardjowasito, SpB SpBTKV
Wajellg Etik a Penaaehal Nama : Dr Sonar Soni Panigoro, SpB.K.Onk
Prof. Dr Muctilis Ramli. SpB(K)-Ork
Jabatan : Ketua PERABOI
Ketua Prwidium
Prof. DR. Dr. Paul Tahalete. SpB.SpBTKV
Wakll KluanCaluiTaipHUi
Dt. R. Suhartono. SpBKBV
Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PERABOI
Wakll Ketua kepada:
Prof. DR. Dr. Sunaryo Hardjowidjolo, SpB SpU Nama : Dr Djoni Darmadjaja, SpB.MARS
Ketua Puma
Prof. Or. Errol U. Hutagahjng. SpB SpOT
Periode 2012-2014
Or. Unp Murtedjo, SpB PGD Pal Med, ECU

Dr. fiizal Polian, SpB SpOT Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Df. Sonar Son Panigonj. SpB K Onk
Dr Patriot Muslim. SpU Bedah Indonesia.
Dr. Poenvadi. SpB SpBA
Dr R Suharlono, SpBKBV
Dr Selyowidi Nugrodo. SpB SpBS
Dr Nurtiayat Usman, SpB KBD Jakarta,
Dr Maizul Anwar, SpB TKV
Dr Ishandono Dachlan, Msc, SpB. SpBP-REIK) 11 Februari 2013
SekratartoJanderal
Or. Ojoni Dannadjaia, SpB MARS
WimSafctan*
Dr. Agung Prasmono. SpB SpBTKV.MARS
Or Barlian Suledja, SpB Dr Sonar Soni Panigoro, SpB.K.Onk Dr. Djoni Dirmadjaja, SpB.MARS
Kwnlsl Organisasi. Legialasi dan Advokasi Ketua PERABOI Sekjen IKABI
Dr. HN râzar, SpB
Or C t » n d r a Svaras, SpB
Komwl Prolesl Bedah. tamimi daw
Dr. (Nurhayal Usman. SpB KBD

Or. Erawan Wiradisuria. SpB KBD
Dr. Henry Boyke Silompul, SpB
Dr. Inzta Arbi. SpB
Komiai GlotMliaaai S, Paiar Bebai

Dr. dr Fathema D Rachmat. SpB SpBTKV
Dr. Hunlal Simamora, SpBP-RE
Komlal K . » n u n i k a » l dan Publlkasi

OR. Dr Yefta Munadjat. SpB SpBP-RE[K)
Prof. DR. Dr Sr Maliawan. SpBS (K)
Dr. Iskandar Budianla, SpB SpBA
Komtol Hubungan Dalam Negri

Prof DR. Dr Andi Asadul Islam, SpBS
Dr BoyVe Sumanin, SpU

Dr ZA Isma, SpB
Komiai Traunq
OR. Or Actimad hMayal, SpB
Or B. Sunoko, SpB
DR. Dr Triwtfiyu Mumi, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH KONSULTAN

BEDAH ONKOLOGI
(PERABOI)
27
D O K T E R SPESIALIS BEDAH KONSULTAN BEDAH ONKOLOGI
(PERABOI)
NO J E N I S TINDAKAN I C D 9-CM
1 Biopsi Jarum Halus 85.1 i(on breast: percutan), 85.12 (open)
2 Biopsi Core 85.1 l(on breast: percutan), 85.12 (open)
3 Aspirasi Kista 85.91 (breast)
4 Biopsi Eksisional 85.11(on breast: percutan), 85.12 (open)
5 Biopsi Incisional 85.11(on breast: percutan), 85.12 (open)
6 Reshaping untuk torus/ tumor tulang
7 Ekstirpasi tumor jinak kulit 86.3, 85.21 (kulit payudara)
8 Eksisi Tumor Jinak Payudara 85.21
9 Tracheostomi 31.1
10 Ekstirpasi Tumor Jinak Jaringan Lunak 83.39
11 Ekstirpasi tumor jinak kulit 86.3, 85.21 (kulit payudara)
12 Eksisi kelenjar getah bening 40.22 (mammary), 40.29 (external), 40.59
(radical), 40.3 (regional)
13 Potong flap 86.71
14 Eksisi Mamae abberant 85.24
15 Mastektomi simpel 85.41 (unilat), 85.42 (bilat)
16 Salphingo oophorektomi bilat 65.61
17 CWL, anthrostomi 22.39
18 Eksisi kelenjar liur submandibula 26.30 (salivary gland), 26.32 (total/
radical), 26.31 (partial)
19 Lobektomi tiroid 06.2 (total), 06.39 (partial)
20 Eksisi luas lokal 85.41 (breast), 86.3 (skin)
21 Eksisi Kista branchiogenik 32.09 (bronchogenic), 32.01
(endoscopic)
22 Eksisi sentinel lymph node
23 Mastektomi subkutan 85.34 (unilat), 85.36 (bilat)
24 Isthmolobektomi 06.2
25 Tiroidektomi subtotal 06.39
26 Near total tiroidektomi 06.4
27 Parotidektomi superficialis 26.31 (partial), 26.32 (complete/radical)
28 Debulking
29 Pembedahan kompartemental partial
30 Mandibuiektomi marginalis 76.31 (partial), 76.42 (total), 76.41 (with
reconstruction)
31 Rekonstruksi sedang(STSG, FTSG,Flap lokal) 86.69
32 Maksilektomi partialis 77.8
33 Eksisi kista duktus tiroglosus 06.7
34 Mastektomi Radikal Klasik 85.45 (unilat), 85.46 (bilat)
35 Mastektomi Radikal Modifikasi 85.43 (unilat), 85.44 (bilat)
36 Breast Conserving Surgery 85.21
37 Parotidektomi Radikal 26.32
38 Parotidektomi Totalis 26.32
39 Mandibuiektomi Totalis 76.42
40 Hemipelvektomi 84.19
41 Hemimandibulektomi 76.31
42 Eksisi Luas Radikal 85.41 (breast), 86.4 (skin radical)
4 - Berita Acara PP PERABOI dan PP IKABI I 29

NO JENIS TINDAKAN I C D 9-CM
43 Hemiglosektomi 85.2
45 Glosektomi Totalis 25.3
46 Maksilektomi Totalis 77.9
47 Total tiroidektomi 06.4
48 Diseksi Leher Radikal 40.40
49 Diseksi Leher Modifikasi/ Fungsional 40.41 (unilat), 40.42 (bilat)
50 Diseksi KGB Pelvis
51 Diseksi KGB Inguinal 40.24 (deep/superficial), 40.54 (radical),
40.3 (regional)
52 Operasi Commando 76.31
53 Pembedahan Forequater
54 Pembedahan Kompartemental
55 Rekonstruksi Mayor
56 TRAM FLAP (Rekonstruki Payudara pasca kemoterapi) 85.7 (total)
57 LD FLAP (Payudara) 85.7
58 Endoscopy Tiroidektomi
59 Endoskopy Diagnostik keganasan kepala dan leher 06.1
60 Persiapan Kemoterapi
61 Pembuatan prolokol kemoterapi
62 Evaluasi efek kemoterapi
63 Advancement of pedicle graft 86.72
64 Angkat (remove) jahitan abdomen. 97.83
65 Angkat (remove) jahitan kepala dan leher 97.38
66 Angkat (remove) jahitan thorax 97.43
67 Angkat (remove) jahitan trunkus 97.84
68 Angkat (remove) WSD 97.41
69 Angkat tracheostomy 97.37
70 Aspirasi hygroma 86.01
71 Aspirasi seroma 86.01
72 Biopsi pembuluh darah 38.21
73 Chemoport 86.07
74 Chest tube 34.04
86.28
75 Debridement
86.91
76 Eksisi kulit untuk graft
86.60
77 Free skin graft
86.63
78 Full thickness skin graft ke tempat lain
86.61
79 Full thickness skin graft ke tangan
83.82
80 Graft otot atau fascia
00.15
81 Immunoterapi
00.10
82 Implantasi zat kemoterapeutik
99.18
83 Infus elektrolit
99.21
84 Injeksi antibiotik 99.25
85 Injeksi BCG untuk kemoterapi 99.28
86 Injeksi biological response modifier sebagai antineoplastik
seperti interleukin dll
87 Jahit arteri 39.31
88 Jahit laserasi dinding dada 34.71
89 Jahit vena 39.32
90 Kemoterapi 99.25
91 Laparoskopi oovorektomi bilat 65.53
92 Laparotomi explorasi 54.11
93 Memotong dan mempersiapkan pedicle graft atau flap 86.71

94 Menempelkan pedicle atau flap graft ke tangan 86.73
95 Menempelkan pedicle atau flap graft ke 86.74
tempat lainnya ''^ •'
96 Oophorectomy bilat 65.51
97 Parenteral infus 99.15
98 Pedicle or flap graft 86.70
99 Pengukuran badan 93.07
100 Revisi pedicle atau flap graft , . 86.75
101 Skin graft ke tangan (yg lain) 86.62
102 Tendon graft 83.81
103 Toilet tracheostomy 96.55
104 Tracheostomy permanent 31.21
105 Tracheostomy temporer 31.1
106 Transfer otot atau transplantasi 83.77
107 Transfusi blood expander seperti dextran 99.08
108 Transfusi packed cells 99.04
109 Transfusi trombosit 99.05
110 Transfusi whole blood perioperatif 99.00
111 Pemeriksaan manual payudara 89.36
112 Insisi kulit mammae/Mastotomy/Mammotomy 85.0
113 Closed biopsy mammae 85.11
114 Eksisi jaringan mammae yang tidak dapat diklasifikasikan 85.2
115 Eksisi lokal mammae seperti lumpektomi/jar. Fibrotik 85.21
116 Quadrantectomy 85.22
117 Subtotal mastektomi 85.23
118 Eksisi jaringan mammae ektopik seperti nipple acessoris 85.25
119 Eksisi nipple 85.24
120 Mammoplasty unilat 85.31
121 Bilat mammoplasty 85.32
122 Masteclomi subkutan unilateral disertai inplant 85.33
123 Mastectomy subkutan bilateral disertai inplant 85.35
124 Extended simple mastectomy unilat/Modified Radical 85.43
Mastectomy (MRM)
125 Extended simple mastectomy bilat 85.44
126 Extended radical mastectomy unilat 85.47
127 Extended radical mastectomy bilat 85.48
128 Jahit laserasi mammae 85.81
129 Split thickness graft mammae 85.82
130 Full thickness graft mammae 85.83
131 Pedicle graft mammae 85.84
132 Muscle flap graft mammae 85.85
133 Transposisi nipple 85.86
134 Rekonstruksi nipple lainnya 85.87
135 Mammoplasty lainnya 85.89
136 Aspirasi mammae 85.91
137 Injeksi agent terapeutik ke dalam mammae 85.92
138 Revisi inplant mammae 85.93
139 Removal inplant mammae 85.94
140 Insersi breast tissue expander 85.95
141 Removal of breast tissue expander 85.96
142 Rekonstruksi total payudara 85.7
143 Eksisi FAM 85.21

144 Eksisi mammae ektopik 85.24
145 Debulking 85.20
146 Transverse Rectus Abdominis Musculocutaneus (TRAM
Flap) 85.7
147 Latissimus Dorsi Flap 85.7
148 Biopsi kulit dan jaringan subkutan 86.11
149 Prosedur diagnostik kulit dan jaringan subkutan lainnya 86.19
150 Disartikulasi hip joint 84.18
151 Disartikulasi knee joint 84.16
152 Amputasi above knee 84.17
153 Amputasi below knee 84.15
154 Amputasi dan disartikulasi jari tangan 84.01
155 Amputasi dan disartikulasi ibu jari tangan 84.02
156 Disartikulasi wrist joint 84.04
157 Disartikulasi elbow 84.06
158 Amputasi forearm 84.05
159 Amputasi humerus 84.07
160 Disartikulasi shoulder joint 84.08
161 Amputasi jari kaki 84.11
162 Amputasi kaki ' 84.12
163 Disartikulasi ankle joint 84.13
164 Biopsi soft tissue 83.21
165 Eksisi ganglion dari tendon seath kecuali tangan 83.31
166 Eksisi kista Baker 83.39
167 Bursektomi 83.5
168 Bursectomy tangan ^vio>.:r:L- 82.31
169 Eksisi ganglion wrist joint 82.21
170 Eksisi radikal lesi di kulit 86.4
171 Debulking soft tissue tumor 86.4
172 Aspirasi thyroid (percutaneus needle drainage) 06.01
173 Reopening thyroid 06.02
174 Aspirasi biopsi (percutaneus) thyroid 06.11
175 Open biopsy thyroid 06.12
176 Biopsi parathyroid 06.13
177 Lobektomi unilat 06.2
178 Partial substernal thyroidectomy 06.51
179 Eksisi lesi thyroid 06.31
180 Isthmektomi .• 06.39
181 Partial thyroidectomy 06.39
182 Total thyroidectomy 06.4
183 Complete substernal thyroidectomy 06.52
184 Eksisi thyroid lingual 06.6
185 Total Parathyroidektomi 06.81
186 Partial Parathyroidectomy - 06.89
187 Division of thyroid isthmus 06.91
188 Ligasi pembuluh darah thyroidea ; •'•rN-:- 06.92
189 Jahit kelenjar thyroid 06.93
190 Reimplantasi jaringan thyroid 06.94
191 Reimplantasi jaringan parathyroid 06.95
192 Operasi lain kelenjar thyroid r 06.98
193 Operasi lain kelenjar parathyroid 06.99 ^^ I
194 Debulking thyroid - . " - 06.31

195 Debulking Parathyroid 06.89
196 Open biopsi (insisi biopsi) sinus nasal 22.12
197 Radical maxillary antrotomy (Caldwell-Luc Approach) 22.31
198 External maxillary antrotomy lainnya 22.39
199 Insisi ginggiva atau tulang alveolar 24.0
200 Biopsi ginggiva 24.11
201 Biopsi alveolar 24.12
202 Prosedur diagnostik gigi, ginggiva dan alveoli lainnya 24.19
203 Eksisi lesi jaringan ginggiva 24.31
204 Closed biopsi lidah 25.01
205 Open biopsi (insisi biopsi) lidah 25.02
206 Prosedur diagnostik lidah lainnya 25.09
207 Eksisi lesi jaringan lidah 25.1
208 Glossektomi radikal 25.4
209 Biopsi tulang palatum 27.21
210 Biopsi uvula dan palatum molle * 27.22
211 Biopsi bibir 27.23
212 Prosedur diagnostik lainnya dari rongga mulut 27.29
213 ' Eksisi lokal lesi jaringan tulang palatum 27.31
214 Eksisi luas (wide excisi) lesi jaringan tulang palatum 27.32
215 Eksisi luas lesi bibir 27.42
216 Eksisi lainnya dari jaringan bibir 27.43
217 Insisi uvula 27.71
218 Eksisi uvula 27.72
219 Hemimaxillektomi 76.39
220 Rekonstruksi mandibula lainnya 76.43
221 Bone graft untuk tulang wajah 76.91
222 Insersi implant sintetik pada tulang wajah 76.92
223 Remove internal fixasi dari tulang wajah ^ 76.97
224 Caldwell operation 24.91
225 Eksisi ranula 26.29
226 Eksisi epulis 24.31
227 Mandibulotomi di ramus 76.62
228 Mandibulotomy di simfisis 76.64
229 Osteotomi segmental maxilla 76.65
230 Osteotomi total maxilla 76.66
231 Eksisi mukosa buccal 27.49
232 Jahit laserasi lidah 25.51
233 Repair dan operasi plastik lidah lainnya 25.59
234 Eksisi kelenjar sublingual 26.30
235 Insisi kelenjar ludah atau salurannya 26.0
236 Closed biopsi kelenjar ludah atau salurannya 26.11
237 Open biopsi (insisi biopsi) kelenjar ludah atau salurannya 26.12
238 Prosedur diagnostik kelenjar ludah lainnya 26.19
239 Marsupialisasi kista kelenjar liur 26.21
240 Eksisi kelenjar liur lainnya 26.29
241 Sialoadenektomi Parsial 26.31
242 Sialoadenektomi Total (enbloc excision) 26.32
243 Jahit laserasi kelenjar liur 26.41
244 Jahit fistula kelenjar liur 26.42
245 Decompression of trigeminal nerve root 04.01
246 Division of trigeminal nerve 04.02

NO JENIS TINDAKAN ICD 9-CM
247 Debulking kelenjar liur 26.31
248 Parotidectomy parsial 26.31
249 Parotidectomy total 26.32
250 Parotidectomy Radikal 26.32
251 Insisi stuktur limfatik 40.0
252 Biopsi struktur limfatik 40.11
253 Prosedur diagnostik lainnya dari struktur limfatik 40.19
254 Eksisi deep cervical lymphnode 40.21
255 Eksisi limfonodus mammaria interna 40.22
256 Eksisi limfonodus axiller 40.23
257 Eksisi limfonodus inguinal 40.24
258 Simple excisi struktur limfatik lainnya 40.29
259 Eksisi limfonodus regional 40.3
260 Radical excision limfonodus axiller 40.51
261 Radical groin dissection 40.54
262 Radical excision limfonodus lainnya 40.59
263 Ligasi ductus thoracicus 40.64
264 Eksisi hygroma 40.29
265 Completion Mastektomi 85.41 (unilat), 85.42 (bilat)
266 Breast Conserving Surgery (BCS) 85.21
267 Breast Conserving of Sentine Node
268 Breast Conserving Surgery dengan Limposcintigraphy
(SNLP)
269 RE BCS
270 Sentinel node procedure pada breast
271 Sentinel Node procedure pada melanoma
272 Sentinel Node procedure pada KSS Head & Neck Ca
273 Eksplorasi Discharge payudara
274 Metastasektomi pada breast Ca metastasis
275 Radioterapi intra operatif 92.29
276 Crayosurgery
277 Endoskopy Mastektomi
278 Duchuloscopy
279 Stereotacic guided wire biopsi
280 BCS dengan tehnik reduksi mamae
281 Banana flap tehnic rekonstruksi pada kanker kulit kepala
282 Laringektomi 30.29 (partial), 30.3 (total)
283 Diseksi leher sentral 40.40 (radical), 40.41 (unilat), 40.42
(bilat)
284 Enukleasi Bulbi pada keganasan
285 Eviserasi bulbi pada keganasan
286 Diseksi KGB Inguinal deep 40.3
287 Rekonstruksi daun telinga pada keganasan 18.71
288 Rekonstruksi palpebra pada keganasan i-
289 Recanalisasi cantus pada keganasan
290 Rekonstruksi free flap pada keganasan
291 Intra arterial infusion kemoterapi f 99.25
292 AffChemopart
293 Bilas Chemopart
294 Parotidektomi dengan rekonstruksi otot temporal flap 26.30
295 Parotidektomi dengan rekonstruksi otot stemocleido mastoid 26.30
flap

296 Parotidektomi ekstended 26.30
297 Parotidektomi dengan graft + nervus 26.30
298 Rekonstruksi bibir pada keganasan
299 Rekonstruksi hidung dengan simple flap pada keganasan 21.83
300 Rekonstruksi hidung dengan fi-ontal flap pada keganasan 21.83
301 Rekonstruksi hidung dengan ft-ee flap 21.83
302 Pungsi plura pada efl\isi akibat keganasan
303 Pungsi ascites
304 Eksisi limpangioma
305 Eksisi Hemangioma
306 Ligasi A Carotis ekstema
307 Ligasi pedikel halmangionua
4 - Berita Acara PP PERABOI dan PP ! K A B ! I

IKABI
JL Kramal R a y a 160, Jakarta P u s a l 10430, Telp & Fax. 021 - 3916774
Website www Ikabi org
Susunan Pengurus PR IKABI

Periode 2012-2014
BERITA ACARA
P«wio PwtimlanMn
Prol Dr SjamsuMdaK Spe.SpS4(B0
Dr. Soerarso Hardjowasito, SpB.SpBTKV
MalaHaEtlfc&P««aehal Nama : Dr R. Suhartono, SpBKBV
Prof. Dr Muchlis Ramli. SpB(K)-Orik
Jabatan : Ketua PESBEVI
KetMPftikllum
Prof. DR. Dr. Paul Tatialele, SpB.SpBTKV Periode 2012-2014
IWifcll Ketuifltetua Teiplllh
Dr. R. Sutiarlono, SpBKBV
Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PESBEVI

Prof DR Dr Sunaryo Hanjjowidjoto. SpB SpU
kepada:
Ketua Puma
Prof DR Dr Suwar>di Sugandi. SpB SpU Nama : Dr Djoni Darmadjaja, SpB.MARS
' Katua MKIBI
Prof. Dr. Errot U. Hutagalung. SpB SpOT
Periode 2012-2014
Dr. Urip Murteô, SpB PGD Pal Med. ECU
Dr. Rizal Pofian. SpB SpOT
Dr Sonar Soni Panigoro, SpB K Onk
Dr Palnol Muslim, SpU Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr R Sutiartono. SpBKBV Bedah Indonesia.
Dr. Setyowidi Nugroho, SpB SpBS
Dr Nurhayal Usman, SpB KBD
Dr. Maizul Anwar. SpB TKV
Dr. Ishandono Dachian. Msc, SpB, SpeP-RE(K) Jakarta,
Sakretirta Jenderal 11 Februari 2013
Dr Djoni Darmadja|a, SpB MARS
Wakll Sekjert
Dr. Agung Prasiwno, SpB SpBTKV MARS
Btoditiin
Dr Barlian Sutedja. SfB
Komisi Organisasi. leaialati Jwi A d w t a i l Dr R. Suhartono, SpBKBV Dr. Djoni parmadjaja, SpB.MARS
Dr HN Mazar, SpB
Dr Chandra Svaras. SpB Ketua PESBEVI Sekjen IKABI
Komisi Profesi Bedah. Asuransi dan
Perpajakan
Or Erawan Wiradisuna. SpB KBD
Dr Henry Boyke Silompul, SpB
Dr. Inzta Arbi, SpB
Komltl Globallsasi t Paiar Bebai

Or Or Falhema D Rachmat, SpB SpBTKV
Dr Huntal Sirrwmora. SpBP-RE
Komiai KoffMinlkasi dan Publlkasi

DR. Or. Yefta Munadjat, SpB SpBP-RE(K)
Prof. DR. Dr. Sri Maliawan, SpBS {Kj
Dr. Iskandar Budianta, SpB SpBA
PiOl. OR. Or Andi Asadul Islam. SpBS

Dr. Emir T Pasanbu SpB.Onk
Kofftisi Pelayanan Ambulance 11B

Or ZAIsma, SpB
Komisi Trauma
OR Dr Achmad Hidayat, SpB
Or B Sunoko, SpB
DR Dr Triwahyu Mumi, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH VASKULER

DAN ENDOVASKULER
(PESBEVI)
39
D O K T E R SPESIALIS BEDAH V A S K U L E R DAN ENDOVASKULER
(PESBEVI)

1 Doppler examination (88.7)
2 Sclerotherapy for varicose veins (39.92)
3 Intravenous cannulation (38.9)
4 Stop bleeding (direct pressure, pressure point. (39.98)
Pressure bandage)
5 Fluid rescucitation (99.1)
6 Arteriography (88.40)
7 CT, MRI, ulrasound (87/88.7/88.9)
8 Infiltration anaesthesia (04.8)
9 Local nerve block (04.81)
10 Incision and drainage of abscess (86.04)
11 Wound cleaning (96.59)
12 Wound debridement with scalpel and scissors (excise: 86.22)
13' Injection of varices with sclerosant (esofagus (endoscopic):42.33,
vein:39.92)
14 To apply a dressing (sling, shoulder bandage, finger (93.5)
Bandage, hand bandage)
15 Treatment of leg ulcers (86.22,86.28)
16 To apply a dressing (leg bandage, foot bandage, (93.5)
Ankle bandage, knee bandage)
17 Brescia-Cimino fistula creation (39.27)
18 CDL for hemodialysis access, temporary and semipermanent (38.95)
19 Port A Cath/Celsite implantation for access in chemotherapy (38.93)
or nutrition
20 Management in emergency major vascular trauma: Control (39.4)
Hemmorrhage
21 Venous Cutdown in Vascular Access (38.94)
22 Peripheral Artery Cannulation (38.91)
23 Gradual External Compression in Vascular Disease (93.56)
24 Wound Management in Vascular Cases (93.5)
25 Anticoagulant Therapy in Vascular Cases (99.1)
26 Sclerotherapy (39.92)
27 Splenectomy in portal hypertension (total:4l.5, partial:41.43)
28 Simple vascular recontruction in peripheral artery trauma. (suture:39.31, dengan graft:39.58)
29 Debridement and Amputation in Diabetic Foot (86.22+84.12)
30 Emergency Trombectomy/Embolectomy in Peripheral Artery (38.0)
31 Hemangioma Excision (38.60)
32 Varicose Veins: Treatment by Intervention Including (39.92)
Sclerotherapy
33 Phlebectomy (38.60)
34 Greater Saphenous Vein High Ligation, Stripping, Perforantes (38.80, 38.59)
Ligation
35 Nonoperative Treatment of Chronic Venous Insufficiency (93.56)
36 Nonoperative management of chronic lymphedema (93.56)
37 Upper extremity amputation: Indication, Operative Technique (84.0)
and Perioperative Management
5 - Berita Acara PP PESBEVI dan PP IKABI I 41

38 Lower extremity amputation:: Indication, Operative Technique (84.1)
and Perioperative Management
39 Diagnosis dan Tata Laksana Permasalahan Kaki Diabetik
(Diabetic Foot Problems)
Termasuk: Pathophysiology Ischemia, Neuropathy dan
Infection, Antibiotic Treatment, Amputation Types
Wound Management, Foot Care
Tambahan yang Penting/Topik Kurikulum Non-Inti: Orthotic (84.12)
Management (86.22/86.28)
Penggunaan Terapi Endovaskuler pada Tata Laksana Penyakit
Pembuluh Darah Perifer (39.7)
Termasuk:
40 Lytic Therapy (39.7)
41 Balloon Angioplasty (39.7)
42 Endoluminal Stents (39.7)
43 Stent Grafts Abdominal (39.71), thoracic (39.73)
44 Angioscopy (39.7)
45 Endoluminal Ultrasound (39.7)
46 Embolization (39.72)
47 Indikasi dan Hasil pada Simpatektomi pada Pasien dengan (thoracal: 05.29, lumbal: 05.23)
Penyakit Arteri Perifer
48 Ruptured Abdominal Aortic Aneurysms (excisi artery: 38.60, rekonstruksi
arteri: 39.31/39.58-dengan graft)
49 Thoracoabdominal Aortic Aneurysm (39.5)
50 Aortic Dissection: Perspectives for the Vascular/Endo vascular (39.91/00.55)
Surgeon
51 Lower Extremity Aneurysms (39.5)
52 Upper Extremity Aneurysms (39.5)
53 Splanchnic Artery Aneurysms (39.5)
54 Infected Aneurysms (39.5)
55 Treatment of Acute Intestinal Ischemia Caused by Arterial (laparotomy+reseksi usus:
54.11+45.79/45.62) ,
Occlusions
(39.79)
56 Endovascular Treatment of Renovascular Disease
(39.24)
57 Open Surgical Repair of Renovascular Disease
(38.8)
58 Repair of Extracranial Occlusive Lesions
(39.59)
59 Carotid Angioplasty and Stenting
(38.60/39.52)
60 Excisi Aneurysms of the Extracranial Carotid Artery: diagnosis
and management
61 Uncommon Disorders the Carotid Arteries: diagnosis and (43.1/39.8)
management
62 Carotid Endarterectomy (38.1)
(39.93)
63 Catheter-Based Interventions for Acute Deep Venous
Thrombosis
64 Surgical Thrombectomy for Acute Deep Venous Thrombosis (upper limb: 38.03, lower limb:
38.0/38.09)
65 Vena Caval Interruption Procedures (38.7)
66 The Surgical Treatment o f Deep Venous Valvular (repair vein: 39.59)
Incompetence

67 Surgical treatment of chronic occlusions o f iliac vein and (38.8)
inferior vena cava
68 Endovascular treatment of chronic occlusions of iliac vein and (39.79)
inferior vena cava
69 Endovascular treatment of vena cava occlusion (39.79)
70 Surgical treatment of superior vena cava syndrome (38.7)
71 Surgical treatment of chronic lymphedema and primary chylous (40.9)
disorders
72 Angioplasty (39.50)
73 Angioplasty/Stenting for Mesenteric Artery Stenosis (39.50)
74 Angioplasty/Stenting for Renal Artery Stenosis (39.50)
75 Angioplasty/Stenting of PAD/PVD (39.50)
76 Angioplasty/Stenting of Subclavian Artery (39.50)
77 Angioplasty/Stenting of Vertebral Artery (39.50)
78 Aorta Surgery (reseksi + rekonstruksi: 35
39.31/39.58, 39.59)
79 Aortofemoral Bypass Grafting (39.58)
80 , Atherectomy for PAD (39.50)
81 Atherectomy (39.50)
82 Branched Aortic Stentgraft Repairs (39.31)
83 Bypass Surgery for Venous Disease (39.59)
84 Carotid Angiography (88.40)
85 Carotid Artery Dissection (39.91)
86 Carotid Stenting (39.90)
87 Carotid-Subclavian Bypass (39.22)
88 Catheter-Directed Thrombolysis (17.5)
89 Complex Aorta Surgery (38.34/38.44)
90 Diagnostic Angiography (38.2)
91 Embolisation of Carotid Body Tumours (38.8)
92 Endovascular Repair of Abdominal Aortic Aneurysms (39.31)
93 Endovascular Repair of Thoracic Aortic Aneurysms (39.31)
94 Endovascular Repair o f Thoracoabdominal Aortic (39.31)
Aneurysms
95 Endovascular Surgery (39.7)
96 Endovenous Laser Therapy (39.7)
97 Fenestrated Aortic Stentgraft Repairs (39.7)
98 First Rib Resection (77.91)
99 IVC Filter Placement (00.63)
100 Laser atherectomy for PAD/PVD (39.50)
101 Minimally Invasive Aortic Surgery (39.7)
102 Percutaneous Mechanical Thrombolysis (17.5)
103 Repair of Venous Aneurysms (39.52)
104 Resection of Carotid Body Tumours (39.8)
105 Resection of Congenital Vascular Lesions (38.6)
106 Surgery for Peripheral Arterial Disease (PAD) (39.31/39.58)
107 Surgery for Peripheral Vascular Disease (PVD) (39.31/39.58, 39.59)
108 Surgery for Portal Hypertension (39.2/41.5/41.43)
109 Surgery for Thoracic Outlet Syndrome (TOS) (38.8)
110 Vascular Ultrasound (00.2)
111 Venous angioplasty/stenting (17.5)
112 Venous Thrombolysis (99.1)
5 - Berita Acara PP PESBEVI dan PP IKABI I 43

IKABI
Jl Kramal R a y a 160, Jakarta Pusat 10430, Telp S Fax. 021 - 3916774
E m a i l : ppikabi@yaboD.com
Susunan Pengurus PP IKABI BERITA ACARA

Periode 2012-2014
Dawan Pailimbanqan
Prol. Dr Sjamsjtiidajat, SpB SpB-KBD
Dr Soerarso Hardjowasito, SpB SpBTKV
Maielt? Ellk ^ Panasehat Nama : Dr Rizal Pohan, SpB.SpOT
Prof. Dr Muclilis Ramli, SpB(K)-Onl<
Jabatan : Ketua PABOI
Ketua Presidium
Prof. DR. Dr Paul Tahaleie, SpB.SpBTKV Periode 2012-2014
Wakil Ketua/Kelua Terpllih
Dr R. Sutiartono, SpBKBV
Wakil Ketua Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PABOI
Prof. DR. Dr. Sunaryo Hardjowidjolo, SpB SpU kepada:
Ketua Purna
Jabatan : Sekretaris Jenderal I K A B I
Ketua MKIBI
Periode 2012-2014
Prof. Dr. Errol U. Hutagaiurg, SpB SpOT
Presidium
Dr. Unp Murtedjo, SpB PGD Pal Med, ECU
Dr Rizal Pohan, SpB SpOT
Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr. Sonar Son PanigonD. SpB K Onk
Dr. Patnot Muslim. SpU
Bedah Indonesia.
Dr. Poerrvadi. SpB SpBA
Dr. R Suhanono, SpBKBV
Dr Setyowidi Nugroho, SpB SpBS
Jakarta,
Dr Maizui Anwar, SpB TKV
Dr Ishandono Dachlan, Msc, SpB, SpBP-RE|K) I I Februari 2013
Sekretaris Jenderal
Dr. Djoni Darniadiaja, SpB MARS
Wakil Sekjen
Dr Agung Prasmono, SpB SpBTKV.MARS
Bendahara
Komisi Organisasi. Legislasi dan Advokasi Drîzal Poh^n, SpB.SpOT Dr. Djoni Ifarmadjaja, SpB.MARS
Dr HN Nazar, SpB
Dr Chandra Svaras, SpB Ketua PABOI Sekjen IKABI
Komisi Profesi Bedah, Asuransi dan
Perpajakap
Or Erawan Wiradisuria, SpB KBD
Dr Henry Boyke Sitompul, SpB
Dr InzlaArt)!, SpB
Komisi Globallsasi & Pasar Beba;

Dr dr. Fathema D Rachmal, SpB SpBTKV
Or Huntal Simamora. SpBP-RE
Komisi Komunikasi dan Publlkasi

DR. Dr. Yefta Munadjat, SpB SpBP-RE(K)
Prol. DR. Dr. Sri Maliawan, SpBS (K)
Komisi Hubungan Dalam Neqeri

Prof. DR. Dr. Andi Asadul Islam, SpBS

Dr ZAIsma. SpB
Komisi Trauma
DR. Dr Achmad Hidayat. SpB
D r B Sunoko. SpB
DR. Dr Tnwahyu Mumi, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH ORTHOPEDI

& TRAUMATOLOGI
(PABOI)
D O K T E R SPESIALIS BEDAH ORTHOPEDI & TRAUMATOLOGI
(PABOI)
1 Procedures and interventions, Not Elsewhere Classified 00
2 Computer assisted surgery [CAS], CT-free navigation, image guided 0 0 J ^,
navigation (IGN), imageless navigation. That without the use of robotic (s)
technology. Code also diagnostic or therapeutic procedure. Excludes: robotic
assisted procedures (17.41-17.49), stereotactic frame
application only (93.59)
3 Computer assisted surgery with CT/CTA 00.31
4 Computer assisted surgery with MR/MRA 00.32
5 Computer assisted surgery with fluoroscopy 00.33
6 Imageless computer assisted surgery 00.34
7 Computer assisted surgery with multiple datasets 00.35
8 Other computer assisted surgery 00.39
Computer assisted surgery NOS
9 Other hip procedures 00,7
10 Revision of hip replacement, both acetabular and femoral components. 00.70
Total hip revision
Code also any :removal of (cement) (joint) spacer (84.57),
type of bearing surface, if known (00.74-00.77
11 Revision of hip replacement, acetabular component. 00.71
Partial, acetabular component only
That with : exchange of acetabular cup and liner, exchange of femoral head
Code also any type of bearing surface, if known (00.74-00.77)
12 Revision of hip replacement, femoral component. 00.72
Partial, femoral component only
That with : exchange of acetabular liner, exchange of femoral stem and head
13 Revision of hip replacement, acetabular liner and/or femoral head only 00.73
14 Hip bearing surface, metal-on-polyethylene 00.74
15 Hip bearing surface, metal-on-metal 00.75
16 Hip bearing surface, ceramic-on-ceramic 00.76
17 Hip bearing surface, ceramic-on-polyethylene 00.77
18 Other knee and hip procedures 00.8
Note : Report up to two components using 00.81 - 00.83 to describe revision
of knee replacements. I f all three components are revised, report 00.80
19 Revision of knee replacement, total (all components), 00.80
Replacement of femoral, tibial, and patellar components (all components)
Code also any removal of (cement) (joint) spacer (84.57)
20 Revision of knee replacement, tibial component. 00.81
Replacement of tibial baseplate and tibial insert (liner)
2! Revision of knee replacement, femoral component. 00.82
That with replacement of tibial insert (liner)
22 Revision of knee replacement, patellar component 00.83
23 Revision of total knee replacement, tibial insert (liner). 00.84
Replacement of tibial insert (liner)
6 - Berita Acara PP PABOI dan PP IKABI I 49

24 Resurfacing hip, total, acetabulum and femoral head.
Hip resurfacing arthroplasty, total 00.85
25 Resurfacing hip, partial, femoral head. Hip resurfacing arthroplasty, NOS.
Hip resurfacing arthroplasty, partial, femoral head 00.86
26 Resurfacing hip, partial, acetabulum.
Hip resurfacing arthroplasty, partial, acetabulum 00.87
27 Other procedures and interventions
28 Transplant from cadaver. 00.9
Code also organ transplant procedure (Massive Tissue Allograft) (Kh) 00.93
29 Intra-operative neurophysiologic monitoring 00.94
30 Operations on spinal cord and spinal canal structures 03
31 Exploration and decompression of spinal canal structures 03.0
32 Removal of foreign body from spinal canal (Cg) 03.01
33 Reopening of laminectomy site (Cg) 03.02
34 Other exploration and decompression of spinal canal 03.09
Decompression : laminectomy, laminotomy. Expansile laminoplasty.
Exploration of spinal nerve root, Foraminotomy.
Code also any synchronous insertion, replacement and revision of posterior
spinal motion preservation device(s), if performed (84.80-84.85)
35 Division of intraspinal nerve root. Rhizotomy 03.1
36 Diagnostic procedures on spinal cord and spinal canal structures 03.3
37 Biopsy of spinal cord or spinal meninges (Cg) 03.32
38 Excision or destruction of lesion of spinal cord or spinal meninges 03.4
Curettage of spinal cord or spinal meninges
Debridement of spinal cord or spinal meninges
Marsupialization of cyst of spinal cord or spinal meninges
Resection of spinal cord or spinal meninges
39 Plastic operations on spinal cord structures 03.5
40 Repair of spinal meningocele 03.51
Repair of meningocele NOS
41 Repair of spinal myelomeningocele 03.52
42 Repair of vertebral fracture 03.53
Elevation of spinal bone fragments
Reduction of fracture of vertebrae
Removal of bony spicules fi-om spinal canal (Cg)
43 Other repair and plastic operations on spinal cord structures 03.59
Repair of: diastematomyelia, spina bifida NOS, spinal cord NOS,
spinal meninges NOS, vertebral arch defect
44 Lysis of adhesions of spinal cord and nerve roots 03.6
45 Injection of destructive agent into spinal canal 03.8
46 Other operations on spinal cord and spinal canal structures 03.9
47 Insertion of catheter into spinal canal for infusion of therapeutic or palliative 03.90
Substances
Insertion of catheter into epidural, subarachnoid, or subdural space of spine
with intermittent or continuous infiasion of drug (with creation of any
reservoir)
Code also any implantation of infusion pump (86.06)
48 Injection of anesthetic into spinal canal for analgesia (Sd) 03.91

49 Injection of other agent into spinal canal 03.92
Intrathecal injection of steroid
Subarachnoid perfusion o f refrigerated saline .f . -
50 Implantation or replacement o f spinal neurostimulator lead(s) 03.93
Code also any insertion of neurostimulator pulse generator (86.94-86.98)
51 Removal of spinal neurostimulator lead(s) 03.94
Code also any removal of neurostimulator pulse generator (86.05)
52 Percutaneous denervation of facet 03.96
53 Other 03.99
54 Operations on cranial and peripheral nerves 04
55 Incision, division, and excision of cranial and peripheral nerves 04.0
56 Other excision or avulsion of cranial and peripheral nerves (Bs). 04.07
Curettage of peripheral nerve
Debridement of peripheral nerve. Resection of peripheral nerve.
Excision of peripheral neuroma [Morton's]
57 Diagnostic procedures on peripheral nervous system 04.1
58 Open biopsy of cranial or peripheral nerve or ganglion 04.12
59 Destruction of cranial and peripheral nerves 04.2
Destruction of cranial or peripheral nerves by :
cryoanalgesia,injection of neurolytic agent, radiofrequency,
radiofrequency ablation
60 Suture of cranial and peripheral nerves 04.3
61 Lysis of adhesions and decompression of cranial and peripheral nerves 04.4
62 Release of carpal tunnel 04.43
63 Release of tarsal tunnel 04.44
64 Other peripheral nerve or ganglion decompression or lysis of adhesions 04.49
Peripheral nerve neurolysis NOS
65 Cranial or peripheral nerve graft 04.5
66 Transposition of cranial and peripheral nerves. Nerve transplantation 04.6
67 Other cranial or peripheral neuroplasty 04.7
68 Hypoglossal-facial anastomosis 04.71
69 Accessory-facial anastomosis 04.72
70 Accessory-hypoglossal anastomosis 04.73
71 Other anastomosis of cranial or peripheral nerve 04.74
72 Revision of previous repair of cranial and peripheral nerves 04.75
73 Repair of old traumatic injury of cranial and peripheral nerves 04.76
74 Other neuroplasty 04.79
75 Injection into peripheral nerve 04.8
76 Peripheral nerve injection, not otherwise specified 04.80
77 Injection of anesthetic into peripheral nerve for analgesia 04.81
78 Injection of other agent, except neurolytic 04.89
79 Other operations on cranial and peripheral nerves 04.9
80 Neurectasis 04.91
81 Implantation or replacement of peripheral neurostimulator lead(s) 04.92
Code also any insertion of neurostimulator pulse generator (86.94-86.98)
82 Removal of peripheral neurostimulator lead(s) (Sd) 04.93
Code also any removal of neurostimulator pulse generator (86.05)
83 Incision, excision, and occlusion of vessels 38

84 The following fourth-
digit subclassification is for use with appropriate categories in section
38.0, 38.1, 38.3, 38.5, 38.6, 38.8, and 38.9 according to site. Valid fourth-
digits are in [brackets] at the end of each code/description.
0 unspecified site
3 upper limb vessels: Axillary, Brachial, Radial, Ulnar
8 lower limb arteries: Femoral (common) (superficial). Popliteal, Tibial
9 lower limb veins: Femoral, Popliteal, Saphenous, Tibial
85 Incision of vessel [38.00-38.09]. Embolectomy, Thrombectomy 38.0
86 Endarterectomy [38.10-38.16,38.18] 38.1
Endarterectomy with: embolectomy, patch graft, temporary bypass during
procedure, thrombectomy
Code also any: number of vascular stents inserted (00.45-00.48), number of
vessels treated (00.40-00.43), procedure on vessel bifurcation (00.44)
87 Resection of vessel with anastomosis [38.30-38.39]. Angiectomy 38.3
Excision of: aneurysm (arteriovenous) with anastomosis, blood vessel (lesion)
with anastomosis
88 Ligation and stripping of varicose veins [38.50-38.53, 38.55, 38.57, 38.59] 38.5
89 Other excision of vessel [38.60-38.69] 38.6
Excision of blood vessel (lesion) NOS
90 Other surgical occlusion of vessels. Clamping of blood vessel, division of 38.8
blood vessel, ligation of blood vessel, occlusion of blood vessels.
91 Other operations on vessels 39
92 Other shunt or vascular bypass 39.2
Code also pressurized treatment of venous bypass graft [conduit] with
pharmaceutical substance, if performed (00.16)
93 Other (peripheral) vascular shunt or bypass 39.29
94 Suture of vessel 39.3
Repair of laceration of blood vessel
95 Suture of unspecified blood vessel 39.30
96 Suture of artery (Bs) 39.31
97 Suture of vein (Bs) 39.32
98 Operation on bone marrow and spleen 41

99 Bone marrow or hematopoietic stem cell transplant 41.0
100 Bone marrow transplant, not otherwise specified 41.00
101 Autologous bone marrow transplant without purging 41.01
102 Allogeneic bone marrow transplant with purging. Allograft of bone marrow 41.02
with in vitro removal (purging) of T-cel!s
103 Allogeneic bone marrow transplant without purging. Allograft of bone 41.03
marrow NOS
104 Autologous hematopoietic stem cell transplant without purging 41.04
105 Allogeneic hematopoietic stem cell transplant without purging 41.05
106 Cord blood stem cell transplant 41.06
107 Autologous hematopoietic stem cell transplant with purging. Cell depletion 41.07
108 Allogeneic hematopoietic stem cell transplant. Cell depletion 41.08
109 Autologous bone marrow transplant with purging. 41.09
With extracorporeal purging of malignant ceils from marrow. Cell depletion

110 INCISION, EXCISION, AND DIVISION OF OTHER BONES 77
The following fourth-digit subclassification is for use with appropriate
categories in section 77-78 to identify the site. Valid fourth-digit categories
are -
in brackets under each code.
0 unspecified site
1 scapula, clavicle, and thorax [ribs and sternum]
2 humerus
3 radius and ulna
4 carpals and metacarpals
5 femur
6 patella
7 tibia and fibula
8 tarsals and metatarsals
9 other. Pelvic bones. Phalanges (of foot) (of hand). Vertebrae
111 Sequestrectomy (77.00-77.09) 77.0
112 Other incision of bone without division. Reopening of osteotomy site (77.11- 77.1
77.19)
113 Wedge osteotomy (77.21-77.29) 77.2
114 Other division of bone, Osteoarthrotomy (77.31 -77.39) 77.3
115 Biopsy of bone (77.41-77.49) 77.4
116 Excision and repair of bunion and other toe deformities 77.5
! 17 Bunionectomy with soft tissue correction and osteotomy of the first metatarsal 77.51
118 Bunionectomy with soft tissue correction and arthrodesis 77.52
119 Other bunionectomy with soft tissue correction 77.53
120 Excision or correction of bunionetle. That with osteotomy 77.54
121 Repair of hammer toe. 77.56
Fusion of hammer toe, Phalangectomy (partial) o f hammer toe. Filleting of
hammer toe
122 Repair of claw toe. 77.57
Fusion of claw toe, Phalangectomy (partial) of claw toe, Capsulotomy of claw
toe. Tendon lengthening of claw toe
123 Other excision, fusion and repair of toes. 77.58
Cockup toe repair, Overlapping toe repair
That with use of prosthetic materials
124 Other bunionectomy. 77.59
Resection of hallux valgus joint with insertion of prosthesis
125 Local excision of lesion or tissue of bone (77.61-77.69) 77.6
126 Excision of bone for graft (77.70-77.79) 77.7
127 Other partial ostectomy (77.80-77.89), Condylectomy 77.8
128 Total ostectomy (77.90-77.99) 77.9
129 Other operations on bones, except facial bones 78
130 Bone graft (78.00-78.09) 78.0
Bone : bank graft, graft (autogenous) (heterogenous)
That with debridement of bone graft site (removal of sclerosed, fibrous or
necrotic bone or tissue). Transplantation of bone
Code also any excision of bone for graft (77.70-77.79)

NO. JENIS TINDAKAN
131 Application of external fixator device (78.10-78.19)
Fixator with insertion of pins/wires/screws into bone.
Code also any type of fixator device, i f known (84.71-84.73)
132 Limb shortening procedures (78.20,78.22-78.25, 78.27-78.29)
Epiphyseal stapling. Open epiphysiodesis. Percutaneous epiphysiodesis.
Resection/ osteotomy
133 Limb lengthening procedures (78.30, 78.32-78.35, 78.37-78.39)
Bone graft with or without internal fixation devices or osteotomy
Distraction technique with or without corticotomy/osteotomy
Code also any application of an external fixation device (78.10-78.19)
134 Other repair or plastic operations on bone (78.40-78.49)
Other operation on bone NEC. Repair of malunion or nonunion fracture NEC
135 Internal fixation of bone without fracture reduction (78.50-78.59)
Internal fixation of bone (prophylactic). Reinsertion of internal fixation
device, Revision of displaced or broken fixation device.
136 Removal of implanted devices from bone (78.60-78.69)
External fixator device (invasive), Internal fixation device. Removal of bone
growth stimulator (invasive). Removal of internal limb lengthening device.
Removal of pedicle screw (s) used in spinal fusion
137 Osteoclasis (78.70-78.79)
138 Diagnostic procedures on bone, not elsewhere classified (78.80-78.89)
139 Insertion of bone growth stimulator (78.90-78.99)
Insertion of; bone stimulator (electrical) to aid bone healing, osteogenic
electrodes for bone growth stimulation, totally implanted device (invasive)
140 REDUCTION OF FRACTURE AND DISLOCATION
Includes : application of cast or splint reduction with insertion
of traction device (Kirschner
wire) (Steinmann pin)
code also any: application of external fixator device (78.10-78.19)
& type of fixator device, if known (84.71-84.73)
categories in section 79 to identify the site. Valid fourth-digit categories
are in [brackets] under each code.
0 unspecified site
I humerus
2 radius and ulna, Arm NOS
3 carpals and metacarpals. Hand NOS
4 phalanges of hand
5 femur
6 tibia and fibula. Leg NOS
7 tarsals and metatarsals, Foot NOS
8 phalanges of foot
9 other specified bone
I Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

141 Closed reduction of fracture without internal fixation (79.00-79.09) 79.0
142 Closed reduction of fracture with internal fixation (79.10-79.19) 79.1
143 Open reduction of fracture without internal fixation (79.20-79.29) 79.2
144 Open reduction of fracture with internal fixation (79.30-79.39) 79.3
145 Closed reduction of separated epiphysis. 79.4
Reduction with or without internal fixation (79.40-.79.42, 79.45, 79.46, 79.49)
146 Open reduction of separated epiphysis (79.50-79.52, 79.55, 79.56, 79.59). 79.5
Reduction with or without internal fixation
147 Debridement of open fracture site (79.60-79.69). 79.6
Debridement of compound fracture
148 Closed reduction of dislocation. 79.7
Includes : closed reduction (with external traction device)
149 Closed reduction of dislocation of unspecified site 79.70
150 Closed reduction of dislocation of shoulder 79.71
151 Closed reduction of dislocation of elbow 79.72
152 Closed reduction of dislocation of wrist 79.73
153 Closed reduction of dislocation of hand and finger 79.74
154 Closed reduction of dislocation of hip 79.75
155 Closed reduction of dislocation of knee 79.76
156 Closed reduction of dislocation of ankle 79.77
157 Closed reduction of dislocation of foot and toe 79.78
158 Closed reduction of dislocation of other specified sites 79.79
159 Open reduction of dislocation 79.8
Includes : open reduction (with internal and external fixation devices)
160 Open reduction of dislocation of unspecified site 79.80
161 Open reduction of dislocation of shoulder 79.81
162 Open reduction of dislocation of elbow 79.82
163 Open reduction of dislocation of wrist 79.83
164 Open reduction of dislocation of hand and finger 79.84
165 Open reduction of dislocation of hip 79.85
166 Open reduction of dislocation of knee 79.86
167 Open reduction of dislocation of ankle 79.87
168 Open reduction of dislocation of foot and toe 79.88
169 Open reduction of dislocation of other specified sites 79.89
170 Unspecified operation on bone injury 79.9
171 Unspecified operation on bone injury, unspecified site 79.90
172 Unspecified operation on bone injury, shoulder 79.91
173 Unspecified operation on bone injury, elbow 79.92
174 Unspecified operation on bone injury, wrist 79.93
175 Unspecified operation on bone injury, hand and finger 79.94
176 Unspecified operation on bone injury, hip 79.95
177 Unspecified operation on bone injury, knee 79.96
178 Unspecified operation on bone injury, ankle 79.97
179 Unspecified operation on bone injury, foot and toe 79.98
180 Unspecified operation on bone injury, other specified sites 79.99

181 INCISION AND EXCISION OF JOINT STRUCTURES 80
Includes : operations on : capsule of joint, cartilage, condyle, ligament,
meniscus, synovial membrane
categories in section 80 to identify the site:
0 unspecified site
1 shoulder
2 elbow
3 wrist
4 hand and finger
Ship
6 knee
7 ankle
8 foot and toe
9 other specified sites. Spine
182 Arthrotomy for removal of prosthesis (80.00-80.09) 80.0
Includes remova; of posterior spinal motion preservation
(dynamic stabilization, facet replacemet, interspinous process) device (s)
Code also any : insertion of (cement)
(joint) (methylmethacrylate) spacer (84.56), removal
of (cement)(joint) (methylmethacrylate) spacer (84.57)
183 Other arthrotomy (80.10-80.19). Arthrostomy 80.1
184 Arthroscopy (80.20-80.29) 80.2
185 Biopsy of joint structure (80.30-80.39). Aspiration biopsy 80.3
186 Division of joint capsule, ligament, or cartilage (80.40-80.49) 80.4
Goldner clubfoot release, Heyman-Hemdon(-
Strong) correction of metatarsus varus
Release of: adherent or constrictive joint capsule, joint ligament
187 Excision, destrucfion and other repair of intervertebral disc 80.5

188 Excision or destruction of intervertebral disc, unspecified. 80.50
Unspecified as to excision or destruction
189 Excision of intervertebral disc. Diskectomy, 80.51
Removal of herniated nucleus pulposus
Level: cervical, thoracic, lumbar (lumbosacral).
That by laminotomy or hemi laminectomy.
That with decompression of spinal nerve root at same level.
Requires additional code for any concomitant decompression of spinal nerve
root at different level from excision site.
Code also any: concurrent spinal fusion (81.00 - 81.09),
repair of the anulus fibrousus (80.53-80.54)
190 Intervertebral chemonucleolysis 80.52
With aspiration of disc fragments. With diskography. Injection of proteolytic
enzyme into intervertebral space (chymopapain)

NO. JENIS TINDAK AN I C D 9-CM
191 Repair of the anulus fibrosus with graft or pi i >thesis, Anular disc repair, 80.53
Closure (sealing) of the annulus fibrosus deft :t
Includes : microsurgical suture repair with >cial autograft, soft tissue re-
approximation repair with tension bands, surgical mesh repair
Code also any : application or administration of adhesion barrier substance, i f
performed (99.77). Intervertebral discectomy, if performed (80.51). Locally
harvested for graft (83.43)
192 Other and unspecified repair of the anulus fibrosus, Anular disc repair. Closure 80.54
(sealing) of the anulus fibrosus defect). Microsurgical suture repair without
fascial autograft. Percutaneous repair of the annulus fibrosus.
Code also any : application or administration of adhesion barrier substance, i f
performed (99.77), intervertebral discectomy, if performed (80.51)
193 Other destruction of intervertebral disc. Destruction NEC, That by laser 80.59
194 Excision of semilunar cartilage of knee. Excision of meniscus of knee 80.6
195 Synovectomy, Complete or partial resection of synovial membrane (80.70- 80.7
80.79)
196 Other local excision or destruction of lesion of joint (80.80-80.89) 80.8
197 Other excision of joint (80.90-80.99) 80.9
198 Repair and plastic operations on joint structures 81
199 Spinal fusion 81.0
Includes : arthrodesis of spine with : bone graft, internal fixafion.
Code also any insertion of interbody spinal fusion device (84.51),
any insertion of recombinant bone morphogenetic protein (84.52),
any synchronous excision of (locally) harvested bone for graft (77.70-77.79),
the total number of vertebrae fused (81.62-81.64)
200 Spinal fusion, not otherwise specified 81.00
201 Atlas-axis spinal fusion. 81.01
Craniocervical fusion by anterior, transoral, or posterior technique.
CI-C2 fusion by anterior, transoral, or posterior technique.
Occiput C2 fusion by anterior, transoral, or posterior technique
202 Other cervical fusion, anterior technique 81.02
Arthrodesis of C2 level or below : anterior (interbody) technique,
anterolateral technique
203 Other cervical fusion, posterior technique 81.03
Arthrodesis of C2 level or below :posterior (interbody) technique,
posterolateral technique
204 Dorsal and dorsolumbar fusion, anterior technique 81.04
Arthrodesis of thoracic or thoracolumbar region :
anterior (interbody) technique, anterolateral technique
205 Dorsal and dorsolumbar fusion, posterior technique 81.05
posterior (interbody) technique, posterolateral technique
206 Lumbar and lumbosacral fusion, anterior technique. 81.06
Anterior lumbar interbody fusion (ALIF)
Arthrodesis of lumbar or lumbosacral region : anterior (interbody) technique,

207 Lumbar and lumbosacral fusion, lateral transverse process technique 81.07
208 Lumbar and lumbosacral fusion, posterior technique 81.08
Arthrodesis of lumbar or lumbosacral region :
posterior (interbody) technique,posterolateral technique
Posterior lumbar interbody fusion (PLIF),
Transforaminal lumbar interbody fusion (TLIF)
209 Arthrodesis and arthroereisis of foot and ankle. Includes : 81.!
arthrodesis of foot and ankle with : bone graft, external fixation device
210 Ankle fusion, Tibiotalar fusion 81.11
211 Triple arthrodesis. Talus to calcaneus and calcaneus to cuboid and navicular 81.12
212 Subtalar fusion 81.13
213 Midtarsal fusion 81.14
214 Tarsometatarsal fusion 81.15
215 Metatarsophalangeal fusion 81.16
216 Other fusion of foot 81.17
217 Subtalar joint arthroereisis 81.18
218 Arthrodesis of other joint 81.2
Includes:
arthrodesis with : bone graft, external fixation device,excision of bone ends and
compression
219 Arthrodesis of unspecified joint 81.20
220 Arthrodesis of hip 81.21
221 Arthrodesis of knee 81.22
222 Arthrodesis of shoulder 81,23
223 Arthrodesis of elbow 81.24
224 Carporadial fusion 81.25
225 Metacarpocarpal fusion 81.26
226 Metacarpophalangeal fusion 81.27
227 Interphalangeal fusion 81.28
228 Arthrodesis of other specified joints 81.29
229 Refusion of spine. Includes :arthrodesis of spine with: 81.3
bone graft, internal fixation,correction of pseudarthrosis of spine.
Code also any insertion of interbody spinal fusion device (84.51),
any insertion of recombinant bone morphogenetic protein (84.52),
any synchronous excision of (locally) harvested bone for graft (77.70-77.79),
the total number of vertebrae fused (81.62-81.64)
230 Refusion of spine, not otherwise specified 81.30
231 Refusion of atlas-axis spine, 81.31
Craniocervical fusion by anterior, transoral, or posterior technique,Cl-
C2 fusion by anterior, transoral, or posterior technique.
Occiput C2 fiasion by anterior, transoral, or posterior technique
232 Refusion of other cervical spine, anterior technique. 81.32
Arthrodesis of C2 level or below :anterior (interbody) technique,
233 Refusion of other cervical spine, posterior technique. 81.33
Arthrodesis of C2 level or below : posterior (interbody) technique, . - j ; , . •.•

N O . ' JENIS TINDAKAN '
234 Refusion of dorsal and dorsolumbar spine, anterior technique. 81.34
anterior (interbody) technique, anterolateral technique
235 Refusion of dorsal and dorsolumbar spine, posterior technique. 81.35
posterior (interbody) technique, posterolateral technique
236 Refusion of lumbar and lumbosacral spine, anterior technique. 81.36
Anterior lumbar interbody fusion (ALIF)
Arthrodesis of lumbar or lumbosacral region :
anterior (interbody) technique,anterolateral technique
237 Refusion of lumbar and lumbosacral spine, lateral transverse process 81.37
technique
238 Refusion of lumbar and lumbosacral spine, posterior technique. 81.38
Arthrodesis of lumbar or lumbosacral region : posterior (interbody) technique,
Posterior lumbar interbody fiasion (PLIF),
Transforaminal lumbar interbody fusion (TLIF)
239 Refusion of spine, not elsewhere classified 81.39
240 Other repair of joint o f lower extremity 81.4
Includes :arthroplasty of lower extremity with :extemal traction or fixation,
graft of bone (chips) or cartilage, internal fixation device
241 Repair of hip, not elsewhere classified 81.40
242 Five-in-one repair of knee. Medial meniscectomy, medial collateral ligament 81.42
repair, vastus medialis advancement, semitendinosus advancement, and pes
anserinus transfer
243 Triad knee repair. 81.43
Medial meniscectomy with repair of the anterior cruciate ligament and the
medial collateral ligament. O'Donoghue procedure
244 Patellar stabilization. Roux- 81.44
Goldthwait operation for recurrent dislocation of patella
245 Other repair of the cruciate ligaments 81.45
246 Other repair of the collateral ligaments 81.46
247 Other repair of knee 81.47
248 Other repair of ankle 81.49
249 Joint replacement of lower extremity 81.5
Includes :arthroplasty of lower extremity with : external traction or fixation,
graft of bone (chips) or cartilage, internal fixation device or prosthesis
250 Total hip replacement. 81.51
Replacement of both femoral head and acetabulum by prosthesis.
Total reconstruction of hip.
Code also any type of bearing surface, i f known (00.74-0 0.77)
251 Partial hip replacement. Bipolar endoprosthesis. 81.52
Code also any type of bearing surface, if known (00.74 - 00.77)
252 Revision of hip replacement, not otherwise specified 81.53
Revision of hip replacement, not specified as to components(s) replaced,
(acetabular, femoral or both)
Code also any : removal of (cement)(joint) spacer (84.57),
type of bearing surface, i f known (00.74-00.77)

253 Total knee replacement. 81.54
Bicompartmental, Tricompartmental, Unicompartmental (hemijoint)
254 Revision of knee replacement,not otherwise specified 81.55
Code also any removal of (cement) spacer (84.57)
255 Total ankle replacement 81.56
256 Replacement of joint of foot and toe 81.57
257 Revision of joint replacement of lower extremity, not elsewhere classified 81.59
258 Other procedures on spine 81.6
Note : Number of vertebrae
The vertebral spine consists of 25 vertebrae in the following order and
number:
Cervical : CI (atlas), C2 (axis), C3, C4, C5, C6, C7
Thoracic or Dorsal: T l , T2, T3, T4, T5, T6, T7, T8, T9, TIO, T l I , T12
Lumbar and Sacral: L I , L2, L3, L4, L5, SI • '
Coders should report only one code from the series 81.62 or 81.63 or 81.64 to
show the total number of vertebrae fused on th epatient.
Code also the level and approach of the fiasion or refusion (81.00-81.08,
81.30-81.39)
259 Fusion or refusion of 2-3 vertebrae 81.62
260 Fusion or refusion of 4- 8 vertebrae 81.63
261 Fusion or refusion of 9 or more vertebrae 81.64
262 Percutaneous vertebroplasty. 81.65
Injection of bone void filler (cement) (polymethylmethacrylate) (PMMA) into
the diseased or fractured vertebral body
263 Percutaneous vertebral augmentation 81.66
Insertion of inflatable balloon, bone tamp, or other device displacing
(removing) (compacting) bone to create a space (cavity) (void) prior to the
injection of bone void filler (cement) (polymethylmethacrylate) (PMMA) or
other substance.
Arcuplasty, Kyphoplasty, Skyphoplasty, Spineoplasty
264 Arthroplasty and repair of hand, fingers and wrist 81.7
Includes: arthroplasty of hand and finger with : external traction or fixation,
265 Arthroplasty of metacarpophalangeal and interphalangeal joint with implant 81.71
266 Arthroplasty of metacarpophalangeal and interphalangeal joint without 81.72
implant
267 Total wrist replacement 81.73
268 Arthroplasty of carpocarpal or carpometacarpal joint with implant 81.74
269 Arthroplasty of carpocarpal or carpometacarpal joint without implant 81.75

270 Other repair of hand, fingers and wrist 81.79
271 Arthroplasty and repair of shoulder and elbow 81.8
Includes: arthroplasty of upper limb NEC with : external traction or fixation,
272 Total shoulder replacement 81.80
273 Partial shoulder replacement 81.81
274 Repair of recurrent dislocation of shoulder 81.82
275 Other repair of shoulder. Revision of arthroplasty of shoulder 81.83

276 Total elbow replacement 81.84
277 Other repair of elbow 81.85
278 Other operations on joint structures 81.9
279 Arthrocentesis. Joint aspiration 81.91
280 Injection of therapeutic substance into joint or ligament 81.92
281 Suture of capsule or ligament of upper extremity 81.93
282 Suture of capsule or ligament of ankle and foot 81.94
283 Suture of capsule or ligament of other lower extremity 81.95
284 Other repair of joint 81.96
285 Revision of joint replacement of upper extremity. 81.97
Partial, Removal of cement spacer, Total
286 Other diagnostic procedures on joint structures 81.98
287 Other 81.99
288 Operations on muscle, tendon, and fascia of hand 82
Includes :operations on : aponeurosis, synovial membrane (tendon sheath),
tendon sheath
289 Incision of muscle, tendon, fascia, and bursa o f hand 82.0
290 Exploration of tendon sheath of hand. Incision of tendon sheath o f hand; 82.01
Removal of rice bodies in tendon sheath of hand
291 Myotomy of hand 82.02
292 Bursotomy of hand 82.03
293 Incision and drainage of palmar or thenar space 82.04
294 Transplantation of muscle and tendon of hand 82.5
295 Advancement of tendon of hand 82.51
296 Recession of tendon of hand 82.52
297 Reattachment of tendon of hand 82.53
298 Reattachment of muscle of hand 82.54
299 Other change in hand muscle or tendon length 82.55
300 Other hand tendon transfer or transplantation 82.56
301 Other hand tendon transposition 82.57
302 Other hand muscle transfer or transplantation 82.58
303 Other hand muscle transposition 82.59
304 Reconstruction of thumb. Includes : digital transfer to act as thumb 82.6
Code also any amputation for digital transfer (84.01, 84.11)
305 Pollicization operation carrying over nerves and blood supply 82.61
306 Other reconstruction of thumb. "Cocked-hat" procedure [skin flap and bone]. 82.69
Grafts : bone to thumb skin (pedicle) to thumb
307 Plastic operation on hand with graft or implant 82.7
308 Tendon pulley reconstruction. Reconstruction for opponensplasty 82.71
309 Plastic operation on hand with graft of muscle or fascia 82.72
310 Plastic operation on hand with other graft or implant. Tendon graft to hand 82.79
311 Other plastic operations on hand 82.8
312 Transfer of finger, except thumb 82.81
313 Repair of cleft hand 82.82
314 Repair of macrodactyly 82.83
315 Repair of mallet finger 82.84
316 Other tenodesis of hand. Tendon fixation of hand NOS 82.85
317 Other tenoplasty of hand. Myotenoplasty of hand 82.86
318 Other plastic operations on hand. Plication of fascia. Repair of fascial hernia 82.89

319 Other operations on muscle, tendon, and fascia of hand 82.9
320 Lysis of adhesions of hand. 82.91
Freeing of adhesions of fascia, muscle, and tendon of hand
321 Aspiration of bursa of hand 82.92
322 Aspiration of other soft tissue of hand 82.93
323 Injection of therapeutic substance into bursa of hand 82.94
324 Injection of therapeutic substance into tendon of hand 82.95
325 Other injection of locally-acting therapeutic substance into soft tissue of hand 82.96
326 Other operations on muscle, tendon, and fascia of hand 82.99
327 Operations on muscle, tendon, fascia, and bursa, except hand 83
Includes :operations on : aponeurosis,
synovial membrane of bursa and tendon sheaths,tendon sheaths
328 Incision of muscle, tendon, fascia, and bursa 83.0
329 Exploration of tendon sheath. Incision of tendon sheath. 83.01
Removal of rice bodies from tendon sheath
330 Myotomy 83.02
331 Bursotomy. Removal of calcareous deposit of bursa 83.03
332 Other incision of soft tissue. Incision of fascia 83.09
333 Division of muscle, tendon, and fascia 83.1
334 Achillotenotomy 83.11
335 Adductor tenotomy of hip 83.12
336 Other tenotomy. Aponeurotomy, Division of tendon. Tendon release. 83.13
Tendon transection. Tenotomy for thoracic outlet decompression
337 Fasciotomy. Division of fascia. Division of iliotibial band. Fascia stripping, 83.14
Release of Volkmann's contracture by fasciotomy
338 Other division of soft tissue. Division of muscle. Muscle release, 83.19
Myotomy for thoracic outlet decompression. Myotomy with division,
Scalenotomy, Transection of muscle
339 Diagnostic procedures on muscle, tendon, fascia, and bursa, including that of 83.2
hand
340 Biopsy of soft tissue 83.21
341 Other diagnostic procedures on muscle, tendon, fascia, and bursa, including 83.29
that of hand
342 Excision of lesion of muscle, tendon, fascia, and bursa 83.3
343 Excision of lesion of tendon sheath. 83.31
Excision of ganglion of tendon sheath, except of hand
344 Excision of lesion of muscle 83.32
Excision of: heterotopic bone,
muscle scar for release of Volkmann's contracture, myositis ossificans
345 Excision of lesion of other soft tissue. Excision of Baker's cyst 83.39
346 Other excision of muscle, tendon, and fascia 83.4
347 Excision of tendon for graft 83.41
348 Other tenonectomy 83.42
Excision o f : aponeurosis, tendon sheath, Tenosynovectomy
349 Excision of muscle or fascia for graft 83.43
350 Other fasciectomy 83.44
351 Other myectomy. Debridement o f muscle NOS. Scalenectomy 83.45
352 Other excision of soft tissue 83.49 ;
353 Bursectomy ^^-^

354 Suture of muscle, tendon, and fascia 83.6
355 Suture of tendon sheath 83.61
356 Delayed suture of tendon . 83.62
357 Rotator cuff repair 83.63
358 Other suture of tendon. Achillorrhaphy, Aponeurorrhaphy 83.64
359 Other suture of muscle or fascia. Repair of diastasis recti 83.65
360 Reconstruction of muscle and tendon 83.7
361 Advancement of tendon 83.71
362 Recession of tendon 83.72
363 Reattachment of tendon 83.73
364 Reattachment of muscle 83.74
365 Tendon transfer or transplantation 83.75
366 Other tendon transposition 83.76
367 Muscle transfer or transplantation. 83.77
Release of Volkmann's contracture by muscle transplantation
368 Other muscle transposition 83.79
369 Other plastic operations on muscle, tendon, and fascia 83.8
370 Tendon graft 83.81
371 Graft of muscle or fascia 83.82
372 Tendon pulley reconstruction 83.83
373 Release of clubfoot, not elsewhere classified. Evans operation on clubfoot 83.84
374 Other change in muscle or tendon length. 83.85
Hamstring lengthening. Heel cord shortening. Plastic achillotenotomy, Tendon
plication
375 Quadricepsplasty 83.86
376 Other plastic operations on muscle. Musculoplasty, Myoplasty 83.87
377 Other plastic operations on tendon. 83.88
Myotenoplasty, Tendon fixation. Tenodesis, Tenoplasty
378 Other plastic operations on fascia. 83.89
Fascia lengthening, Fascioplasty, Plication of fascia
379 Other operations on muscle, tendon, fascia, and bursa 83.9
380 Lysis of adhesions of muscle, tendon, fascia, and bursa 83.91
381 Insertion or replacement of skeletal muscle stimulator 83.92
Implantation, insertion, placement, or replacement of skeletal muscle :
electrodes, stimulator
382 Removal of skeletal muscle stimulator 83.93
383 Aspiration of bursa 83.94
384 Aspiration of other soft tissue 83.95
385 Injection of therapeutic substance into bursa 83.96
386 Injection of therapeutic substance into tendon 83.97
387 Injection of locally-acfing therapeutic substance into other soft tissue 83.98
388 Other operations on muscle, tendon, fascia, and bursa. Suture of bursa 83.99
389 Other procedures on musculoskeletal system 84
390 Amputation of upper limb 84.0
391 Upper limb amputation, not otherwise specified Amputation of upper limb 84.00
Closed flap amputation of upper limb NOS.
Kinepiastic amputafion of upper limb NOS
Open or guillotine amputation of upper limb NOS.
Revision of current traumatic amputation of upper limb NOS

392 Amputation and disarticulation of finger 84.01
393 Amputation and disarticulation of thumb 84.02
394 Amputation through hand. Amputation through carpals 84.03
395 Disarticulation of wrist 84.04
396 Amputation through forearm. Forearm amputation 84.05
397 Disarticulation of elbow 84.06
398 Amputation through humerus. Upper arm amputation 84.07
399 Disarticulation of shoulder 84.08
400 Interthoracoscapular amputation. Forequarter amputation 84.09
401 Amputation of lower limb 84.1
402 Lower limb amputation, not otherwise specified. 84.10
Closed flap amputation of lower limb NOS
Kinepiastic amputation of lower limb NOS.
Open or guillotine amputation of lower limb NOS
Revision of current traumatic amputation of lower limb NOS
403 Amputation of toe. Amputation through metatarsophalangeal joint. 84.11
Disarticulation of toe.
Metatarsal head amputation.
Ray amputation of foot (disarticulation of the metatarsal head
of the toe
extending across the forefoot just proximal to the metatarsophalangeal crease)
404 Amputation through foot. Amputation of forefoot. 84.12
Amputation through middle of foot. Chopart's amputation.
Midtarsal amputation. Transmetatarsal amputation (amputation of the
forefoot, including all the toes)
405 Disarticulation of ankle 84.13
406 Amputation of ankle through malleoli of tibia and fibula 84.14
407 Other amputafion below knee. Amputafion of leg through fibia and fibula NOS 84.15
408 Disarticulation of knee. Batch, Spifier, and McFaddin amputation. 84.16
Mazet amputation. S.R Roger's amputation
409 Amputation above knee. Amputation of leg through femur. 84.17
Amputation of thigh. Conversion of betow-knee amputation into above-
knee amputation. Supracondylar above-knee amputation
410 Disarticulation of hip 84.18
411 Abdominopelvic amputation. Hemipelvectomy, Hindquarter amputafion 84.19
412 Reattachment of extremity 84.2
413 Thumb reattachment 84.21
414 Finger reattachment 84.22
415 Forearm, wrist, or hand reattachment 84.23
416 Upper arm reattachment. Reattachment of arm NOS 84.24
417 Toe reattachment 84.25
418 Foot reattachment 84.26
419 Lower leg or ankle reattachment. Reattachment of leg NOS 84.27
420 Thigh reattachment 84.28
421 Other reattachment 84.29
422 Revision of amputation stump. 84.3
Reamputation of stump, Secondary closure o f stump. Trimming of
slump

NO. ^ ' JENIS TINDAKAN • ' .-y-^r-:.
423 Implantation or fitting of prosthetic limb device 84.4

424 Implantation or fitting of prosthetic limb device, not otherwise specified 84.40
425 Fitting of prosthesis of upper arm and shoulder 84.41
426 Fitting of prosthesis of lower arm and hand 84.42
427 Fitting of prosthesis of arm, not otherwise specified 84.43
428 Implantation of prosthetic device of arm 84.44
429 Fitting of prosthesis above knee 84.45
430 Fitting of prosthesis below knee 84.46
431 Fitting of prosthesis of leg, not otherwise specified 84.47
432 Implantation of prosthetic device of leg 84.48
433 Implantation of other musculoskeletal devices and substances 84.5
434 Insertion of interbody spinal fusion device 84.51
Insertion of; cages (carbon, ceramic, metal, plastic or titanium),
interbody fusion cage, synthetic cages or spacers, threaded bone dowels
Code also refusion of spine (81.30 - 81.39).
Code also spinal fusion (81.00 - 81.08)
435 Insertion of recombinant bone morphogenetic protein. rhBMP. 84.52
That via collagen sponge, coral, ceramic and other carriers
Code also primary procedure performed : fracture repair (79.00-79.99),
spinal fusion (81.00 - 81.08), spinal refusion (81.30-81.39)
436 Implantation of internal limb lengthening device with kinetic distraction 84.53
Code also limb lengthening procedure (78.30 - 78.39)
437 Implantation of other internal limb lengthening device 84,54
Implantation of internal limb lengthening device. Not Otherwise Specified
(NOS)
Code also limb lengthening procedure (78.30 - 78.39)
438 Insertion of bone void filler 84.55
Insertion of: acrylic cement (PMMA), bone void cement,
calcium based bone void filler, polymethylmethacrylate (PMMA)
439 Insertion or replacement of (cement) spacer. 84.56
Insertion or replacement of joint (methylmethacrylate) spacer
440 Removal of (cement) spacer. Removal of joint (methylmethacrylate) spacer 84.57
441 Insertion of other spinal devices 84.59
442 Replacement of spinal disc 84.6
Includes : non-fusion arthroplasty of the spine with insertion of artificial disc
prosthesis
443 Insertion of spinal disc prosthesis, not otherwise specified. 84.60
Replacement of spinal disc, NOS
Includes: diskectomy (discectomy)
444 Insertion of partial spinal disc prosthesis, cervical. 84.61
Nuclear replacement device, cervical
Partial artificial disc prosthesis (flexible), cervical.
Replacement of nuclear disc (nucleus pulposus), cervical.

445 Insertion of total spinal disc prosthesis, cervical. 84.62
Replacement of cervical spinal disc, NOS.
Replacement of total spinal disc, cervical.
Total artificial disc prosthesis (flexible), cervical.
Includes : diskectomy (discectomy)
446 Insertion of spinal disc prosthesis, thoracic. 84.63
Artificial disc prosthesis (flexible), thoracic.
Replacement of thoracic spinal disc, partial or total.
447 Insertion of partial spinal disc prosthesis, lumbosacral. 84.64
Nuclear replacement device, lumbar
Partial artificial disc prosthesis (flexible), lumbar.
Replacement of nuclear disc (nucleus pulposus) lumbar.
448 Insertion of total spinal disc prosthesis, lumbosacral. 84.65
Replacement of lumbar spinal disc, NOS
Replacement of total spinal disc, lumbar.
Total artificial disc prosthesis (flexible), lumbar.
Includes : diskectomy (discectomy)
449 Revision or replacement of artificial spinal disc prosthesis, cervical. 84.66
Removal of (partial) (total) spinal disc prosthesis with synchronous insertion
of new (partial) (total) spinal disc prosthesis, cervical.
Repair of previously inserted spinal disc prosthesis, cervical
450 Revision or replacement of artificial spinal disc prosthesis, thoracic 84.67
of new (partial) (total) spinal disc prosthesis, thoracic.
Repair of previously inserted spinal disc prosthesis, thoracic
451 Revision or replacement of artificial spinal disc prosthesis, lumbosacral. 84.68
of new (partial) (total) spinal disc prosthesis, lumbosacral.
Repair of previously inserted spinal disc prosthesis, lumbosacral
452 Revision or replacement of artificial spinal disc prosthesis, not otherwise 84.69 '
specified
of new (partial) (total) spinal disc prosthesis.
Repair of previously inserted spinal disc prosthesis
453 Adjunct codes for external fixator devices 84.7
Code also any primary procedure performed :
application of external fixator device (78.10, 78.12-78.13, 78.15,78.17- 78.19)
, reduction of fracture and dislocation (79.00-79.89)
454 Application of external fixator device, monoplanar system 84.71
455 Application of externa! fixator device, ring system. 84.72
Ilizarov type, Sheffield type
456 Applicafion of hybrid external fixator device. Computer 84.73
(assisted) (dependent) external fixator device. '
Hybrid system using both ring and monoplanar devices

457 Insertion, replacement and revision of posterior spinal motion preservation 84.8
device(s)
Dynamic spinal stabilization device(s).
Includes any synchronous facetectomy (partial, total) performed at the same
level. Code also any synchronous surgical decompression (foraminotomy,
laminectomy, laminotomy), if performed (03.09)
458 Insertion or replacement of interspinous process device(s). 84.80
Interspinous process decompression device(s).
Interspinous process distraction device(s)
459 Revision of interspinous process device(s). 84.81
Repair of previously inserted interspinous process device(s)
460 Insertion or replacement of pedicle-based dynamic stabilization device(s) 84.82
461 Revision of pedicle-based dynamic stabilization device(s) 84.83
Repair of previously inserted pedicle-based dynamic stabilization device(s)
462 Insertion or replacement of facet replacement device(s). Facet arthroplasty 84.84
463 Revision of facet replacement device(s). 84.85
Repair of previously inserted facet replacement device(s)
464 Other operations on musculoskeletal system 84.9
465 Amputation, not otherwise specified 84.91
466 Separation of equal conjoined twins 84.92
467 Separation of unequal conjoined twins. Separation of conjoined twins NOS 84.93
468 Other 84.99
469 Operations on skin and subcutaneous tissue 86
Includes : operations on : hair follicles, male perineum, nails,
sebaceous glands, subcutaneous fat pads, sudoriferous glands,
superficial fossae
470 Incision of skin and subcutaneous tissue 86.0
471 Aspiration of skin and subcutaneous tissue 86.01
Aspiration of: abscess of nail, skin, or subcutaneous tissue. Hematoma of
nail, skin, or subcutaneous tissue. Seroma of nail
hematoma of nail, skin, or subcutaneous tissue,
seroma of nail, skin, or subcutaneous tissue
472 Injection or tattooing of skin lesion or defect. Injection of filling material, 86.02
insertion of filling material, pigmenting of skin of filling material.
473 Incision of pilonidal sinus or cyst 86.03
474 Other incision with drainage of skin and subcutaneous tissue 86.04
475 Incision with removal of foreign body or device from skin and subcutaneous 86.05
tissue. Removal of carotid sinus baroreflex activation device.
Remova! of loop recorder.
Removal of neurostimulator pulse generator (single array, dual array).
Removal of tissue expander(s) from skin or soft tissue other than breast tissue
476 Insertion of totally implantable infusion pump. 86.06
Code also any associated catheterization
477 Insertion of totally implantable vascular access device [VAD]. 86.07
Totally implanted port

JENIS TINDAKAN I C D 9-CM
Other incision of skin and subcutaneous tissue. 86.09
Creation of thalamic stimulator pulse generator pocket, new site.
Escharotomy. Exploration : sinus tract, skin & superficial fossa
Relocation of subcutaneous device pocket NEC.
Reopening subcutaneous pocket for device revision without replacement.
Undercutting of hair follicle
479 Diagnostic procedures on skin and subcutaneous tissue 86.1
480 Biopsy of skin and subcutaneous tissue 86.11
481 Other diagnostic procedures on skin and subcutaneous tissue 86.19
482 Excision or destruction of lesion or tissue of skin and subcutaneous tissue 86.2
483 Excision of pilonidal cyst or sinus. Marsupialization of cyst 86.21
484 Excisional debridement of wound, infection, or burn 86.22
Removal by excision o f : devitalized fissue. necrosis, slough
485 Removal of nail, nail bed, or nail fold 86.23
486 Chemosurgery of skin, Chemical peel of skin 86.24
487 Dermabrasion, That with laser 86.25
488 Ligation of dermal appendage 86.26
489 Debridement of nail, nail bed, or nail fold. Removal o f : necrosis, slough 86.27
490 Nonexcisional debridement of wound, infection or bum. Debridement NOS. 86.28
Maggot therapy
Removal of devitalized fissue, necrosis and slough by such methods as :
brushing, irrigation (underpressure), scrubbing, washing. Water scalpel (jet)
491 Other local excision or destruction of lesion or tissue of skin and subcutaneous 86.3
tissue
Destruction of skin by : cauterization cryosurgery, fulguration, laser beam.
That with Z-plasty
492 Radical excision of skin lesion 86.4
Wide excision of skin lesion involving underlying or adjacent structure
Code also any lymph node dissection (40.3-40.5)
493 Suture or other closure of skin and subcutaneous tissue 86.5
494 Replantation of scalp 86.51
495 Closure of skin and subcutaneous fissue of other sites.adhesive (surgical) 86.59
(tissue), staples, sutures
496 Free skin graft. Includes : excision of skin for autogenous graft 86.6
497 Free skin graft, not otherwise specified 86.60
498 Full-thickness skin graft to hand 86.61
499 Other skin graft to hand 86.62
500 Full-thickness skin graft to other sites 86.63
501 Hair transplant 86.64
502 Heterograft to skin. Pigskin graft. Porcine graft 86.65
503 Homograft to skin. 86.66
Graft to skin of: amnionic membrane from donor skin from donor
504 Dermal regenerafive graft. Artificial skin, NOS. Creation of "neodermis". 86.67
Decellularized allodermis. Integumentary matrix implants.
Prosthetic implant of dermal layer of skin. Regenerate dermal layer of skin
68 Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

505 Other skin graft to other sites 86.69
506 Pedicle grafts or flaps 86.7
507 Pedicle or flap graft, not otherwise specified 86.70
508 Cutting and preparation of pedicle grafts or flaps. 86.71
Elevation of pedicle from its bed. Flap design and raising.
Partial cutting of pedicle or tube. Pedicle delay
509 Advancement of pedicle graft 86.72
510 Attachment of pedicle or flap graft to hand 86.73
511 Attachment of pedicle or flap graft to other sites. Attachment by: advanced 86.74
flap, double pedicled flap, pedicle graft, rotating flap, sliding flap, tube graft
512 Revision of pedicle or flap graft. Debridement of pedicle or flap graft. 86.75
Defatting of pedicle or flap graft.
5i3 Other repair and reconstruction of skin and subcutaneous tissue 86.8
514 Repair for facial weakness 86.81
515 Facial rhytidectomy, Face lift 86.82
516 Size reducfion plastic operation. Liposucfion. Reduction of adipose tissue o f : 86.83
abdominal wall (pendulous), arms (batwing), buttock, thights
(trochanteric lipomatosis)
517 Relaxation of scar or web contracture o f skin. Z-plasty of skin 86.84
518 Correction of syndactyly 86.85
519 Onychoplasty 86.86
520 Other repair and reconstruction of skin and subcutaneous tissue 86.89
521 Other operations on skin and subcutaneous tissue 86.9
522 Excision of skin for graft. Excision of skin with closure of donor site 86.91
523 Electrolysis and other epilation of skin 86.92
524 Insertion of tissue expander. Insertion (subcutaneous) (soft tissue) of expander 86.93
(one or more) in scalp (subgaieal space), face, neck, trunk except breast, and
upper and lower extremities for development of skin flaps for donor use.
525 Insertion or replacement of single array neurostimulator pulse generator, not 86.94
specified as rechargeable. Pulse generator (single array, single
channel) for intracranial, spinal, and peripheral neurostimulator.
Code also any associated lead implantation (02.93,03.93,04.92)
526 Insertion or replacement of dual array neurostimulator pulse generator, not 86.95
specified as rechargeable.
Pulse generator (dual array, dual channel) for intracranial, spinal, and
peripheral neurostimulator.
527 Insertion or replacement of other neurostimulator pulse generator. 86.96
528 Insertion or replacement of single array rechargeable neurostimulator pulse 86.97
generator
Rechargeable pulse generator (single array, single channel) for intracranial,
spinal, and peripheral neurostimulator.

NO. JENIS TINDAKAN ICD 9-CIVI
529 Insertion or replacement of dual array rechargeable neurostimulator pulse 86.98
generator
Rechargeable pulse generator
(dual array, dual channel) for intracranial,spinal, and peripheral neurostimulator.
530 Other 86.99
531 Physical therapy, respiratory therapy, rehabilitation, and related procedures 93
532 Diagnostic physical therapy 93.0
533 Functional evaluation 93.01
534 Orthotic evaluation 93.02
535 Prosthetic evaluation 93.03
536 Manual testing of muscle function 93.04
537 Range of motion testing 93.05
538 Measurement of limb length 93.06
539 Body measurement. Girth measurement, Measurement of skull circumference 93.07
540 Electromyography 93.08
541 Other diagnostic physical therapy procedure 93.09
542 Physical therapy exercises 93.1
543 Assisting exercise 93.11
544 Other active musculoskeletal exercise 93.12
545 Resistive exercise 93.13
546 Training in joint movements 93.14
547 Mobilization of spine 93.15
548 Mobilization of other joints 93.16
549 Other passive musculoskeletal exercise 93.17
550 Breathing exercise 93.18
551 Exercise, not elsewhere classified 93.19
552 Other physical therapy musculoskeletal manipulation 93.2
553 Manual and mechanical tracfion 93.21
554 Ambulafion and gait training 93.22
555 Fitting of orthotic device 93.23
556 Training in use of prosthetic or orthotic device. Training in crutch walking 93.24 .
557 Forced extension of limb 93.25
558 Manual rupture of joint adhesions 93.26
559 Stretching of muscle or tendon 93.27
560 Stretching of fascia 93.28
561 Other forcible correction of deformity 93.29
562 Other physical therapy therapeufic procedures 93.3
563 Assisted exercise in pool 93.31
564 Whirlpool treatment 93.32
565 Other hydrotherapy 93.33
566 Diathermy 93.34
567 Other heat therapy. Acupuncture with smouldering moxa, Hotpacks, 93.35
hyperthermia NEC, Infrared Irradiation, Moxibustion, Paraffin bath
568 Cardiac retraining 93.36
569 Prenatal training. Training for natural childbirth 93.37

570 Combined physical therapy without mention of the components 93.38
571 Other physical therapy 93.39
572 Skeletal traction and other traction 93.4
573 Spinal traction using skull device. Traction using : caliper tongs, 93.41
Crutchfield tongs, halo device, Vinke tongs
574 Other spinal traction. Cotrel's traction 93.42
575 Intermittent skeletal traction 93.43
576 Other skeletal traction. 93.44
Bryant's traction, Dunlop's traction, Lyman Smith traction, Russell's traction
577 Thomas' splint traction 93.45
578 Other skin traction of limbs. 93.46
Adhesive tape traction, Boot traction. Buck's traction. Gallows traction
579 Other immobilization, pressure, and attention to wound 93.5
580 Application of plaster jacket 93.51
581 Application of neck support. Application o f : cervical collar, Minerva jacket, 93.52
molded neck support
582 Application of other cast 93.53
583 Application of splint. Plaster splint. Tray splint 93.54
584 Dental wiring 93.55
585 Application of pressure dressing. Application o f : Gibney bandage, 93.56
Robert Jones' bandage, Shanz dressing
586 Application of other wound dressing. Porcine wound dressing 93.57
587 Application of pressure trousers. Application o f : anti-shock trousers, 93.58
MAST trousers, vasopneumatic device
588 Other immobilization, pressure, and attention to wound, 93.59
Elastic stockings. Electronic gaiter. Intermittent pressure device,
Oxygenation of wound (hyperbaric). Stereotactic head frame application,
Strapping (non-traction), Velpeau dressing
589 Osteopathic manipulative treatment 93.6
590 Osteopathic manipulative treatment for general mobilization. 93.61
General articulatory treatment
591 Osteopathic manipulative treatment using high- velocity, low- 93.62
amplitude forces. Thrusting forces
592 Osteopathic manipulative treatment using low- velocity, high- 93.63
amplitude forces. Springing forces
593 Osteopathic manipulative treatment using isotonic, isometric forces 93.64
594 Osteopathic manipulative treatment using indirect forces 93.65
595 Osteopathic manipulative treatment to move tissue fluids. Lymphatic pump 93.66
596 Other specified osteopathic manipulative treatment 93.67
597 Replacement and removal of therapeufic appliances 97
598 Other nonoperative removal of therapeutic device 97.8
599 Removal of retroperitoneal drainage device 97.81
600 Removal of peritoneal drainage device 97.82
601 Removal of abdominal wall sutures 97.83
602 Removal of sutures from trunk, not elsewhere classified 97.84
603 Removal of packing from trunk, not elsewhere classified 97.85
6 - Berita Acara PP PABOI dan PP IKABf I 71

NO. JENIS T I N D A K A N ICD 9-CM
604 Removal of other device from abdomen 97.86
605 Removal of other device from trunk 97.87
606 Removal of external immobilization device. Removal of: brace, cast, splint 97.88
607 Removal of other therapeutic device 97.89
608 Nonoperative removal of foreign body or calculus 98
609 Removal of other foreign body without incision 98.2
610 Removal of foreign body, not otherwise specified 98.20
611 Removal of superficial foreign body from eye without incision 98.21
612 Removal of other foreign body without incision from head and neck. 98.22
Removal of embedded foreign body from eyelid or conjunctiva without
incision
613 Removal of foreign body from vulva without incision 98.23
614 Removal of foreign body fi"om scrotum or penis without incision 98.24
615 Removal of other foreign body without incision from trunk except scrotum, 98.25
penis, or vulva
616 Removal of foreign body from hand without incision 98.26
617 Removal of foreign body without incision from upper limb, except hand 98.27
618 Removal of foreign body from foot without incision 98.28
619 Removal of foreign body without incision from lower limb, except foot 98.29

IKABI
Jl, Kiamat R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774
Website; www.ikabi.org
E m a i l : ppikabi@yahoo,com
Susunan Pengums PP IKABI

Periode 2012-2014
BERITA ACARA
Dewin Pertimbangan
Prof. Dr, Sfamsuhidaial, Sp8 SpB-KBD
Or. Soerarso Hardjowasito. SpB.SpBTKV Yang bertanda tangan dibawah ini
Majelis Ellk g Penaiehat Nama : Dr Chaidir Arif Mochtar, SpU.PhD
Prof. Dr. Muctilis Ramii, SpB(K)-Oil(
Jabatan : Ketua l A U I
Ketua PreiMluni
Prof Dfi. Dr. Paul Tatwiele, SpB.SpBTKV Periode 2012-2014
Wakll KeluaffCeluaTemlllh
Or R Sutiartono, SpBKBV
Wakll Ketua Menyerahkan i berkas naskah asli daftar kewenangan klinis profesi lAUI
Prof. OR. Dr. Sunaiyo HanJjowdjoto, SeB SpU
kepada:
KrtuaPuma
Prof. DR. Dr. Suwandi Sugandi. SpB SpU Nama : Dr Djoni Darmadjaja, SpB.MARS
Prof. Dr Enol U. Hutagalung, SpB SpOT
Periode 2012-2014
Dr. Unp Munedjo, SpB PGD Pal Med, ECU
Dr Rizal Pohan, SpB SpOT
Dr Sonar Soni Panigoro, SpB K.Onli
Dr Patriot Muslim, SpU Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr Poerwadi, SpB SpBA
Dr R Suharlono, SpBKBV Bedah Indonesia.
Or. Setyowdi Nugroho. SpB SpBS
Dr Nurtiayat Usman. SpB KBD
Dr Maizul Anwar, S{>8 TKV
Dr. Ishandono Dachlan, Msc, SpB. SpBP-RE(K) Jakarta,
11 Februari 2013
Dr. Djoni Dannadjafa. SpB MARS
Wakll SeKjen
Dr. Aflung Prasmono. SpB SpBTKVMARS
Baitdahara
Dr Barlian Suledja, SpB
Komlal Ofqanlaael. LegtelMl dan Advokasi Dr Chaidir Arif Mochtar, SpU.PhD Dr armadjaja, SpB.MARS
Dr HN Nazar, SpB
Dr Chandra Svaras, SpB Ketua lAUI Sekjen IKABI
Komlil ProfttI Bedah. Asuransi dan
Patpaakari
Dr. Nurtiayat Usman, SpB KBD
Or Erawan Wiradisuna, SpB K80
Dr Inzta Arbi, SpB
K<mmGtoballtasl A Pasar Bebas

Dr dr Fatfwma D Rachmat, SpB SpBTKV
DR. Or. Yefta Munadjal, SpB SpBP-RE(K)

Prof. DR Dr. Sri Maliawan, SpBS (K)
Komisi Hubungan Dalam Hegeri

Prof DR Or Andi Asadul Islam, SpBS
DI Enur T Pasaribu SpB.Onk
Komlal Petoynnn Ambulance 11B

Or ZA Isma, SpB
Dr Agi Salna, SpB KBD
Komisi Trauma
DR. Dr. Achmad Hidayat, SpB
Dr. B. Sunoko, SpB
OR. Dr Triwahyu Mumi, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS UROLOGI

(lAUI)
75
D O K T E R SPESIALIS UROLOGI (lAUI)
NO TINDAKAN I C D 9-CM
OPERATIONS ON ADRENAL
1 Adrenalectomy (abdominothoracal) 07.29
2 Adrenalectomy 07.22
OPERATIONS ON KIDNEY . 55 ^
3 Nephrotomy and nephrostomy 55.0
4 Nephrotomy. Deroofing/unroofing cysta. Pyeionephrolithotomy 55.01
5 Nephrostomy 55.02
6 Percutaneous nephrostomy without fragmentation 55.03
Bivalve/anatropic nephrolithotomy
7 Percutaneous nephrostomy with fragmentation 55.04
8 Pyelotomy and pyelostomy 55.1
9 Pyelotomy. Pyelolithotomy 55.11
10 Pyelostomy 55.12
Extended pyelolithotomy
11 Diagnostic procedures on kidney. Pyelocalicotomy 55.2
12 Nephroscopy 55.21
13 Pyeloscopy. Diseksi kelenjar getah bening pelvis per laparoskopi 55.22
14 Closed (percutaneous)(needle) biopsy of kidney 55.23
15 Open biopsy of kidney 55.24
16 Other diagnostic procedures on kidney 55.29
17 Local excision or destruction of lesion or tissue of kidney 55.3
18 Marsupialization of kidney lesion 55.31
19 Open ablation of renal lesion or tissu 55.32
20 Percutaneous ablation of renal lesion or tissu 55.33
21 Laparoscopic ablation of renal lesion or tissu 55.34
22 Other and unspecified ablation of renal lesion or tissue 55.35
23 Other local excision or destruction of lesion or tissue of kidney 55.39
24 Partial nephrectomy: Calycectomy, Wedge resection of kidney 55.4
25 Complete nephrectomy 55.5
26 Nephroureterectomy. Nephroureterectomy with bladder cuff 55.51
Total nephrectomy (unilat)
27 Nephrectomy of remaining kidney. Removal of solitary kidney 55.52
28 Removal of transplated or rejected kidney. Radical Nephrectomy 55.53
29 Bilat nephrectomy 55.54
30 Transplant of kidney 55.6
31 Renal autotransplantation 55.61
32 Other kidney transplantation. Recipient transplantation 55.69
33 Nephropexy. Fixation or suspension of movable (floating) kidney 55.7
34 Other repair of kidney ^ 55.8
35 Suture laceration of kidney/renoraphy 55.81
36 Closure of nephrostomy and pyelostomy 55.82
37 Closure of other fistula of kidney 55.83
38 Reduction of torsion of renal pedicle 55.84
39 Symphysiotomy for horseshoe kidney. Koreksi horseshoe kidney 55.85
40 Anastomosis of kidney: 55.86
Nephropyeioureterostomy, Pyeloureterovesical anastomosis, Ureterocalyceal
anastomosis
41 Correction of ureteropelvic junction. Pyeloplasty 55.87
7 - Berita Acara PP l A U I dan PP I K A B I I 77

42 Other 55.89
43 Other operation on kidney 55.9
44 Decapsulation of kidney. Capsulectomy of kidney. Decortication of kidney. 55.91
Nephrectomy for donor transplant
45 Percutaneous aspiration of kidney (pelvis). Aspiration of renal cyst. 55.92
Renipuncture. Punksi dan sklerosing kista ginjal
46 Replacement of nephrostomy tube 55.93
47 Replacement of pyelostomy tube 55.94
48 Local perfusion of kidney 55.95
49 Other injection of therapeutic substance into kidney 55.96
Injection to renal cyst
50 Implantation or replacement of mechanical kidney 55.97
51 Removal of mechanical kidney 55.98
52 other 55.99
53 Recontruction of renovascular 39.50
OPERATION ON URETER 56
54 Transurethral removal of obstruction from ureter and renal pelvis 56.0
Removal of: blood clot, calculus, foreign body. From ureter or renal pelvis
without incision. URS
55 Ureteral meatotomy 56.1
56 Ureterotomy 56.2
Incision of ureter for: drainage, exploration, removal of calculus
Ureterolithotomy
57 Ureterolithotomy proximal 56.21
58 Ureterolithotomy distal 56.22
59 Diagnostic procedures on ureter 56.3
60 Ureteroscopy 56.31
61 Closed percutaneous biopsy of ureter 56.32
62 Closed endoscopic biopsy of ureter 56.33
63 Open biopsy of ureter 56.34
64 Endoscopy of ileal conduit: cystoscopy, looposcopy 56.35
65 Other diagnostic procedures on ureter 56.39
66 Ureterectomy 56.4
67 Ureterectomy, NOS 56.40
68 Partial ureterectomy. Excision of lesion of ureter. Shortening o f ureter with 56.41
reimplantation. Reimplantasi ureter bilat
69 Total ureterectomy 56.42
70 Cutaneous uretero-ileostomy 56.5
71 Formation of cutaneous uretero-ileostomy. Ileal conduit (Bricker) 56.51
72 Revision of cutaneous uretero-ileostomy 56.52
73 Other external urinary diversion 56.6
74 Formation of other cutaneous ureterostomy. Anastomosis of ureter to skin. 56.61
Ureterostomy NOS. Ureterokutaneostomi
75 Revision of other cutaneous ureterostomy. 56.62
Revision of ureterostomy stoma
76 Other anastomosis or bypass of ureter 56.7
77 Urinary diversion to intestine 56.71
78 Revision of ureterointestinal anastomosis 56.72
79 Nephrocystanastomosis, NOS 56.73

NO ' TINDAKAN'''' ' — - ^^-^-^^ ICD9-C]
80 Ureteroneocystostomy. Replacement of ureter with bladder flap 56.74
Ureterovesical anastomosis. Reimplantasi ureter unilateral
Psoas Hitch/ Boari flap
81 Transuretero-ureterostomy. Uretero-ureterostomy 56.75
82 Other. Anastomosis end to end ureter 56.79
83 Repair of ureter 56.8
84 Lysis of intraluminal adhesions of ureter 56.81
85 Suture of laceration 56.82
86 Closure of ureterostomy 56.83
87 Closure of other fistula of ureter 56.84
88 Ureteropexy 56.85
89 Removal of ligature from ureter 56.86
90 Other repair of ureter. Tailoring ureter 56.89
91 Other operations on ureter 56.9
92 Dilation of uretral meatus 56.91
93 Implantation of electronic ureteral stimulator 56.92
94 Replacement of electronic ureteral stimulator 56.93
95 Removal of electronic ureteral stimulator 56.94
96 Ligation of ureter 56.95
97 Other 56.99
98 Removal DJ stent 97.79
OPERATIONS ON URINARY BLADDER 57

99 Transurethral clearance of bladder 57.0
Drainage of bladder without incision
Removal o f (blood clots, calculus, foreign body) from bladder without
incision
Lithotripsi batu buli
100 Cystostomy 57.1
101 Percutaneous aspiration of bladder 57.11
102 Lysis of intraluminal adhesions with incision into bladder 57.12
103 Percutaneous cystostomy 57.17
Closed cystostomy, percutaneos suprapubic cystostomy
104 Other suprapubic cystostomy. Railroading ruptur uretra 57.18
105 Other cystostomy. Lithopalaksi. Sectio alta/ vesikolithotomi 57.19
106 Vesicostomy 57.2
107 Vesicostomy 57.21
108 Revision or closure of vesicostomy 57.22
109 Diagnostic procedures on bladder 57.3
UO Cystoscopy through artificial stoma. Sistoskopi ODS 57.31
111 Other cystoscopy. Transurethral cystoscopy 57.32
112 Closed (transurethral) biopsy of bladder. TUR tumor buli 57.33
113 Open biopsy of bladder 57.34
114 Other diagnostic procedures on bladder 57.39
115 Transurethral excision/destruction of bladder tissue 57.4
116 Transurethral lysis of intraluminal adhesions 57.41
117 Other transurethral excision/destruction of lesion/tissue of bladder 57.49
Endoscopic resection of bladder lesion
118 Other excision/destruction of bladder tissue 57.5
119 Excision of urachus. Excision of urachal sinus of bladder 57.51

120 Open excision/destruction of other lesion/tissue of bladder 57.59
Endometrectomy of bladder. Suprapubic excision of bladder lesion
Diverticulectomy of bladder
121 Partial cystectomy. Excision of bladder dome, trigonectomy, wedge resection of 57.6
bladder. Reduction of cystosplasty
122 Total cystectomy. Total cystectomy with urethrectomy 57.7
Radical cystectomy
123 Radical cystectomy 57.71
124 Other total cystectomy 57.79
125 Other repair of urinary bladder 57.8
126 Suture of laceration of bladder 57.81
127 Closure of cystostomy 57.82
128 Repair of fistula involving bladder and intestine 57.83
Fistulectomy: (rectovesicovaginal, vesicosigmoidovaginal)
Repair fistel enterovesika. Repair fistel vesikorektal
129 Repair of other fistula of bladder 57.84
Fistulectomy: cervicovesical, urethroperineo vesical, uterovesical, vaginovesical.
Repair fistel vesikokutan
130 Cystourethroplasty and plastic repair of bladder neck 57.85
Plication of sphincter of urinary bladder
Rekonsiruction/V-Y plasty of bladder neck
131 Repair of bladder extrophy 57.86
132 Reconstruction of urinary bladder 57.87
Anastomosis of bladder with isolated segment of ileum, augmentation of bladder,
replacement of bladder with ileum/sigmoid (closed ileal bladder)
133 Other anastomosis of bladder 57.88
Anastomosis of bladder to intestine NOS, cystocolic anastomosis
134 Other repair of bladder. Neobladder 57.89
135 Other operations on bladder 57.9
136 Sphincterotomy of bladder. Division of bladder neck 57.91
137 Dilation of bladder neck 57.92
138 Control of (post operative) hemorrhage of bladder 57.93
139 Insertion of indwelling urinary catheter 57.94 ,
140 Replacement of indwelling urinary catheter 57,95
14! Implantation of electronic bladder stimulator 57.96
142 Replacement of electronic bladder stimulator 57.97
143 Removal of electronic bladder stimulator 57.98
144 Other 57.99
OPERATIONS ON URETHRA 58
145 Urethrotomy 58.0
Excision o f urethral septum, formation o f urethrovaginal fistula, perineal
urethrostomy, removal of calculus from urethra by incision
146 Urethral meatotomy , 58.1
147 Diagnostic procedures on urethra 58.2
148 Perineal urethroscopy 58.21
149 Other urethroscopy. PER (primary endoscopic realignment) 58.22
Uretroskopi/ uretrosistoskopi
150 Biopsy of urethra 58.23

NO TINDAKAN ICD 9-CM
151 Biopsy o f periurethral tissue 58.24
152 Other diagnostic procedures on urethra and periurethral tissue 58.29
153 Excision/destruction of lesion or tissue of urethra 58.3
154 Endoscopic excision/destruction of lesion or tissue of urethra 58.3!
Fulguration of urethral lesion
Kauterisasi
155 Other local excision/destruction of lesion or tissue of urethra ;! 58.39
Excision of: (congenital valve, lesion, stricture) of urethra
Urethrectomy. Divertikulum uretra. Insisi posterior urethral valve
156 Repair of urethra 58.4
157 Suture of laceration of urethra 58.4!
158 Closure of urethrostomy 58.42
159 Closure of other fistula of urethra. Fistulektomi/ repair fiste! uretra 58.43
160 Reanastomosis of urethra. Anastomosis of urethra. 58.44
Reseksi-anastomosis uretra
161 Repair of hypospadias/epipadias 58.45
162 Other reconstruction of urethra. Urethral construction. Johanson 58.46
163 Urethral meatoplasty 58.47
164 Other repair of urethra 58.49
Benenenti rotation of bulbous urethra. Repair of old obstetric laceration of
urethra. Urethra! plication. Uretroplasty
165 Release of urethral stricture. 58.5
Cutting of urethral sphincter. Internal urethral sphincter. Urethrolysis. Uretrotomi
interna (Sachse)
166 Dilation of urethra 58.6
Dilation of urethrovesical junction
Passage of sound through urethra
Removal of calculus from urethra without incision
Businasi/dilatasi uretra
167 Other operations on urethra and periurethral tissue 58.9
168 Incision of periurethral tissue. Drainage of bulbourethral gland 58.91
169 Excision of periurethral tissue 58.92
170 Implantation of artificial urinary sphincter 58.93
171 Other 58.99
172 Kalibrasi urethra 89.29
173 Insertion catheter 96.48
OTHER OPERATION ON URINARY TRACT 59

174 Dissection of retroperitoneal tissue 59.0
175 Retroperitoneal dissection, NOS 59.00
Limfadeneklomi retroperitoneal/ RPLND
176 Ureterolysis with freeing/repositioning of ureter for retroperitoneal fibrosis 59.01
177 Other lysis of perirenal/periureteral adhesions 59.02
Ureterolysis
178 Laparoscopic lysis of perirenal/periureteral adhesions 59.03
179 Other incision of perirenal/periureteral tissue 59.09
Exploration of perinephric area. Incision of perirenal abscess
180 Incision of perivesical tissue 59.1
181 Other lysis of perivesical adhesions 59.11
182 Laparoscopic lysis of perivesical adhesions 59.12
7 - Berita Acara PP l A U l dan PP i K A B I I

183 Other incision of perivesical tissue 59.19
Exploration of perivesical tissue. Incision of hematoma of space of Retzius.
Retropubic exploration
184 Diagnostic procedures on perirenal and perivesical tissue 59.2
185 Biopsy of perirenal or perivesical tissue 59.21
186 Other diagnostic procedures on perirenal tissue, perivesical tissue and 59.29
retroperitoneum
187 Plication of urethrovesical junction 59.3
188 Suprapubic sling operation. MMK7 sling uretra 59.4
189 Retropubic urethral suspension 59.5
190 Paraurethral suspension 59.6
191 Other repair of urinary stress incontinence 59.7
192 Levator muscle operation for urethrovesical suspension 59.71
193 Injection of implant into urethra and/or bladder neck 59.72
Collagen implant. Collagen implant. Endoscopic injection of implant
Fat implant. Polylel implant
194 Other 59.79
Anterior urethropexy, repair o f stress incontinence NOS, tudor "rabbit
ear"urethropexy
195 Ureteral catheterization. Drainage of kidney by catheter 59.8
Insertion o f ureteral stent/DJ stent. Ureterovesical orifice dilation
Drainage periureter. Insersi ureter kateter for RPG
196 Other operations on urinary system 59.9
197 Excision of perirenal or perivesical tissue 59.91
198 Other operations on perirenal or perivesical tissue 59.92
199 Replacement of ureterostomy tube: Change, reinsertion 59.93
200 Replacement of cystostomy tube 59.94
201 Ultrasonic fragmentation of urinary stones. Shattered urinary stones 59.95
202 Other 59.99
203 Ureterosigmoidostomy (Coffey) 69.22
OPERATIONS ON PROSTATE AND SEMINAL VESICLES 60

204 Incision of prostate. Drainage of prostatic abscess. Prostatolithotomy 60.0
205 Diagnostic procedures on prostate and seminal vesicles 60.1 '
Biopsi prostat
206 Closed (percutaneous) (neddle) biopsy of prostate 60.11
207 Open biopsy of prostate 60.12
208 Closed (percutaneous) biopsy of seminal vesicles 60.13
Needle biopsy of seminal vesicles
209 Open biopsy of seminal vesicles 60.14
210 Biopsy of periprostatic tissue 60.15
211 Other diagnostic procedures on prostate and periprostatic tissue 60.18
212 Other diagnostic procedures on seminal vesicles 60.19
213 Transurethral prostatectomy 60.2
214 Transurethral (ultrasound) guided laser induced prostatectomy (TULIP) 60.21
TRUS
215 Other transurethral prostatectomy: 60.29
Excision of median bar by transurethral apparoach, TEVAP, transurethral
enucleative procedures, transurethral prostatectomy NOS, TURP, TUIP, B N l ,
TVP, TMP
216 Suprapubic prostatectomy. Transvesical prostatectomy 60.3

NO TINDAKAN I C D 9-C
217 Retropubic prostatectomy 60.4
218 Radical prostatectomy. Prostatovesiculectomy 60.5
219 Other prostatectomy 60.6
220 Local excision of lesion of prostate. Open prostatectomy 60.61
221 Perineal 60.62
222 Other 60.69
223 Operations on seminal vesicles 60.7
224 Percutaneous aspiration of seminal vesicles 60.71
225 Incision of seminal vesicles 60.72
226 Excision of seminal vesicles 60.73
Excision of Mullerian duct cyst, spermatocystectomy
227 Other operations on seminal vesicles 60.79
228 Incision/excision of periprostatic tissue 60.8
229 Incision of periprostatic tissue. Drainage of periprostatic tissue 60.81
230 Excision of periprostatic tissue 60.82
Excision of lesion of periprostatic tissue
231 Other operations on prostate 60.9
23? Percutaneous aspiration of prostate 60.91
233 Injection into prostate 60.92
234 Repair of prostate 60.93
235 Control of (postoperative) hemorrhage of prostate 60.94
Coagulation of prostetic bed
Cystoscopy for control of prostatic hemorrhage
236 Transurethral balloon dilation of the prostatic urethra 60.95
237 Transurethral destruction of prostate tissue by microwave 60.96
thermotherapy
Transurethral microwave thermotherapy (TUMT) of prostate
238 Other transurethral destruction of prostate tissue by other 60.97
Thennotherapy. Radiofrequency thermotherapy
Transurethral needle ablation (TUNA) of prostate
239 Other 60.99
240 Masase prostate 99.94
OPERATION ON SCROTUM AND TUNICA VAGINALIS 61

241 Incision and drainage of scrotum and tunica vaginalis 61.0
242 Diagnostic procedures on scrotum and tunica vaginalis 61.1
243 Biopsy of scrotum or tunica vaginalis 61.11
244 Other diagnostic procedures on scrotum and tunica vaginalis 61.19
245 Excision of hydrocele (of tunica vaginalis) 61.2
246 Excision/destruction o f lesion or tissue of scrotum: fulguration of lesion. 61.3
reduction of elephantiasis, partial scrotectomy
247 Repair of scrotum and tunica vaginalis 61.4
248 Suture of laceration of scrotum and tunica vaginalis 61.41
249 Repair of scrotal fistula 61.42
250 Other repair of scrotum and tunica vaginalis 61.49
Reconstruction with rotational or pedicle flaps. Scrotoplasty
251 Other repair on scrotum and tunica vaginalis 61.9
252 Percutaneous aspiration of tunica vaginalis 61.91
Aspiration of hydrocele of tunica vaginalis
253 Excision of lesion of tunica vaginalis other than hydrocele 61.92
254 Other 61.99
7 ~ Berita Acara PP l A U I dan PP I K A B I I 83

OPERATIONS ON TESTIS 62
255 Incision of testis. Eksplorasi testis (microsurgery) 62.0
256 Diagnostic procedure of testis 62.1
257 Closed {percutenous)(needle) biopsy of testis 62.11
258 Open biopsy of testis 62.12
259 Other diagnostic procedure of testis 62.19
260 Excision/destruction of testicular lesion 62.2
Excision of appendix testis. Excision of cyst of Morgagni in the male
261 Unilat orchidectomy 62.3
262 Bilat orchidectomy. Male castration. Radical bilat orchidectomy 62.4
263 Removal of both testis at same operative episode 62.41
Bilat orchidectomy NOS. Extended orchidectomy
264 Removal of remaining testis 62.42
Removal of solitary testis. Subcapsular orchidectomy
265 Orchidopexy (UDT, torsio testis) 62.5
266 Repair of testis 62.6
267 Suture of laceration of testis 62.61
268 Other repair of testis. Testicular graft 62.69
269 Insertion of testicular prosthesis 62.7
270 Other operations on testis 62.9
271 Aspiration of testis 62.91
272 Injection of therapeutic substance into testis 62.92
273 Other 62.99
OPERATION ON SPERMATIC CORD, EPIDIDYMIS, AND VAS DEFERENS 63

274 Diagnostic procedures on spermatic cord, epididymis, and vas deferens 63.0
275 Biopsy of spermatic cord, epididymis, and vas deferens 63.01
276 Other diagnostic procedures on spermatic cord, epididymis, and vas deferens 63.09
277 Excision of varicocele and hydrocele of spermatic cord 63.1
High ligation o f spermatic vein. Hydrocelectomy o f canal o f Nuck.
Funicocelectomy. Varicocelectomy (palomo)
278 Excision of cyst of epididymis. Spennatocelectomy 63.2
279 Excision of other lesion or tissue of spermatic cord and epididymis 63.3
Excision of appendix epididymis
280 Epididymectomy 63.4
281 Repair of spermatic cord and epididymis 63.5
282 Suture of laceration of spermatic cord and epididymis 63.51
283 Reduction of torsion of testis or spermatic cord 63.52
284 Transplantation of spermatic cord 63.53
285 Other repair of spermatic cord and epididymis 63.59
286 Vasotomy. Vasostomy. Vasovasostomy 63.6
287 Vasectomy and ligation of vas deferens 63.7
288 Male sterilization procedure, NOS 63.70
289 (ligation, crushing, division) of vas deferens 63.71
290 Ligation of spermatic cord 63.72
291 Vasectomy 63.73
292 Repair of vas deferens and epididymis 63.8
293 Suture of laceration of vas deferens and epididymis 63.81
294 Reconstruction of surgically divided vas deferens 63.82
295 Epididymovasostomy 63.83
296 Removal of ligature from vas deferens 63.84
297 Removal of valve from vas deferens 63.85

NO • TINDAKAN I C D 9-CM
298 Other repair of vas deferens and epididymis 63.89
299 Other operations on spermatic cord, epididymis and vas deferens 63.9
300 Aspiration of spermatocele 63.91
301 Epididymotomy 63.92
302 Incision of spermatic cord 63.93
303 Lysis of adhesions of spermatic cord 63.94
304 Insertion of valve in vas deferens 63.95
305 Other 63.99
OPERATIONS ON PENIS 64
306 Circumcision (male) 64.0
307 Diagnostic procedures on the penis 64.1
308 Biopsy of penis 64.11
309 Other diagnostic procedures on penis 64.19
310 Local excision/destruction of lesion of penis 64.2
Eksisi plaque {Peyronie disease). Excisi webbed penis
311 Amputation of penis 64.3
312 Repair and plastic operation on penis 64.4
313 Suture of laceration of penis 64.4!
314 Release of chordae/chordectomy 64.42
315 Construction of penis 64.43
316 Reconstruction of penis. Eksisi fibroma 64.44
317 Replantation of penis. Reattachment of amputated penis 64.45
318 Other repair of penis. Operasi priapismus (prosedur Winter) 64.49
Koreksi priapismus
319 Other operations on male genital organs 64.9
320 Dorsal or lateral slit of prepuce 64.91
321 Incision of penis 64.92
322 Division of penile adhesions 64.93
323 Fitting of external prosthetis of penis 64.94
324 Insertion or replacement of non-inflatable penile prosthesis 64.95
Insertion of semi-rigid rod prosthesis into shaf^ of penis
325 Removal of internal prosthesis of penis 64.96
326 Insertion or replacement of inflatable penile prosthesis 64.97
Insertion of cylinders into shaft of penis and placement of pump and reservoir
327 Other operations on penis. Corpora cavemosa-corpus spongiosum shunt 64.98
Corpora-saphenous shunt. Irrigation of corpus cavemosum
328 Other 64.99
329 Dissection of lymp node of inguinal 40.54
330 Hidrokelektomi per inguinal/ligasi tinggi 69.19
331 Incisi abses perineum 86.09
332 Lymphadenectomy ilioinguinal 40.29
333 Vasography 87.94
334 Dissection of lymp node of pelvis 54.3
335 ESWL 98.52
336 Laparotomy exploration 54.11
337 Operasi sistokel 40.51
338 Insersi catheter Tenckhoff untuk CAPD 54.98
339 Uroflowmetri 89.24
340 Infiltrasi sitostatika intravesica 96.49
34! Chemotherapy 99.25

IKATAN D O K T E R INDONESIA
PERHIMPUNAN D O K T E R S P E S I A L I S B E D A H INDONESIA
IKABI
Jl, Kramat Raya 160, Jakarta Pusat 1CM30, Telp & Fax. 021 - 3916774
Website: www. ikabj,org
Email; ppikabi@yahoo.com
Susunan Pengurus PP. IKABI BERITA ACARA

Periode 2012-2014
Dewan Pertimbangan
Ptof. Dr. Sjamsuhidaiat, SpB.SpB-KBD
•r. Soerarso Hardjowasilo, SpB.SpBTKV Yang bertanda tangan dibawah ini
Majelis Etik t Penawhal Nama : Dr Setyowidi Nugroho, SpB.SpBS
Prof. Dr Miichlis Ram!i, SpB(K)-Onk
Jabatan : Ketua PERSPEBSI
M<ii.?m\<iim
Prof DR. Df Paul Talialele, SpB.SpBTKV Periode 2012-2014
m» K^lua/Ketua Terpillh
Dt R. Suliartono, SpBKBV
Wakll Ketua Mcnyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PERSPEBSI
Prof DR. Dr Suriaryo Hardjowidjolo, SpB SpU kepada:
Katua Puma
Prof DR. Dr. Suwandi Sugandi, SpB SpU
KaluaMKIB]
Prof. Or Errol U Hulagaiung, SpB SpOT

Periode 2012-2014
Presidium
Dr. Urip Mtirtedio, SpB PGD Pal Med, ECU
Dr. Rizal Potian, SpB SpOT Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr. Sonar Sori Panigoro. SpB K.Onk
Dr, Patnol Muslim, SpU Bedah Indonesia.
Dr. R Sjhanoro, SpBKBV
Dr, Setyowidi Njgroho, SpB SpBS
Dr Nurhayat Usman, SpB KBD Jakarta,
Dr Ishandono Odchlar, Msc, SpB, SpBP-RE(K) 11 Februari 2013
Sekretaris JBndsral
Dr Djoni Darnadjaia, SpB MARS
Wakll Sekjen
Dr Agung Prasmono, SpB SpBTKV MARS
Bfiodahaa
Homisi Orjianisasi, LeqIslatI dan AdvoKasi Dr Setyowidi Nugroho, SpB.SpBS Dr. DjoniiDarmadjaja, SpB.MARS
Or HN Nazar, SpB
Dr. Chandra Svaras. SpB Ketua PERSPEBSI Sekjen IKABI
Komlal Profesi Bedah, Asuransi dan
Perpjjakan
Dr Nurhayal Usman, SpB KGO
Dr, Erawan Wiradlsuria, SpB KBD
Dr. Inzta Arfti, SpB
Komlsi Globalisasi & Pagar Bebas

Dr. dr. Fathema D Rachmal, SpB SpBTKV
Or Hunlal Simamora, SpBP-RE
Komijl Komunlkasi dan PublikasI

OR. Or. Yefta Munadjal, SpB Sp6P-RE{K)
Prol. DR. Dr, Sri Maliawan, SpBS (K)
Dr Iskandar Budianla, SpB SpBA
Komisi Hubunqan Dalam Neqerl

Prof. DR. Dr. Ardi Asadul Islam, SpBS
Dr. Boyke Sumanln, SpU
Dr. EmirT Pasaribu SpB.Onk
Homisi Pelayanan Ambulance 118

Dr ZAIsma,Spe
Dr. Agi Salria, SpB KBD
Komisi Trauma
DR. Dr. Achmad Hidayal, SpB
Dr.B Sunoko,SpB
DR, Dr Tiiwahyu Mumi, SpB SpBTKV

: • 1
DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH SARAF

INDONESIA (PERSPEBSI)
89
D O K T E R SPESIALIS BEDAH SARAF INDONESIA (PERSPEBSI)
NO JENIS TINDAKAN . I C D 9-CM

Kongenitai
Kranial
1 Koreksi (Kranioplasti) Mikrosefal (Kraniostenosis) 02.06
2 Hidrocephalus
Simpel: Shunting 39.28
Kompleks/malfungsi pirau: Shunting/revisi 39.28
3 KistaArahnoid: Marsupialisasi/ekstirpasi (kraniotomi konvensional/ 01.24 + 01.59
Mikroskopik, endoscopic)
4 MeningokelAnterior: Reseksi & Rekonstruksi kraniofasial 01.51
5 Meningokel Posterior: Reseksi & Rekonstruksi 02.12
6 Deformitas kranium: Koreksi dan rekonstruksi
7 Dandy Walker Malformaion:Trepanasi 01.24
Spinal
Spinal Disrafisme: Koreksi struktur Anatomi, release tethered cord
Deformitas Atlanto-oksipital: Koreksi struktur Anatomi, stabihsasi (auto/allo 78.00 + 03.93
bone graft, implant - spine intrumentasi)
10 S i n d r . A r n o l d - C h i a r y / S i r i n g o m i e l i : Koreksi struktur Anatomi (decompression brain:
(Oksipitoservikal decompresi, myelostomy dan duroplasty) 01.24, spinal cord: 03.09)
(myelotomy spine: 03.29,
percutaneous: 0 3 . 2 1 ,
duraplasty: 02.12))
11 Spinal Deformity: Koreksi dan satbilisasi (implant - spine instrumentasi) 03.93
Infeksi
12 Abses Serebri: Mengeluarkan Abses (Reseksi, drainage) 01.39
13 Tuberkuloma: Mengangkat Tumor
14 Infeksi Komensal/lmunitas turun: Biopsi diagnostik (brain: 01.13/01.14,
cerebral meninges:
01.11/01.12, spinal cord:
03.32)
Kelainan Parasiter
15 Cacing: Biopsi diagnostik (brain: 01.13/01.14,
cerebral meninges:
03.32)
16 Jamur: Biopsi diagnostik (brain: 01.13/01.14,
cerebral meninges:
03.32)
17 SpondilitisTBC: Debridemen, stabihsasi (auto/allo bonegarft, impant spme
instrumentasi) bila diperlukan 03.4
18 Morbus Hansen: Dekompresi saraf
01.24
8 - Berita Acara PP PERSPEBSI dan PP I K A B I I 91

Neoplasma
Kranium
19 Granuloma Eosinofilik: Mengangkat tumor (excisi lesion brain/
cerebral: 01.59, meninges;
01.51, spinal cord: 03.4)
20 Plasmositoma; Mengangkat tumor (sama dengan atas)
21 Osteoma: Mengangkat tumor (sama dengan atas)
22 Fibrous Displasia: Mengangkat tumor (sama dengan atas)
23 Hamartoma: Mengangkat tumor (sama dengan atas)
24 Tumor Metastase: Mengangkat tumor (sama dengan atas)
25 Neurotibrosarkom/Osteosarkom: Mengangkat tumor (sama dengan atas)
Supratentorial
(sama dengan atas) +
26 Glioma: Mengangkat tumor chemotherapy (99.25)
Glioma simpel: Mengangkat tumor chemotherapy (99.25)
Glioma kompleks: Mengangkat tumor chemotherapy (99.25)
27 Ependymoma: Mengangkat tumor chemotherapy (99.25)
(sama dengan atas)
28 Pleksus Papiloma: Mengangkat tumor chemotherapy (99.25)
Meningioma
29 Meningioma simpel: Mengangkat tumor (excisi meninges (cerebral:
0J.51, spinal: 03.4))
30 Meningioma kompleks: (excisi meninges (cerebral:
Mengangkat tumor, Radiosurgery, embolisasi (prosedur endovaskuler) 01.51, spinal: 03.4))
(embolisasi intracranial:
38.81)
Tumor Sella
31 Kraniofaringioma: Mengangkat tumor
32 Adenoma hipofise: Mengangkat tumor, Radiosurgery
33 Tumor daerah Pineal Body: Mengangkat tumor. Radiosurgery (sama dengan atas)
chemotherapy (99.25)
Tumor metastase
34 Tumor Metastase simpel: Mengangkat tumor (sama dengan atas) +
35 Tumor Metastase kompleks: Mengangkat tumor. Radiosurgery, embolisasi (sama dengan atas) +
(prosedur endovaskuler) chemotherapy (99.25)
36 Angioma simpel: Mengangkat tumor
37 Angioma kompleks: Mengangkat tumor. Radiosurgery, prosedur
endovaskuler
Infratentorial:
Glioma
38 Simpel: Mengangkat tumor (sama dengan atas) +

39 Kompleks: Mengangkat tumor (sama dengan atas) +
40 Akustic Neuroma: Mengangkat tumor, Radiosurgery
Meningioma
41 Meningioma simpel: Mengangkat tumor. (excisi meninges (cerebral:
01.51, spinal: 03.4))
42 Meningioma kompleks: Mengangkat tumor. Radiosurgery (excisi meninges (cerebral:
01.51, spinal: 03.4))
43 Medulloblastoma: Mengangkat tumor (sama dengan atas) +
44 Coiesteatoma: Mengangkat tumor
45 Ependymoma: Mengangkat tumor (sama dengan atas) +
46 Pleksus Papiloma: Mengangkat tumor
Angioma
47 Angioma simpel: Mengangkat tumor
48 Angioma kompleks: Mengangkat tumor, radiosurgery, prosedur
endovaskuler
Tumor Spinal
49 Glioma: Mengangkat tumor (excisi spinal cord: 03.4) +
50 Meningioma: Mengangkat tumor, radiosurgery (sama dengan atas)
51 Ependimoma: Mengangkat tumor (sama dengan atas) +
52 Schwanoma: Mengangkat tumor, radiosurgery (sama dengan atas)
53 Angioma: Mengangkat tumor, radiosurgery, prosedur endovaskuler (sama dengan atas)
54 Tumor Saraf Tepi
55 Schwanoma: Mengangkat tumor
Ket.
Chemotherapy: C9253, J9328, J8700
Trauma
Trauma Kranial
56 Depressed Fracture: Koreksi/Kranioplasti 02.06
57 Epidural Hematoma: Evakuasi Hematom 01.24
58 Subdural Hematoma Acut: Evakuasi Hematom 01.31
59 Subdural Hematoma Kronik: Evakuasi Hematom 01.31
60 Intracerebral Hematoma: Evakuasi Hematom 01.39
61 Intraventricular Hematoma: Evakuasi Hematom (vein intracranial: 38.01)
62 Trauma tembus: Pengangkatan BendaAsing ( i n c i s i brain: 01.39,
without incision into
brain:01.24, incisi cerebral
meninges: 01.31, incisi
spinal: 03.01)
63 Bocoran likuor: Penutupan Bocoran

NO JENIS T I N D A K A N ICD 9-CM
64 Karotis-Kavemosus Fistul: Penutupan Fistul (Kraniotomi mikirosurgery, (01.24+21.06, ligasi
ligasi a. carotis, prosedur endovaskular) intracranial: 38.81)
Trauma Medula Spinalis

65 Kompresi Medula: Dekompresi tanpa/dengan stabilisasi (auto/allo bonegraft, (decompression brain:
impant spine instrumentasi) 01.24, spinal cord: 03.09)
66 Kompresi Radiks: Dekompresi tanpa/dengan stabilisasi (auto/allo bonegraft, (decompression brain:
impant spine instrumentasi) 01.24, spinal cord: 03.09)
Trauma Saraf Perifer

67 Lesi Saraf Tepi: Menyambung Saraf 04.79
68 Lesi Pleksus: Menyambung Pleksus
Degeneratif
Spinal
Degenerasi diskus intervertebral
69 Lumbal: Dekompresi (laminekstomi konvensional, mikrolumbal diskektomi, 03.09+80.51
endoscopic surgery), stabilisasi bila diperlukan (auto/allo bonegraft, implant-
spine intsrumentasi)
70 Servikal: Dekompresi (posterior foraminotomi. Anterior Cervical Diskektomy 03.09
+ Fusi; Cloward, cervical allograft atau implant;, endoscopic surgery),
71 Spondilolistesis: Stabilisasi (implant - spine instrumentasi) 78.00 + 03.93
72 Kanal Stenosis: Dekompresi, stabilisasi bila diperlukan (auto/allo bonegraft, (decompression brain:
implant- 01.24, spinal cord: 03.09)
spine intsrumentasi) (myelotomy spine: 03.29,
percutaneous: 03.21,
duraplasty: 02.12))
(stabilisasi: 78.00, 03.93)
Saraf Perifer
73 Entrapment syndrome: Dekompresi (bedah terbuka, endoscopic surgery) (decompression brain:
01.24, spinal cord: 03.09)
Vaskuler
Intrakranial
74 AVM Simpel: Reseksi, Embolisasi (prosedur endovaskular), radiosurgery 38.31,38.80
75 A V M Kompleks: Reseksi, Embolisasi (prosedur endovaskular), 38.31.38.80
radiosurgery
76 Aneurysm: Penutupan Aneurisma (kraniotomi + clipping, Coilling/stenting 01.24 + 39.51/39.7
prosedur endovaskuler)
77 Cavemoma; Eksisi Kavemoma, radiosurgery
78 Spontaneous ICH: Evakuasi Hematom 75.91
79 Stroke Iskemik (Stenosis/trombus: Operasi Anastomosis, Rekanalisasi
dengan prosedur endovaskular /emboli intrakranial)
80 Dural AV Fistula: Penutupan fistula (microsurgery, prosedur endovaskuler) 39.53
81 Trombosis vena intrakranial: Microsurgery, prosedur endovaskuler
Spinal
82 AVM: Reseksi, Embolisasi (prosedur endovaskular), radiosurgery
83 AV fistula: Menutup Fistul (Microsurgery, Prosedur endovaskular) 39.53
84 Aneurysma: Microsurgery, prosedur endovaskuler 39.51/39.52, 39.7

Fungsiona!
85 Movement disorders
Movement Disorder simpel: Memperbaiki Fungsi (prosedur stereotaktik ; 03.93
ablasi. Implant Deep Brain Stimulation)
Movement Disorder kompleks: Memperbaiki Fungsi (prosedur stereotaktik;
ablasi, Implant Deep Brain Stimulation)
86 Pain
Pain Surgery simpel: Menghilangkan Nyeri (Therapeutic nerve block - pulse
radioirequency, thermal ablation) epidural steroid injection,, intrathecal drug
delivery, neurolytic Blockade)
Pain Surgery kompleks: Menghilangkan Nyeri (Therapeutic nerve block
(pulse radiofrequency, thermal ablation), epidural steroid injection,,
intrathecal drug delivery, neurolytic Blockade), Dorsal Rhizotomy,
Myelotomy, Thalamothomy, Deep Brain Stimulaion, Dorsal Collum
Stimulation
87 Epilepsi; Menghilangkan Kejang (Microsurgery, Implant Deep Brain
Stimulation, Ablasi, Radiosurgery)
88 Intracranial compression syndr: Dekompresi (Microvascular Decompresi), 01.24
Ablasi (chemical agent. Radiosurgery, radiofrequency)
89 Psichosis: Memperbaiki Fungsi - Psikosurgery (Microsurgery, Implant Deep
Brain Stimulation)
Tekanan Tinggi Intrakranial

90 Bendungan Cairan Otak: Pemasangan Pirau, External-Ventriculo Drainage
(EVD)
91 Pembengkakan jaringan otak: Dekompresi, Intracranial Pressure Monitoring 01.24
(ICP Monitoring)
92 Diagnosa Penyakit Kranial dan Spinal: Prosedur Digital Substraksi 88.40
Angiografi (DSA) kranial dan Spinal
93 Insisi dan eksisi pada Skull, Brain dan Meninges 01
94 Pungsi Cranial 01.0
95 Pungsi sistema. Tapping sistema 01.01
96 Pungsi ventrikel melalui implant kateter 01.02
Pungsi melalui tube ventrikel shunt
97 Pungsi cranial yang lain. Ruang subdural. Aspirasi cranial 01.09
Pungsi melalui fontanella anterior
98 Prosedur diagnostic pada Skull, Brain dan Meninges OI.l
99 Biopsi skull 01.15
100 Craniotomy dan craniectomy 01.2
101 Insisi dan drainase sinus cranialis 01.21
102 Reopening tempat craniotomy 01.23
103 Debridemen kepala 01.25
104 Rekonstruksi tulang kepala
105 Insisi pada brain dan cerebral menings 01.3
106 Lobotomy dan tractotomy. Jaringan otak. Traktus serebri 01.32
Pcrkutaneus singulotomy
107 Operasi pada thalamus dan globus pallidus 01.4
108 Thalamus. Chemothalamectomy. Thalamotomy 01.41
109 Globus Pallidus. Pallidoansectomy. Pallidotomy 01.42
110 Eksisi atau Destruksi jaringan otak dan meninges 01.5

111 Hemisferektomy 01.52
tI2 Lobeklomy 01.53
113 Tindakan lain pada Skull, Brain dan Meninges 02
114 Cranioplasty 02.0
115 Membuka sutura cranial. Linear craniectomy. Strip craniectomy 02.01
116 Elevasi fragmen tulang kepala yang patah 02.02
Debridemen fraktur tulang kepala
Dekompresi fraktur tulang kepala
117 Cranial bone flap 02.03
118 Bone graft. Autograf cranioplasty 02.04
119 Pemasangan implant skull defek. Cranioplasty acrylic 02.05
Cranioplasty titanium mesh
120 Pengangkatan implant skull defek 02.07
121 Rekonstruksi cerebral menings 02.1
122 Penjahitan primer duramater 02.11
123 Ligasi menings. Sinus sagitalis. Arteri meningea media 02.13
124 Choroid plexectomy kauterisasi pleksus koroid 02.14
125 Ventriculostomy. Cervical dan rongga subarachnoid. Sistema magna. Insersi 02.2
Holter Valve. Endoscopy Third Ventriculostomy
126 Ekstrakranial ventricular shunt 02.3
127 Ventrikel shunt dihubungkan dengan struktur pada kepala dan leher 02.31
Ventricular - nasofarings shunt. Ventricular mastoid anastomose. Ventricular-
sistema shunt
128 Ventricular shunt dengan system sirkulasi 02.32
Ventriculo-atrial anastomosis. Ventriculo-atrial shunt
129 Ventricular shunt dengan cavum thorasic 02.33
Ventriculo-pleural shunt
130 Ventricular shunt dengan cavum abdomen dan organs 02.34
Ventriculo-peritoneostomy
131 Revisi, removal dan irrigasi dari ventricular shunt 02.4
132 Irrigasi dan eksplorasi ventricular shunt 02.41
133 Penggantian ventricular shunt. Penggantian ventricular kateter. Revisi VP 02.42
shunt pada sisi yang sama
134 Pengangkatan ventricular kateter 02.43
135 Operasi Spinal cord dan Struktur kanalis spinalis 03-
136 Eksplorasi dan dekompresi struktur canalis spinalis 03.0
137 Reopening laminectomy 03.02
138 Intraspinal nerve root. Rhizotomy 03.1
139 Chordotomy. Perkutaneus chordotomy. Tractotomy 03.2
140 Prosedur diagnostik untuk spinal cord dan struktur canalis spinalis 03.3
141 Tapping spinal. Lumbal pungsi 03.31
142 Plastic operation pada struktur spinal cord 03.5
143 Repair meningocele 03.51
144 Repair spinal myelomeningocele 03.52
145 Repair fraktur vertebra. Elevasi fragmen tulang. Pengangkatan serpihan 03.53
tulang
146 Repair Spina bifida. Spinal meninges. Spinal cords. Defect arkus vertebra 03.59
147 Lisis dari adhesi spinal cord dan nerve root , 03.6
148 Spinal theca shunt 03.7
149 Spinal subarachnoid-peritoneal shunt. Lumbo-peritoneal shunt 03.72
150 Spinal subarachnoid-ureteral shunt 03.72

151 Yang lain: Pleurothecal anastomosis, Lumbal-subarachnoid shunt, Syringo- 03.79
subdural shunt
152 Injeksi agen destruksi ke dalam canalis spinalis 03.92
Percutaneus epidurolisis
153 Prosedur operasi spine yang lain. 03.98
Pengangkatan spinal theca shunt
154 Operasi pada saraf cranial dan saraf tepi 04
155 Insisi, divisi dan eksisi nervus cranial dan nervus perifer 04.0
156 Eksisi akustik neuroma 04.01
157 Bagian dari nervus trigeminal. Retrogasserian neurotomy 04.02
158 Prosedur diagnostic dari system nervus perifer 04.1
159 Closed percutaneous biopsy nervus cranial atau nervus perifer atau 04.11
ganglion
160 Open biopsy nervus cranial atau nervus perifer atau ganglion 04.12
161 Destruksi nervus cranial atau nervus perifer 04.2
162 Penjahitan nervus cranialis dan nervus perifer 04.3
163 Penghancuran dari adhesi dan dekompresi nervus cranial dan nervus 04.4
perifer
164 Dekompresi nevus trigeminal 04.41
165 Dekompresi nervus yang lain 04.42
166 Release carpal tunnel 04.43
167 Release tarsal tunnel 04.44
168 Neurolisis nerve perifer 04.49
169 Graft Nervus cranial atau nervus perifer 04.5
170 Transposisi Nervus cranial atau nervus perifer 04.6
171 Transplantasi nervus 04.6
172 Injeksi ke dalam nervus perifer 04.8
173 Injeksi nervus perifer 04.80
174 Injeksi anestesi ke nervus perifer 04.81
175 Injeksi agen lain selain neurolisis 04.89
176 Neurectasis 04.91
177 Operasi saraf simpatis atau ganglia 05.0
178 Prosedur diagnostic saraf simpatis atau ganglion 05.1
179 Biopsi 05.11
180 Simpatektomy 05.2
181 Injeksi ke dalam saraf simpatis atau ganglion 05.3
8 - Berita Acara PP PERSPEBSI dan PP I K A B I I

PERHIMPUNAN D O K T E R S P E S I A L I S BEDAH INDONESIA
IKABI
Jl. Kramat Raya 160. Jakarta Pusal 10430, Telp & Fax. 021 - 3916774
Website: wwwikabi.org
Email: ppikabi@yahoo.com

Periode 2012-2014
Dtwtn Pwtlmbaninn
Prof. Dr. Sjamsuhidaial. SpB.SpS-KBD
Dr. Soerarso Hardjowasito, SpB.SpBTKV
HalelHEtlkAPenMthal Nama : Dr Poerwadi, SpB.SpBA
Prot Dr. Muchlis Ramli, SpB|K]-Onk
Jabatan : Ketua PERBANI
Ketui PrMidiutn
Prof. DR. Dr Paul Tahalele, SpB.SpBTKV Periode 2012-2014
Wakll Kilua/Ketua Terpillh
Dr. R. Suhanono. SpBKBV
Menyerahkan I berkas naskah asli daftar kewenangan klinis profesi PERBANI
Prof OR. Or. Sunaryo Hardjowkljolo. SpB SpU
kepada:
Prof. DR. Dr. Suwandi Sugandi. SpB SpU Nama : Dr Djoni Darmadjaja, SpB.MARS
KitUi MKIBI Jabatan : Sekretaris Jenderal IKABI
Prof Dr. Errol U. Nutagalung, SpB SpOT
Periode 2012-2014
Priildlum
Dr, Urip Mjrtedjo, SpB PGD Pal Med. ECU
Dr. Rizal Pohan, SpB SpOT
Dr Sonar Soni Panigoro, SpB K Onk Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr Patnol Muslim, SpU
Dr Poenradi. SpB Sp8A Bedah Indonesia.
Dr R Suhartono. SpBKBV
Dr. Setyowidi Nugrofio, SpB SpBS
Dr Nutliayat Usmar. SpB KBD
Dr Maral Anwar. SpBTKV Jakarta,
Or Istiandono Dachlan, Msc, SpB, SpBP-RE|K)
Sekfatirl* Jenderal 11 Februari 2013
Or. Djoni Darmadjaja. SpB UARS
BiDdibin
Dr Barlian Sutedga, SpB
Komisi Organisasi. LtgislasI dan Advokaii 'oerwadi, SpB.SpBA Dr. Djoni Dbrmadjaja. SpB.MARS
Dr HN Nazar, SpB
Dr Chandra Svaras, SpB Ketua PERBANI Sekjen IKABI
Komisi Profe«l Bedah. Aauransi dan
Ptfpâkan
Dr hlurtiayat Usman. SpB KBD
Dr Erawan Wiradisuna. SpB KBD
Dr Henry Boyke Silompul, SpB
Dr inzlaAibi. SpB
Komlai Globalliail t PaMf Btbw

Dr. dr Fathema 0 Rachmat, SpB SpBTKV
Df. Huntal Simamora, SpBP-RE
Komisi Komunlliasi dan Publlkasi

DR Dr Yefta Mjrad|at, SpB SpBP-RE(K|
Prof, DR. Dr Sn Maliawan, SpSS (K)
Dr Iskandar Budianta, Sp8 SpBA
Komlii Hubungm Oalam Megirl

Pfof DR Dr. Andi Asadul Islam. SpBS
Or Boyke Suinanln, SpU
Dr Emif T Pasanbo SpB Onk
Komlil Pelayanan Ambulance 118

Dr. ZA Isma, SpB
Dr Agi Satria, SpB KBD
KomtiilHuma
DR. Di. Aciimad Mklayat, SpB
Or B. Sunoko, SpB
DR. Dr. Tiiwahyu Mumi, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH ANAK

(PERBANI)
101
DAFTAR KOMPETENSI DAN KEWENANGAN K L I N I S
D O K T E R SPESIALIS BEDAH ANAK (PERBANI)
NO. NAMA TINDAKAN ICD-9 C M

1 Abdominoperineal Pull Through (Malformasi Anorectal) 48.49
2 Abdominorectal Pull Through (Swenson Procedure) 48.49
3 Amputasi eksisi kista bronchiogenik 39.09, 32.01 (endoscopic)
4 Appendiktomi 47.0
5 Bedah laparoskopi diagnostik anak 54.21
6 Billroth I & II/ reseksi gaster parsial 43.6/43.7
7 Biopsi rectum "Full thickness" 48.25 (open), 48.24 (brush/
endoscopic)
8 Biopsi eksisional dalam narkose 86.11 (skin & subcutaneous tisuue)
9 Biopsi insisional dalam narkose 86.19 (skin & subcutaneous tisuue)
10 Biopsi perlaparotomi 54.23
11 Biopsi/eksisi KGB,lipoma,ateroma,ganglion Biopsi ganglion (04.11,04.12), excisi
ganglion (82.21), excisi KGB (40.29).
40.11, 86.2 (biopsy/excisi skin &
subcutaneous tisuue)
12 Chordektomi 64.42 (release chordae)
13 Cystojejenostomi 51.32 (anastomosis gallbladder to
intestine)
14 Debulking tumor ganas Tergantung iokasi/regio
15 Detorsi testis + orchidopexy 62.5
16 Duodenoduodenostomi/duodenojejunostomi 45.91
17 Eksisi Baker cyst 83.39
18 Eksisi granuloma umbilical 86.3 (excisi/destruction lession of skin
& subcutaneous tissue)
19 Eksisi hemangioma besar/ multiple 39.99 (other operation on vessels)
20 Eksisi hemangioma dengan skin graft STSG/FTSG 39.99 (other operation on vessels)
21 Eksisi hemangioma kecil 39.99 (other operation on vessels)
22 Eksisi higroma colli/ limfangioma simple 40.29
23 Eksisi higroma colli/ axilla pada neonatus 40.29
24 Eksisi kelenjar getah bening 40.29
25 Eksisi kelenjar liur submandibula 26.30, 26.31 (partial), 26.32 (total/
radikal)
26 Eksisi kista branchial 29.2 (branchial cleft cyst)
27 Eksisi kista duktus tiroglosus 06.7
28 Eksisi kista salura empedu 51.69, 51.64 (endoscopic)
29 Eksisi kista urachus 57.51 (bladder), 54.3 (abd. wall)
30 Eksisi neuroblastoma 04.07 ( e x c i s i nerve c r a n i a l /
peripheral)
31 Eksisi teratoma retroperitoneal 54.4
32 Eksisi teratoma sacrococcygeal 04.07 (excisi nerve cranial/
peripheral)
33 Eksisi tumor jaringan lunak ukuran kecil (marginal margin 83.39
eksisi)
34 Ekstirpasi tumor jinak kulit < 3 cm 86.3
35 Ekstirpasi tumor jinak kulit > 3 cm 86.3
36 Endorectal pull through (Soave- BoUey Procedure) 48.41
37 Esofagomyotomi (operasi heller) 42.7
38 Esofagostomi+ gastrostomi (atresia esophagus) 42.10 + 43.1
9 - Berita Acara PP PERBANI dan PP I K A B I I

NO. NAMA T I N D A K A N IC0-9 C M
39 Esophagus replacement procedure 42.89
40 Fistulektomi pada fistula perianal 49.12
41 Fundoplikasi gaster 44.66
42 Gastrotomy anak 43.0
43 Gastrotomy neonates 43.0
44 Genitoplasty (clitoroplasty,vaginoplasty,phalioplasty) 70.61/70.62, 64.43/64.44
45 Glosektomi totalis 25.3
46 Hemiglosektomi 25.2
47 Hemimandibulektomi 76.31
48 Hemiotomi Ligasi Tinggi (Unilat) 53.01 (direct), 53.02 (indirect)
49 Hemiotomi bilat Ligasi Tinggi 53.11 (direct), 53.12 (indirect)
50 Hemiotomi pada hernia Inguinal strangulate 46.03
51 Hemiotomi residif 53.9
52 Hemiotomi umbilikalis 53.4 (53.49, 53.41)
53 Hemiotomi+ laparotomy+ reseksi+ anastomosis 53.9+ 54.11+45.79 ( L I ) / 4 5 . 6 2
(SI)+45.94 (L-L)/45.93 (L-S). 45.94
(S-S)
54 Ileostomi 46.21 (temporary), 46.22 (permanent),
46.01 (loop)
55 Insisi abses perianal 49.01
56 Insisi drainase/ debridement abses 86.04
57 Insisi tongue tie 25.91
58 Koreksi/rekonstruksi/amputasi Polydactyly kaki atau tangan Amputasi jari (84.01), jempol (84.02)
59 Koreksi constriction ring kaki/tangan single 86.2
60 Separasi syndactyly (multiple) 86.85
61 Separasi syndactyly (single) 86.85
62 Repair Kelainan umbilicus 53.4 (repair hernia umbilikalis)
63 Kolesistektomi 51.22, 51.23 (laparoscopic)
64 Kolostomi anak 46.10
65 Kolostomi naonatus 46.10
66 Prosedur Ladd 54.95
67 Laparoskopik appendiktomi 47.01
68 Laparoskopik diagnostic/ biopsi 54.24 (biopsi intraabdominal)
69 Laparoskopik gastrektomi 43.99 (gastrectomy)
70 Laparoskopik kolektomi 45.7/45.8
71 Laparotomi + appendiktomi pada app perforasi 54.1+47.0
72 Laparotomi + milking/ reseksi pada invaginasi 54.11+46.80+45.62 (SI)/45.79 (LI)
73 Laparotomi'+ reseki anastomose 54.11+45.62 (SI)/45.79 (LI) + 45.94
(L-L)/45.93 (L-S), 45.94 (S-S)
74 Laparotomi + reseksi usus halus/ kolon 54.11 + 45.62 (SI)/45.79 (LI)
75 Laparotomi adhesiolisis 54.11+54.59
76 Laparotomi eksplorasi/ biopsy 54.11
77 Laparotomi pada perforasi usus 54.11
78 Laparotomi pada trauma abdomen 54.11
79 Laparotomi pada peritonitis neonates 54.11
80 Limpoma, atheroma, excisi/extirpasi 86.2
81 Lobektomi subtotalis (tiroid) 06.39
82 Marsupialisasi dengan ranula ^n-j 26.21
83 Minimal/ limited PSARP 49.79
84 Near total tiroidektomi 06.39 (subtotal), 06.4 (total)
85 Nefrektomi parsial 55.4
55.51
86 Nefrourektomi tumor Wilms '•

87 Orchidektomi unilat 62.3
88 Orchidektomi bilat 62.41
89 Orchidektomi subkapsuler i 62.42
90 Parotidektomi radikal 26.32
91 Parotidektomi superficial 26.31
92 Parotidektomi totalis 26.32
93 Pasang akses port ceisite 86.07
94 Pasang PEG 78.05
95 Pemasangan double lumen kateter dengan local anastesi; 89.62 (pemasangan CVP)
Insersi catheter vein (38.95), artery
(38.91)
96 Plikasi diaftâgma 53.81
97 Polipektomi 86.3
98 Polipektomi rectum 48.36
99 Portoenteroskopi (operasi Kasai) 51.37
100 Postero sagital anorectoplasty/PSARP 49.79
101 Postero sagital anorectovaginourethroplasty/ PSARVUP 49.79
102 Potong stump 48.35
103 Proedur Tiersch pada prolap rekti 48.76
104 PSARP+laparotomi 49.79+54.11
105 Pyeloplasty 55.87
106 Pyoloromyotomy (operasi Fredet Ramstedt) 43.3
107 Release sinekia vulva 71.8
108 Repair bladder extrophy 57.86
109 Repair cloacal extrophy 70.91
110 Repair defek dinding perut (omphalocele/ gastroschizis) 53.49/54.71
111 Repair defek hernia umbilikalis 53.4
112 Repair fistel rectovaginal 70.73
113 Repair Diafi-agma pada CDH 53.7/53.8
114 Repair rupture perineum lama Pria (71.79/71.71), wanita
(86.89/86.59)
115 Repair vesika urinaria 57.89
116 Reseksi+ anastomosis esophagus 42.41/42.42+42.59
117 Reseksi anastomosis pada atresia usus, duplikasi Reseksi usus: L I (45.79/45.8), SI
(45.62/45.63). anastomosis: 45.94 (L-
L)/45.93 (L-S), 45.94 (S-S)
118 Reseksi esophagus & rekonstruksi 42.41/42.42+42.59
119 Reseksi gaster 43.5, 43.6, 43.7, 43.8, 43.9
120 Reseksi hepar (tumor, trauma) 50.22 (partial), 50.3 (lobus total), 50.4
(total)
121 Reseksi sigmoid 45.76
122 Reseksi urachus 57.51
123 Retrorectal pull through(Duhamel procedure) 48.65
124 Salpingo oophorektomi bilat 65.61
125 Sirkumsisi (narkose) Pria (64.0), wanita (71.4)
126 Sistostomi 57.17/57.18
127 Skleroterapi dengan anastesi 39.92
128 Sphincterotomy 49.51,49.52, 49.59 (anal sphincter)
129 Splenectomy pada trauma 41.43 (partial), 41.5 (total)
130 Spelenectomy ec hipertensi portal/ kelainan hematologi lain 41.43 (partial), 41.5 (total)
131 Suntik scleroting agent malformasi vaskuler 39.92
132 Thoracotomy +anastomosis esophagus 34.00 + 42.59

133 Tiroidektomi subtotalis 06.39
134 Total gastrektomi dan rekonstruksi 43.9 + 44.69
135 Tracheostomy (temporary) 31.1
136 Transanal mucosektomy 49.3
137 Uretero neosistostomi 56.74
138 Ureteroplasty(hipospadia) 56.89
139 Vena seksi dan pasang akses vaskuler 38.00
140 Yeyunostomi 46.41
141 Operations on thyroid and parathyroid glands 06
142 Unilat thyroid lobectomy 06.2
143 Substernal thyroidectomy 06.5
144 Excision of lingual thyroid 06.6
145 Partial parathyroidectomy 06.8
146 Complete parathyroidectomy 06.81
147 Other operations on thyroid and parathyroid glands 06.9
148 Operations on other endocrine glands 07
149 Exploration of adrenal glands 07.0
150 Partial adrenalectomy 07.2
151 Bilat adrenalectomy 07.3
152 Other operations on adrenal glands 07.4
153 Thymectomy 07.8
154 Transplantation of thymus 07.9
155 Other operations on endocrine glands 07
156 Operation on tongue 25
157 Exicision or destruction of lesion of tongue 25.1
158 Radical glossectomy 25.4
159 Operations on salivary glands and ducts 26
160 Incision of salivary glands and ducts 26.0
161 Exicision of lesion of salivary gland 26.2
162 Other exicision of salivary gland 26.29
163 Repair of salivary gland or duct 26.49
164 Other operations on salivary glands and duct 26.9
165 Other operations on mouth and face 27
166 Drainage of face or floor of mouth 27.0
167 Incision of palate 27.1
168 Exicision of branchial cleft vestiges
169 Other operations on larynx and trachea 31
170 Injection into larynx ' 31.0
171 Permanent tracheostomy 31.2
172 Other incision of larynx or trachea 31.3
173 Local exicision or destruction of trachea 31.5
174 Operations on chest wall, pleura, mediastinum and diaphragm 34
175 Incision of chest wall and pleura 34.01
176 Incision of mediastinum 34.1
177 Excision or destruction of mediastinal lesion 34.3
178 Excision or destruction of chest wall lesion 34.4
179 Repair of chest wall 34.7
180 Operations on diaphragm 34.8
181 Operations on lymphatic system 40
182 Incision on lymphatic system 40.0
183 Simple excision of lymphatic structure 40.2
184 Regional lymph node exicision 40.3

NO. N A M A TINDAKAN'"'^^^^^^^ • • ICD-9 C M
185 Radical exicision of cervical lymph nodes 40.4
186 Other radical excision of lymph nodes 40.5
187 Operation on thoraric duct 40.6
188 Other operations on lymphatic structures , ' , . 40.9
189 Operations on esophagus 42
190 Esophagotomy u;.'^..; 42.0 - ^
191 Esophagostomy 42.0 ^*
192 Local Exicision or destruction of lesion of esophagus 42.3 -
193 Exicision of esophagus (with end to end anastomosis) 42.4 '''
194 Anastomosis of esphogus (intrathoracic) 42.5
195 Antestemal anastomosis of esophagus 42.6
196 Other repair of esophagus 42.8
197 Manipulation within esophagus 42.89 -
198 Other operations on esophagus 42.9 "-
199 Incision and exicision of stomach 43
200 Gastrotomy 43.6
201 Temporary Gastrotomy 43.1
202 Permanent gastrostomy 43.1
203 ' Exicision or destruction of lesion of stomach 43.4
204 Partial gastrectomy with anastomosis to esophagus 43.5
205 Partial gastrectomy with anastomosis to duodenum 43.6
206 Partial gastrectomy with anastomosis to jejunum 43.7
207 Other partial gastrectomy 43.8
208 Other operations on stomach 44
209 Vagatomy . ..^ . , 44.0
210 Pyloroplasty 44.2
211 Gastroenterostomy (without gastrectomy) 44.3
212 Suture of gastric or duodenal ulcer site 44.4
213 Revision of gastric anastomosis 44.5
214 Other Repair of stomach 44.6
215 Other operations on stomach ^^SJ^'! 44.9
216 Incision, exicision and anastomosis of intestine 45
217 Enterotomy 45.0
218 Exicision or destruction of lesion of small intestine 45.3
219 Exicision or destruction of lesion of large intestine 45.4
220 Isolation of intestinal segment 45.5
221 Other exicision of small intestine 45.6
222 Exicision of large intestine, partial 45.7
223 Total colectomy 45.8
224 Anastomosis, small to small intestine 45.91
225 Anastomosis, small to large intestine 45.93
226 Anastomosis, large to large intestine 45.94
227 Other operations on intestine 46
228 Exteriorization of intestine 46.0
229 Other enterostomy 46.3
230 Repair of intestinal stoma 46.4
231 Closure of intestinal stoma 46.5
232 Fixation of intestine 46.6
233 Other repair of intestine 46.7
234 Intra-abdominal manipulation of intestine 46.8
235 Other operations on intestine 46.9
236 Operations on appendix 47

237 Drainage of appendix abscess 47.2
238 Other Operations on appendix 47.9
239 Operations on rectum 48
240 Proctotomy 48.0
241 Proctostomy 48.1
242 Local exicision or destruction of rectum 48.3
243 Pull-through exicision of rectum 48.4
244 Abdominoperineal exicision of rectum 48.5
245 Other exicision of rectum 48.6
246 Repair of rectum 48.7
247 Incision or excision of perirectal tissue 48.8
248 Other operations on rectum and perirectal tissue 48.9
249 Operations on anus 49
250 Incision or excision of perianal tissue 49.0
251 Incision or excision of anal fistula 49.1
252 Other local excisionor destruction of anus 49.3
253 Hemorrhoidectomy 49.4
254 Division of anal sphincter 49.5
255 Other exicision of anus 49.6
256 Repair of anus 49.7
257 Other operations on anus 49.9
258 Operations on liver 50
259 Hepatotomy 50.0
260 Liver transplant 50.5
26! Repair of liver 50.6
262 Other operations on liver 50.9
263 Operations on gallbladder and biliary tract 51
264 Anastomosis of gallbladder or bile duct 51.3
265 Incision of bile ducts, for relief of obtruction for calculus,
stricture or tumor 51.4
266 Other Incision o f bile ducts for drainage, endoscopy,
exploration,radiography 51.5
267 Local excision or destruction of bile ducts 51.6
268 repair of bile ducts 51.7
269 Removal of prosthetic appliance from hi le duct 51.95
270 Operation on sphincter of oddi 51.8
27! Other operations on billiary tract 51.9
272 Operations on pancreas 52
273 Pancreatotomy 52.0
274 Partial pancreatectomy 52.5
275 Local exicision or destruction of pancreas 52.2
276 Marsupialization of pancreatic cyst . 52.3
277 Internal drainage of pancreatic cyst 52.4
278 Total pancreatectomy 52.6
279 Radical pancreaticoduodenectomy 52.7
280 Anastomosis o f Pancreatic duct anastomosis to stomach, ^"
jejunum or ileum implant of tube 52.96
281 Transplant of pancreas 52.8
282 Other operations on pancreas 52.9
283 Repairofhemia * o u^, .; 53 r'-
284 Repair of femoral hernia 53.2
285 Repair of inguinofemoral hernia with graft or prosthesis 53.03

NO. NAMATINDAKAN " - - - - - - - - - - - - - - - - = ICD-9 C M ^ '
286 Bilat repair of femoral hernia 53.3
287 Bilat repair of inguinofemoral hernia with graft or prosthesis 53.15
288 Repair of other hernia of anterior abdominal wall 53.5
289 Repair of other hernia of anterior abdominal wall with graft or
prosthesis 53.6
290 Other operations in abdominal region 54
291 Incision of abdominal parietes 54.0
292 Exicision or destruction of abdominal wall and umbilicus 54.3
293 Exicision or destruction of peritoneum 54.4
294 Division of peritoneal adhesions 54.5
295 Suture of abdominal wall and peritoneum 54.6
296 Other repair of abdominal wall and peritoneum 54.7
297 Other operations in abdominal region 54.9
298 Nephrotomy and nephrostomy 55.0
299 Pyelotomy and pyelostomy 55.1
300 Local exicision or destruction of kidney 55.3
301 Total nephrectomy 55.5
302 Cystotomy 57.1
303 Cystostomy 57.1
304 Reconstruction of urinary bladder 57.87
305 Urethral meatotomy 58.1
306 Repair of urethra 58.4
307 Dissection of retroperitoneal tissue 59.0
308 Incision of scrotum and tunica vaginalis drainage 61.0
309 Excision o f hydrocele ( o f tunica vaginalis) repair o f
hydrocele 61.2
310 Exicision of varicocele and hydrocele of spermatic cord 63.1
311 Unilat oophorectomy 65.3
312 Unilat salpingo-oophorectomy 65.4
313 Bilat oophorectomy 65.5
314 Reconstruction of muscle and tendon 83.7
315 Local exicision of lesion of breast 85.22
316 Complete mastectomy 85.44
317 Other Operation on breast 85.9
318 Mastotomy 85.0
319 Incision of pilonidal sinus 86.03
320 Surgical toilet of wound or infected tissue removal of slough 86.27
321 Cytotoxic drug therapy
322 Other arterial injection of cytotoxic drug
323 Pleural instillation of cytotoxic drug
324 Peritoneal instillation of cytotoxic drug
325 Bladder instillation of cytotoxic drug
326 Superficial application of cytotoxic drug
327 Other cytotoxic drug therapy
328 Sclerosing of hemangioma 39.92
329 Other sclerosing injection 39.92

109
PERHIMPUNAN D O K T E R S P E S I A L I S BEDAH INDONESIA
IKABI
Jl Kramat Raya 160, Jakarta Pusat 10430. Telp & Fax. 021 - 3916774

Periode 2012-2014
Dewan Parti mbarôan
Prol Dr. Sjamsjtiidaiat, SpB SpB-KBD
Dr Soerarso Hardjowasito, SpB.SpBTKV
MaialHEIIk&Panasahat Nama : Dr Maizul Anwar, SpBTKV
Prof. Dr Mgclilis Ramli, SpB(K)-Orl(
Jabatan : Ketua HBTKVI
Hslua Prasidium
Prof. DR. Dr Paul Tahalele, SpB.SpBTKV Periode 2012-2014
WlhilKetua/KetuaTflrpilih
Dr R. Suhartono, SpBKBV
tIMMia Menyerahkan I berkas naskah asli daftar kewenangan klinis profesi H B T K V I

Prof. DR. Dr. Sjnaryo Hardjowidjoto, SpB SpU kepada:
Kalua Purna Nama : Dr Djoni Darmadjaja, SpB.MARS
Prof. DR. Dr. Sjwandi Sugardi, SpB SpU
KsIuaMIBI
Periode 2012-2014
Prof, Dr. Errol U. Hutagaljng, SpB SpOT
Pwldlum
Dr Urip Muitedjo. SpB PGD Pal Med, ECU Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Dr. Rizal Pohan. SpB SpOT
Dr. Sonar Soni Panigoro, SpB K Onk Bedah Indonesia.
Df Patriot Muslim, SpU
Dr Poerwadi, SpB SpBA
Dr R Suhartono, SpBKBV
Dr Setyowidi Nugroho, SpB SpBS Jakarta,
Dr. Maizul Anwar, SpB TKV I I Februari 2013
Dr. Isfiandono Dachlan. Msc, SpB, SpBP-RE(K}
S^kraljirit Jand^ral
Dr. Djoni Darmadjaja, SpB MARS
Or Agung Prasmono, SpB SpBTKV.MARS
pendahara
Dr. Barlian Sutedta, SpB
KoiP|8i OfaanisaBi. Ugislasi dan Advokasi Dr MaiitjhAnwar, SpBTKV Dr. DjoniiDarmadjaja, SpB.MARS
Dr. HN Nazar, SpB
Dr. Chandra Svaras, SpB Ketua HBTKVI Sekjen I K k B I
Kgml*' Pro(i«l Badah. Aguransi dan
PBrp^jakan
Dr. Nurhayat Usman. SpB KBD
Dr Erawan Wiradisuria. SpB KBD
Dr. Henry Boylô Silompul, SpB
Dr. InztaArbi, SpB
Uprplai Globaiisaaj ft Pâar Baliag

Dr dr Fathema D Raciimat, SpB SpBTKV
Dr. Huntal Simamora, SpBP-RE
Komi»t Komunlkasi dan Pubilkaai

DR, Dr. Yefta Munadjal. SpB SpBP-RE[K)
Prof. DR. Dr Sri Maliawan, SpBS (K)
Dr. Iskandar Budianta, SpB SpBA
Komisi Hubungan Dalam Nagiri

Prol. DR, Dr Andi Asadul Islam, SpBS
Dr. Emir T Pasaribu SpB.Onii
Komlal Pitavanan Ambulanca 11B

Dr ZAIsma, Sp8
OR. Dr Achmad Hidayat, SpB

Dr B. Sunoiio, SpB
DR. Dr. Triwahyu Mumi, SpB SpBTKV
Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia B 111

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH THORAKS

KARDIAK DAN VASKULAR
(HBTKVI)
113
DAFTAR K O M P E T E N S I DAN K E W E N A N G A N K L I N I S
D O K T E R SPESIALIS B E D A H T H O R A K S K A R D I A K DAN V A S K U L A R

EXCISION OF LARYNX 30
1 Excision or destruction of lesion or tissue of larynx 30.0
2 Marsupialization of laryngeal cyst 30.01 î-
3 Other excision or destruction of lesion or tissue of larynx, Stripping of 30.09
vocal cords
4 Hemilaryngectomy 30.1
5 Other partial laryngectomy 30.2
6 Epiglottidectomy 30.21
7 Vocal cordectomy. Excision of vocal cords 30.22
8 Other partial laryngectomy. Excision of laryngeal cartilage 30.29
9 Complete laryngectomy, Block dissection of larynx (with thyroidectomy) 30.3
(with synchronous tracheostomy), Laryngopharyngectomy
10 Radical laryngectomy. Complete [total] laryngectomy with radical neck 30.4
dissection (with thyroidectomy) (with synchronous tracheostomy)
OPERASI PADATRAKEA
11 Trakeostomi temporer, temporary percutaneus dilatational trakeostomy 31.1
(PDT)
12 Trakeostomi permanen 31.2
13 Trakeostomi trakea mediastinum 31.21
14 PDT permanen 31.29
15 Insisi pada laring dan trakea (Iain - lain) 31.3
16 Prosedur diagnostik pada larings dan trakea (laringoskopik/ 31.4
trakeoskopik)
17 Trakeoskopi melalui stoma artifisial . 31.41
18 Laringoskopi atau Trakeoskopi lain - lain 31.42
19 Biopsi larings (endoskopik) 31.43
20 Biopsi trakea (endoskopik) 31.44
21 Biopsi terbuka trakea/larings 31.45
22 Prosedur diagnostik yg lain pd laring 31.48
23 Prosedur diagnostik yg lain pd trakea 31.49
24 Eksisi/destruksi lesi trakea 31.5
25 Repair laring 31.6
26 Sutur(jahit) laserasi larings 31.61
27 Penutupan tistula laring. mis.: Laryngotracheal fistulektomy. Take-down 31.62
of laringostomi
28 Revisi laringostomi 31.63
29 Repair fraktur laring 31.64
30 Repair laring yang lain: Aritenoidopeksi, Grat^ laring, Transposisi korda 31.69
vokalis
31 Repair & operasi plastik pada trakea 31.7
32 Sutur(jahit) laserasi trakea 31.71
33 Tutup trakeostomi/fistula trakea 31.72
34 Tutup fistula trakeo-esofagus (fistulektomi) 31.73
35 Revisi trakeostomi 31.74
36 Rekonstruksi trakea dan konstruksi laring artifisial. mis: Trakeoplasti 31.75
dengan laring artifisial
37 Repair dan operasi plastik lain - lain pada trakea 31.79
38 Operasi lain pada laring & trakea 31.9
10 - Berita Acara PP H B T K V i dan PP I K A B I I 115

39 Pemisahan nervus laringeal 31.91
40 Adesiolisis pada trakea dan laring 31.92
41 Penggantian stent laring atau trakea 31.93
42 Injeksi bahan terapetik yg bekerja lokal pada trakea 31.94
43 Fistulisasi tracheoesophageal 31.95
44 Operasi yang lain pada laring. 31.98
mis.: dilatasi laring, Pemisahan web kongenitaipadalaring, Pengangkatan
stent laring.
45 Operasi yang lain pada trakea 31.99
EKSISI PARU DAN BRONKHUS
46 Eksisi/destruksi lokal (simpel) lesi pada bronkhus 32.0
47 Endoskopik eksisi atau destruksi lesi atau jaringan pada bronkus 32.01
48 Lokal eksisi atau destruksi lesi atau jaringan pada baronkus (Iain-lain) 32.09
49 Reseksi bronkhus 32.1
50 Lokal eksisi/destruksi lesi/jaringan di paru 32.2
51 Eksisi lesi/jaringan paru terbatas (wedge) melalui torakoskopik (VATS) 32.20
52 Plikasi jaringan emfisematosa .' 32.21
53 Operasi reduksi volume paru 32.22
54 Ablasi lesi paru terbuka 32.23
55 Ablasi perkutaneus pada lesi atau jaringan paru 32.24
56 Ablasi lesi paru dengan torakoskopik/VATS 32.25
57 Ablasi Iain-Iain pada lesi atau jaringan paru (unspecified) 32.26
58 Termoplasty bronkial bronkoskopik, ablasi pada otot polos saluran 32.27
nafas
59 Endoskopik eksisi atau destruksi pada lesi atau jaringan paru 32.28
60 Reseksi baji (wedge resection) paru 32.29
61 Reseksi segmental paru, lobektomi parsial 32.3
62 Reseksi segmental paru dengan torakoskopik/VATS 32.30
63 Reseksi paru segmental lain - lain (unspecified) 32.39
64 Lobektomi paru, bilobektomi 32.4
65 Lobektomi dengan torakoskopik/VATS 32.41
66 Lobektomi paru (Iain-lain) 32.49
67 Pneumonektomi komplit 32.5
68 Pneumonektomi dengan torakoskopik 32.50
69 Pneumoektomi lain - lain (unspecified) 32.59
70 Diseksi radikal struktur toraks 32,6
71 Eksisi paru (Iain-lain) 32.9
72 Insisi bronkhus 33.0
73 Insisi paru 33.1
74 Prosedur diagnostik pada paru dan bronkhus 33.2
75 Biopsi paru dengan torakoskopik/VATS 33.20
76 Bronkoskopi melalui stoma artifisial 33.21
77 Bronkoskopi 33.22
78 Bronkoskopi Iain-lain "' 33.23
79 Biopsi tertutup (endoskopik) pada bronkus ^ 33.24
80 Biopsi bronkhus terbuka . , 33.25
81 Biopsi paru per kutan (FNA, TTNB) '^'^ ' 33.26
82 Biopsi tertutup (endoskopik) pada paru 33.27
83 Biopsi paru terbuka 33.28
84 Prosedur diagnostik yang lain pada paru dan bronkus 33.29

OPERASI LAIN PADA PARU
85 Operasi untuk paru kolaps 33.3
86 Destruksi nervus frenikus untuk paru kolaps 33.31
87 AirPlumbage 33.32
88 Pneumoperitoneum untuk paru kolaps 33.33
89 Torakoplasti 33.34
90 Muscle plumbage, operasi kolaps paru lainnya 33.39
91 Jahit laserasi bronkhus 33.41
92 Tutup fistula bronkhus (fistulectomy), tutup bronkostomi 33.42
93 Repair laserasi paru 33.43
94 Repair dan operasi plastik yang Iain pada bronkus 33.48
95 Repair dan operasi plastik yang Iain pada paru 33.49
96 Transplantasi paru 33.5
97 Transplantasi paru (not otherwise specified) 33.50
98 Transplantasi paru unilat 33.51
99 Transplantasi paru bilat 33.52
100 Transpalantasi paru-jantung 33.6
101 Prosedur endoskopik iain-lain pada bronkus dan paru 33.7
lb2 Insersi atau penggantian katup bronkial endoskopik, satu lobus 33.71
103 Pengukuran aliran udara di paru secara endoskopik 33.72
104 Insersi atau penggantian katup bronkial endoskopik, multi lobus 33.73
105 Pelepasan alat atau bahan pada bronkial secara endoskopik 33.78
106 Insersi alat atau bahan pada bronkial lainnya secara endoskopik 33.79
107 Operasi lainnya pada paru dan bronkus 33.9
108 Dilatasi bronkus 33.91
109 Ligasi bronkus 33.92
110 Puncture/penusukan paru 33.93
111 Operasi lainnya pada bronkus 33.98
112 Operasi lainnya pada paru 33.99
OPERASI PADA DINDING DADA, PLEURA, MEDIASTINUM DAN
DIAFRAGMA
113 Insisi pada dinding dada dan pleura 34.0
114 Insisi dinding dada, drainase ekstrapleura dinding dada 34.01
115 Torakotomi Eksplorasi 34.02
116 Redo Torakotomi 34.03
117 Pemasangan drainase toraks (WSD, kateter) 34.04
118 Shunt pleuro-peritoneal 34.05
119 Drainase empiema/ efusi dengan torakoskopik/VATS 34.06
120 Prosedur Open Window, Eloeser Flap 34.09
121 Prosedur Diagnotik Pada Dinding Dada, Pleura, Mediastinum, dan 34.2
Diafiâgma
122 Diagnostik pada Timus 07.1
123 Biopsi timus 07.16
124 Diagnostik lain pada timus 07.19
125 Timektomi 07.80
126 Eksisi timus parsial terbuka 07.81
127 Eksisi timus total terbuka 07.82
128 Operasi lain pada timus 07.9
129 Eksplorasi timus 07.91
130 Insisi pada timus 07.92
10 - Berita Acara PP H B T K V I dan PP I K A B I I 117

131 Repair timus 07.93
132 Transplantasi timus 07.94
133 Lain - lain (timopeksi) 07.99
134 Biopsi pleura dengan torakoskopik/VATS 34.20
135 Torakoskopik transpleura 34.21
136 Mediastinoskopi 34.22
137 Biopsi dinding dada 34.23
138 Biopsi pleura lainnya 34.24
139 Biopsi mediastinum per kutan 34.25
140 Biopsi mediastinum terbuka 34.26
141 Biopsi diatragma 34.27
142 Prosedur diagnostik lainnya pada dinding dada, pleura dan diafragma 34.28
143 Prosedur diagnostik lainnya pada mediastinum 34.29
Operasi Pada Dinding Dada Dan Pleura
144 Eksisi/destruksi lesi/jaringan di mediastinum 34.3
145 Eksisi/destruksi lesi/jaringan di dinding dada 34.4
146 Pleurektomi 34.5
147 Dekortikasi 34.51
148 Dekortikasi dengan torakoskopik/VATS . 34.52
149 Eksisi lesi pada pleura 34.59
150 Pleurodesis (terbuka) 34.6
151 Repair dinding dada 34.7
152 Repair (jahit) laserasi dinding dada 34.71
153 Tutup torakostomi 34.72
154 Tutup /repair fistula dinding dada (bronko-pleura-kutan) 34.73
155 Repair Pektus Karinatum/'Ekskavatum 34.74
156 Repair kelainan dindidng dada lainnya 34.79
157 Operasi pada Diafiâgma 34.8
158 Eksisi lesi/jaringan pada diafi'agma 34.81
159 Repair laserasi diafi'agma 34.82
160 Repair fistula diafi'agma 34.83
161 Plikasi diafi'agma, repair lain diafi-agma 34.84
162 Impiantasi pace maker diafi'agma 34.85
163 Operasi diafi'agma lainnya 34.89
164 Operasi lainnya pada toraks 34.9
165 Torakosistesis 34.91
166 Pleurodesis 34.92
167 Repair pleura 34.93
168 Lainnya* 34.99
169 Operations on valves and septa of heart. Includes: stemotomy (median) 35
(transverse) as operative approach thoracotomy as operative approach
170 Closed heart valvotomy 35.0
171 Closed heart valvotomy, unspecified valve 35.00
172 Closed heart valvotomy, aortic valve 35.01
173 Closed heart valvotomy, mitral valve 35.02
174 Closed heart valvotomy, pulmonary valve 35.03
175 Closed heart valvotomy, tricuspid valve 35.04
176 Open heart valvuloplasty without replacement. Includes: open heart 35.1
valvotomy
177 Open heart valvuloplasty without replacement, unspecified valve 35.10
178 Open heart valvuloplasty of aortic valve without replacement 35.11
179 Open heart valvuloplasty of mitral valve without replacement 35.12

180 Open heart valvuloplasty of pulmonary valve without replacement 35.13
181 Open heart valvuloplasty of tricuspid valve without replacement 35.14
182 Replacement of heart valve. Includes: excision of heart valve with 35.2
replacement
183 Replacement of unspecified heart valve, 35.20
Repair of unspecified heart valve with tissue graft or prosthetic implant
184 Replacement of aortic valve with tissue graft 35.21
Repair o f aortic valve w i t h tissue graft ( a u t o g r a f t )
(heterograft)(homograft)
185 Other replacement of aortic valve 35.22
Repair of aortic valve with replacement: NOS, prosthetic (partial)
(synthetic) (total)
186 Replacement of mitral valve with tissue graft 35.23
Repair of mitral valve with tissue graft (autograft)
187 Other replacement of mitral valve 35.24
Repair o f mitral valve with replacement: NOS, prosthetic (partial)
(synthetic) (total)
188 Replacement of pulmonary valve with tissue graft 35.25
Repair of pulmonary valve with tissue graft (autograft) (heterograft)
(homograft)
189 Other replacement of pulmonary valve 35.26
Repair of pulmonary valve with replacement: NOS, prosthetic (partial)
(synthetic) (total)
190 Replacement of tricuspid valve with tissue graft 35.27
Repair o f tricuspid valve w i t h tissue graft (autograft)
191 Other replacement of tricuspid valve 35.28
Repair of tricuspid valve with replacement: NOS, prosthetic (partial)
(synthetic) (total)
192 Operations on structures adjacent to heart valves 35.3
193 Operations on papillary muscle, Division o f papillary muscle, 35.31
Reattachment of papillary muscle
Repair of papillary muscle
194 Operations on chordae tendineae, Division of chordae tendineae. Repair 35.32
of chordae tendineae
195 Annuloplasty, Plication of annulus 35.33
196 Infundibulectomy, Right ventricular infundibulectomy 35.34
197 Operations on trabeculae cameae cordis, Division of trabeculae cameae 35.35
cordis. Excision o f trabeculae carneae cordis, Excision of aortic
subvalvular ring
198 Operations on other strucfiares adjacent to valves of heart. Repair of sinus 35.39
of Valsalva (aneurysm)
199 Production of septal defect in heart 35.4
200 Enlargement o f existing atrial septal defect. Septostomy (atrial) 35.41
(balloon)Rashkind procedure
201 Creation of septal defect in heart, Blalock-Hanlon operation 35.42
202 Repair of atrial and ventricular septa with prosthesis, 35.5
Includes: repair of septa with synthetic implant or patch

NO JENIS TINDAKAN
203 Repair of unspecified septal defect of heart with prosthesis
204 Repair o f atrial septal defect with prosthesis, open technique.
Atrioseptoplasty with prosthesis
Correction of atrial septal defect with prosthesis. Repair: foramen ovale
(patent)
with prosthesis ostium secundum defect with prosthesis
205 Repair of atrial septal defect with prosthesis, closed technique
Insertion of atrial septal umbrella [King-Mills]
206 Repair of ventricular septal defect with prosthesis, open technique.
Correction o f ventricular septal defect with prosthesis. Repair of
supracristal defect with prosthesis
207 Repair of endocardial cushion defect with prosthesis
Repair: atrioventricular canal with prosthesis (grafted to septa), ostium
primum defect with prosthesis (grafted to septa), valvular defect
associated with atrial and ventricular septal defects with prosthesis
(grafted to septa)
208 Repair of ventricular septal defect with prosthesis, closed technique
209 Repair of atrial and ventricular septa with tissue graft
210 Repair of unspecified septal defect of heart with tissue graft
211 Repair of atrial septal defect with tissue graft, Atrioseptoplasty with
tissue graft
Correction of atrial septal defect with tissue graft
Repair: foramen ovale (patent) with tissue graft, ostium secundum defect
with tissue graft
212 Repair of ventricular septal defect with tissue graft. Correction o f
ventricular septal defect with tissue graft. Repair of supracristal defect
with tissue graft
213 Repair of endocardial cushion defect with tissue graft
Repair of: atrioventricular canal with tissue graft, ostium primum defect
with tissue graft,
valvular defect associated with atrial and ventricular septal defects with
tissue graft
214 Other and unspecified repair of atrial and ventricular septa
Other and unspecified repair of unspecified septal defect of heart. Repair
of septal defect NOS
215 Other and unspecified repair of atrial septal defect
Repair NOS: atrial septum, foramen ovale (patent), ostium secundum
defect
216 Other and unspecified repair of ventricular septal defect
Repair NOS: supracristal defect, ventricular septum
217 Other and unspecified repair of endocardial cushion defect. Repair NOS:
atrioventricular canal, ostium primum defect, valvular defect associated
with atrial and ventricular septal defects
218 Total repair of certain congenital cardiac anomalies
Note: For partial repair of defect [e.g. repair of atrial septal defect in
tetralogy of Fallot] ~ code to specific procedure

m JENIS TINDAKAN ' ..mmwm^w^': ICD9-CM
219 Total repair of tetralogy of Fallot 35.81
One-stage total correction o f tetralogy o f Fallot with or without:
commissurotomy of pulmonary valve. Infundibulectomy, outflow tract
prosthesis, patch graft of outflow tract, prosthetic tube for pulmonary
artery, repair of ventricular septal defect (with prosthesis), take-down of
previous systemic-pulmonary artery anastomosis
220 Total repair of total anomalous pulmonary venous connection 35.82
One-stage total correction o f total anomalous pulmonary venous
connection with or without: anastomosis between (horizontal) common
pulmonary trunk and posterior wall of left atrium (side-to-side)
enlargement of foramen ovale
incision [excision] of common wall between posterior left atrium
and coronary sinus and roofing of resultant defect with patch graft
(synthetic)
ligation o f venous connection (descending anomalous vein) (to left
innominate vein) (to superior vena cava), repair of atrial septal defect
(with prosthesis)
221 Total repair of truncus arteriosus 35.83
One-stage total correction o f truncus arteriosus with or without:
construction (with aortic homograft) (with prosthesis) of a pulmonary
artery placed from right ventricle to arteries supplying the lung ligation
of connections between aorta and pulmonary artery
repair of ventricular septal defect (with prosthesis)
222 Total correction o f transposition o f great vessels, not elsewhere 35.84
Classified
Arterial switch operation [Jatene]
Total correction of transposition of great arteries at the arterial level
by switching the great arteries, including the left or both coronary
arteries, implanted in the wall of the pulmonary artery
223 Other operations on valves and septa of heart 35.9
224 Interatrial transposition of venous return; Bangkatle: Atrial, Interatrial; 35.91
Mustard's operation
Resection o f atrial septum and insertion of patch to direct systemic
venous return to tricuspid valve and pulmonary venousretum to mitral
valve
225 Creation o f conduit between right ventricle and pulmonary artery; 35.92
Creation of shunt between right ventricle and (distal) pulmonary artery;
Creation of conduit between left ventricle and aorta
Creation of apicoaortic shunt; Shunt between apex of left ventricle and
aorta
226 Prosedur Shunt Ventrikel Kiri-Aorta 35.93
227 Creation of conduit between atrium and pulmonary artery; Fontan 35.94
procedure
228 Revision of corrective procedure on heart; Replacement of prosthetic 35.95
heart valve poppet
Resuture of prosthesis of: Septum, Valve

NO JENIS TINDAKAN
229 Percutaneous valvuloplasty; Percutaneous balloon valvuloplasty
230 Other operations on septa of heart
231 Other operations on valves of heart
232 Operations on vessels of heart. Includes: stemotomy (median) (transverse)
as operative approach
thoracotomy as operative approach
233 Removal of coronary artery obstruction and insertion of stent(s)
234 Open chest coronary artery angioplasty; Coronary (artery): endarterectomy
(with patch graft)
thromboendarterectomy (with patch graft), Open surgery for direct relief
of coronary artery obstruction
235 Intracoronary artery thrombolytic infusion That by direct coronary
artery injection, infusion, or catheterization, enzyme infusion. Platelet
inhibitor
236 Insertion of non-drug-eluting coronary artery stent(s); Bare stent(s);
Bonded stent(s); Drug-coated stent(s), i.e. heparin coated; Endograft(s);
Endovascular graft(s); Stent grafts
237 Insertion o f drug-eluting coronary artery stent(s); Endograft(s);
Endovascular graft(s); Stent graft(s)
238 Other removal of coronary artery obstruction; Coronary angioplasty
NOS
239 Bypass anastomosis for heart revascularization; CABG
240 Aortocoronary bypass for heart revascularization, not otherwise
Specified
Direct revascularization: cardiac with catheter stent, prosthesis, or vein
graft coronary with catheter stent, prosthesis, or vein graft heart muscle
with catheter stent, prosthesis, or vein graft myocardial with catheter
stent, prosthesis, or vein graft; Heart revascularization NOS
241 (Aorto)coronary bypass of one coronary artery
242 (Aorto)coronary bypass of two coronary arteries
243 (Aorto)coronary bypass of three coronary arteries
244 (Aorto)coronary bypass of four or more coronary arteries
245 Single internal mammary-coronary artery bypass
Anastomosis (single): mammary artery to coronary artery, thoracic artery
to coronary artery
246 Double internal mammary-coronary artery bypass
Anastomosis, double: mammary artery to coronary artery; thoracic artery
to coronary artery
247 Abdominal - coronary artery bypass; Anastomosis: Gastroepiploic -
coronary artery;
248 Other bypass anastomosis for heart revascularization
249 Heart revascularization by arterial implant
Implantation of: aortic branches [ascending aortic branches] into heart
muscle, blood vessels into myocardium, internal mammary artery
[internal thoracic artery] into: heart muscle, Myocardium, Ventricle,
ventricular wall; Indirect heart revascularization NOS
250 Other heart revascularization
251 Open chest transmyocardial revascularization

252 Other transmyocardial revascularization 36.32
253 Endoscopic transmyocardial revascularization; Robot-assisted 36.33
transmyocardial revascularization
Thoracoscopic transmyocardial revascularization
254 Percutaneous transmyocardial revascularization; Endovascular 36.34
transmyocardial revascularization
255 Other heart revascularization, Abrasion o f epicardium, Cardio- 36.39
omentopexy, Intrapericardial poudrage, Myocardial graft: mediastinal
fat, omentum, pectoral muscles
256 Other operations on vessels of heart 36.9
257 Repair of aneurysm of coronary vessel 36.91
258 Other operations on vessels of heart, Exploration of coronary artery, 36.99
Incision of coronary artery
Ligation of coronary artery. Repair of arteriovenous fistula
259 Other operations on heart and pericardium 37
260 Pericardiocentesis 37.0
261 Cardiotomy and pericardiotomy 37.1
262 Incision of heart, not otherwise specified, Cardiolysis NOS 37.10
263 Cardiotomy, Incision of: Atrium, Endocardium, Myocardium, Ventricle 37.11
264 Pericardiotomy, Pericardial window operation, Pericardiolysis, 37.12
Pericardiotomy
265 Biopsy of pericardium 37.24
266 Biopsy of heart 37.25
267 Pericardiectomy and excision of lesion of heart 37.3
268 Pericardiectomy, Excision of: adhesions of pericardium constricting scar 37.31
of: Epicardium, Pericardium
269 Excision of aneurysm of heart. Repair of aneurysm of heart 37.32
270 Excision or destruction of other lesion or tissue of heart,open approach. 37.33
Ablation of heart tissue (cryoablation) (electrocurrent) (laser) (microwave)
(radiofrequency) (resection), open chest approach. Cox-maze procedure.
Maze procedure. Modified maze procedure, trans-thoracic approach
271 Excision or destruction of other lesion or tissue of heart,other approach. 37.34
Ablation of heart tissue (cryoablation) (electrocurrentXlaser) (microwave)
(radiofrequency) (resection), via peripherally
inserted catheter. Modified maze procedure, endovascular approach
272 Partial ventriculectomy. Ventricular reduction surgery. Ventricular 37.35
remodeling
273 Repair of heart and pericardium 37.4
274 Implantation of prosthetic cardiac support device around the heart. 37.41
Cardiac support device (CSD)
Epicardial support device. Fabric (textile) (mesh) device. Ventricular
support device on surface of heart
275 Other repair of heart and pericardium 37.49
276 Heart replacement procedures 37.5
277 Heart transplantation 37.51
278 Implantation o f total replacement heart system. Artificial heart. 37.52
Implantation o f fully implantable total replacement heart system,
including ventriculectomy
279 Replacement or repair o f thoracic unit o f total replacement heart 37.53
system
10 ~ Benta Acara PP H B T K V I dan PP I K A B I I 123

NO JENIS TINDAKAN
280 Replacement or repair o f other implantable component o f total
replacement heart system
Implantable battery. Implantable controller. Transcutaneous energy
transfer [TET] device
281 Implantation of heart and circulatory assist system
282 Implant of pulsation balloon. Pemasangan lABP
283 Insertion of non-implantable heart assist system. Insertion of heart assist
system, NOS
Insertion of heart pump
284 Repair of heart assist system. Replacement o f parts of an existing
ventricular assist device (VAD)
285 Removal of heart assist system
286 Implant of external heart assist system
Note: Device (outside the body but connected to heart) with external
circulation and pump.
Includes open chest (stemotomy) procedure for cannulae attachments
287 Insertion of implantable heart assist system. Axial flow heart assist
system. Diagonal pump heart assist system. Left ventricular assist device
(LVAD). Pulsatile heart assist system. Right ventricular assist device
(RVAD). Rotary pump heart assist system. Transportable, implantable
heart assist system. Ventricular assist device (VAD) not otherwise
specified. Note: Device directly connected to the heart and implanted in
the upper left quadrant of peritoneal cavity.
This device can be used for either destination therapy (DT) or bridge-
to-transplant (BTT)
288 Implantation of cardiomyostimulation system. Note: Two-step open
procedure consisting of transfer of one end of the latissimus dorsi muscle;
wrapping it around the heart; rib resection; implantation of epicardial
cardiac pacing leads into the right ventricle; tunneling and pocket creation
for the cardiomyostimulator.
289 Insertion o f percutaneous external heart assist device. Includes
percutaneous [femoral] insertion of cannulae attachments. Circulatory
assist device. Extrinsic heart assist device VAD. Percutaneous heart
assist device
290 Insertion, revision, replacement, and removal of leads; insertion o f
temporary pacemaker system; or revision of cardiac device pocket
291 Initial insertion of lead [electrode], not otherwise specified
Pemasangan Pacemaker Temporer
292 Initial insertion of transvenous lead [electrode] into ventricle
293 Initial insertion of transvenous leads [electrodes] into atrium and
ventricle
294 Initial insertion of transvenous lead [electrode] into atrium
295 Insertion or replacement of epicardial lead [electrode] into Epicardium.
Insertion or replacement of epicardial by: Stemotomy, Thoracotomy

296 Revision of lead [electrode]. Repair of electrode [removal with re- 37.75
insertion]. Repositioning of lead(s) (AICD) (cardiac device) (CRT-D)
(CRT-P). (defibrillator) (pacemaker) (pacing) (sensing) [electrode].
Revision of lead NOS
297 Replacement of transvenous atrial and/or ventricular lead(s) [electrode]. 37.76
Removal or abandonment of existing transvenous or epicardial lead(s)
with transvenous lead(s) replacement
298 Removal of lead(s) [electrode] without replacement. Removal: epicardial 37.77
lead (transthoracic approach) transvenous lead(s)
299 Revision or relocation of pacemaker pocket. Debridement and reforming 37.79
pocket (skin and subcutaneous tissue). Insertion o f loop recorder.
Relocation of pocket [creation of new pocket] pacemaker or CRT-P.
Removal of cardiac device/pulse generator without replacement. Removal
of the implantable hemodynamic presssure sensor (lead) and monitor
device. Removal without replacement of cardiac resynchronization
defibrillator device. Repositioning of implantable hemodynamic pressure
sensor (lead) and monitor device. Repositioning o f pulse generator.
Revision of cardioverter/defibrillator (automatic) pocket. Revision of
pocket for intracardiac hemodynamic monitoring. Revision or relocation
of CRT-D pocket. Revision or relocation of pacemaker, defibrillator, or
other implanted cardiac device pocket
300 Insertion, replacement, removal, and revision of pacemaker device 37.8
Note: Device testing during procedure - omit code
301 Insertion of permanent pacemaker, initial or replacement, type of device 37.80
not specified
302 Initial insertion o f single-chamber device, not specified as rate 37.81
responsive
303 Initial insertion of single-chamber device, rate responsive. 37.82
Rate responsive to physiologic stimuli other than atrial rate
304 Initial insertion of dual-chamber device. Atrial ventricular sequential 37.83
device
305 Replacement of any type pacemaker device with single-chamber 37.85
device, not specified as rate responsive
306 Replacement of any type of pacemaker device with singlechamber 37.86
device, rate responsive . Rate responsive to physiologic stimuli other
than atrial rate
307 Replacement of any type pacemaker device with dual-chamber device. 37.87
Atrial ventricular sequential device
308 Revision or removal of pacemaker device 37.89
Removal without replacement of cardiac resynchronization pacemaker
device [CRT-P]
309 Other operations on heart and pericardium 37.9
310 Insertion of left atrial appendage device. Left atrial fiher. Left atrial 37.90
occluder. Transsepta! catheter technique
311 Open chest cardiac massage 37.91
312 Injection of therapeutic substance into heart 37.92
10 - Berita Acara PP H B T K V i dan PP I K A B I I 125

313 Injection of therapeutic substance into pericardium 37.93
314 Implantation or replacement of automatic cardioverter/ defibrillator, total 37.94
system [AICD]
Implantation of defibrillator with leads (epicardial patches), formation
of pocket (abdominal fascia) (subcutaneous), any transvenous leads,
intraoperative procedures for evaluation of lead signals, and obtaining
defibrillator threshold measurements
Techniques: lateral thoracotomy, medial sternotomy, subxiphoid
procedure
315 Implantation of automatic cardioverter/defibrillator lead(s) only 37.95
316 Implantation of automatic cardioverter/defibrillator pulse generator 37.96
only
317 Replacement of automatic cardioverter/defibrillator lead(s) only 37.97
Replacement of automatic cardioverter/defibrillator pulse generator 37.98
only
318 Other 37.99
319 Incision, excision, and occlusion of vessels 38
320 Incision of vessel: Embolectomy, Thrombectomy 38.0
321 Endarterectomy. Endarterectomy with: Embolectomy, patch graft 38.1
temporary bypass during procedure. Thrombectomy
322 Diagnostic procedures on blood vessels 38.2
323 Biopsy of blood vessel 38.21
324 Percutaneous angioscopy 38.22
325 Spektroskopi intra vaskular* 38.23
326 Imaging koroner intra vaskular dengan optikal koherens tomografi* 38.24
327 Imaging non koroner intra vaskular dengan optikalkoherens tomografi* 38.25
328 Insersi sensor tekanan implantabel tanpa lead untukmonitoring 38.26
hemodinamik intra kardiak dan pembuluh darah besar*
329 Other diagnostic procedures on blood vessels 38.29
330 Resection of vessel with anastomosis. Angiectomy 38.3
Excision of: aneurysm (arteriovenous) with anastomosis blood vessel
(lesion) with anastomosis
331 Resection of vessel with replacement. Angiectomy. Excision of: 38.4
aneurysm (arteriovenous) or blood vessel (lesion) with replacement.
Partial resection with replacement
332 Ligation and stripping of varicose veins 38.5
333 Other excision of vessel. Excision of blood vessel (lesion) NOS 38.6
334 Interruption of the vena cava. Insertion of implant or sieve in vena cava. 38.7
Ligation of vena cava (inferior) (superior). Plication of vena cava
335 Other surgical occlusion of vessels. Clamping of blood vessel. Division 38.8
of blood vessel. Ligation of blood vessel. Occlusion of blood vessel
336 Puncture of vessel 38.9
337 Arterial catheterization 38.91
338 Umbilical vein catheterization 38.92
339 Venous catheterization, not elsewhere classified 38.93
340 Venous cutdown 38.94
341 Kateterisasi vena untuk dialisa ginjal 38.95

342 Pemasangan kateter vena sentral dengan tuntunan: EKG, fluoroskopi, 38.97
ultrasound
343 Penusukan arteri lainnya 38.98
344 Flebotomi 38.99
345 Other operations on vessels 39
346 Systemic to pulmonary artery shunt. Descending aorta-pulmonary artery 39.0
anastomosis (graft)
Left to right anastomosis (graft). Subclavian-pulmonary anastomosis
(graft)
347 Shunt Vena Intra Abdominal (portocavaJ, mesocaval, portal ~- vena cava 39.1
inferior)
348 Other shunt or vascular bypass 39.2
349 Caval-pulmonary artery anastomosis 39.21
350 Aorta-subclavian-carotid bypass. Bypass (arterial): aorta to carotid and 39.22
brachial, aorta to subclavian and carotid, carotid to subclavian
351 Other intrathoracic vascular shunt or bypass. Intrathoracic (arterial) 39.23
bypass graft NOS
352 Aorta-renal bypass 39.24
353 Aorta-iliac-femoral bypass. Bypass: Aortofemoral, Aortoiliac, aortoihac 39.25
to popliteal, Aortopopliteal, iliofemoral [iliac-femoral]
354 Other intra-abdominal vascular shunt or bypass. Bypass: Aortoceliac, 39.26
aortic-superior mesenteric
common hepatic-common iliac-renal. Intra-abdominal arterial bypass
graft NOS
355 Arteriovenostomy for renal dialysis. Anastomosis for renal dialysis, 39.27
Formation of (peripheral) arteriovenous fistula for renal [kidney]
dialysis
356 Extracranial-intracranial (EC-IC) vascular bypass 39.28
357 Other (peripheral) vascular shunt or bypass. Bypass (graft): axillary- 39.29
brachial, axillary-femoral [axiliofemoral] (superficial), Brachial, femoral-
femoral, Femoroperoneal, femoropopliteal (arteries), femorotibial
(anterior) (posterior), Popliteal, vascular NOS
358 Suture of vessel. Repair of laceration of blood vessel 39.3
359 Suture of unspecified blood vessel 39.30
360 Suture of artery 39.31
361 Suture of vein 39.32
362 Revision of vascular procedure 39.4
363 Control of hemorrhage following vascular surgery 39.41
364 Revision of arteriovenous shunt for renal dialysis. Conversion of renal 39.42
dialysis: end-to-end anastomosis to end-to-side, end-to-side anastomosis
to end-to-end, vessel-to-vessel cannula to arteriovenous shunt. Removal
of old arteriovenous shunt and creation of new shunt
365 Removal of arteriovenous shunt for renal dialysis 39.43
366 Other revision of vascular procedure. Declotting (graft). Revision of: 39.49
anastomosis of blood vessel
vascular procedure (previous)
367 Other repair of vessels 39.5

NO JENIS TINDAKAN
368 Angioplasty or atherectomy of other non-coronary vessel(s). Percutaneous
transluminal angioplasty (PTA) of non-coronary vessels: Lower extremity
vessels, Mesenteric artery. Renal artery. Upper extremity vessels. Code
also any: injection or infusion of thrombolytic agent (99.10), Insertion
of non-coronary stent(s) or stent grafts(s) (39.90), percutaneous insertion
of carotid artery stent(s) (00.63), number of vascular stents inserted
(00.45-00.48), number of vessels treated (00.40-00.43), procedure on
vessel bifurcation (00.44)
369 Clipping of aneurysm
370 Other repair o f aneurysm. Repair o f aneurysm by: Coagulation,
Electrocoagulation, Filipuncture, methyl methacrylate. Suture, Wiring,
Wrapping
371 Repair of arteriovenous fistula. Embolization of carotid cavernous fistula.
Repair of arteriovenous fistula by: Clipping, Coagulation, ligation and
division
372 Re-entry operation (aorta). Fenestration o f dissecting aneurysm of
thoracic aorta
373 Reimplantation of aberrant renal vessel
374 Repair of blood vessel with tissue patch graft
375 Repair of blood vessel with synthetic patch grai^
376 Repair of blood vessel with unspecified type of patch graft
377 Other repair of vessel. Aorticopulmonary window operation. Arterioplasty
NOS. Construction of venous valves (peripheral). Plication of vein
(peripheral). Reimplantation of artery
378 Extracorporeal circulation and procedures auxiliary to heart surgery
379 Extracorporeal circulation auxiliary to open heart surgery. Artificial heart
and lung. Cardiopulmonary bypass. Pump oxygenator
380 Hypothermia (systemic) incidental to open heart surgery
381 Cardioplegia. Arrest: Anoxic, Circulatory
382 Intraoperative cardiac pacemaker.
Temporary pacemaker used during and immediately following cardiac
surgery
383 Extracorporeal membrane oxygenation [ECMO]
384 Percutaneous cardiopulmonary bypass. Closed chest
385 Endovascular repair of vessel. Endoluminal repair
386 Endovascular implantation of graft in abdominal aorta. Endovascular
repair of abdominal aortic aneurysm with graft. Stent graft(s)
387 Endovascular repair or occlusion of head and neck vessels. Coil
embolization or occlusion
Endograft(s). Endovascular graft(s). Liquid tissue adhesive (glue)
embolization or occlusion
Other implant or substance for repair, embolization or occlusion that for
repair of aneurysm, arteriovenous malformation[AVM] or fistula
388 Endovascular implantation of graft in thoracic aorta. Endograft(s).
Endovascular graft(s). Endovascular repair of defect of thoracic aorta
with graft(s) or device(s). Stent graft(s) or device(s) that for repair of
aneurysm, dissection, or injury

389 Endovascular removal of obstruction from head and neck vessel(s). 39.74
Endovascular embolectomy
Endovascular thrombectomy of pre-cerebral and cerebral vessels.
Mechanical embolectomy or thrombectomy
390 Other endovascular repair ( o f aneurysm) o f other vessels. Coil 39.79
embolization or occlusion. Endograft(s), Endovascular graft(s). Liquid
tissue adhesive (glue) embolization or occlusion.
Other implant or substance for repair, embolization or occlusion
391 Operations on carotid body and other vascular bodies. Chemodectomy. 39.8
Denervation of: aortic body, carotid body, Glomectomy, carotid.
Implantation into carotid body: electronic stimulator.
Pacemaker
392 Other operations on vessels 39.9
393 Insertion of non-drug-eluting peripheral vessel stent(s). Bare stent(s), 39.90
Bonded stent(s). Drug-coated stent(s), i.e., heparin coated, Endograft(s),
Endovascular graft(s). Endovascular recanalization techniques. Stent
graft(s)
394 Freeing of vessel. Dissection and freeing of adherent tissue: artery-vein- 39.91
nerve bundle, vascular bundle
395 Injection of sclerosing agent into vein 39.92
396 Insertion of vessel-to-vessel cannula. Formation of: arteriovenous: fistula 39.93
by external cannula,
shunt by external cannula. Code also any renal dialysis (39.95)
397 Replacement of vessel-to-vessel cannula. Revision of vessel-to-vessel 39.94
cannula
398 Hemodialysis. Artificial kidney. Hemodiafiltration. Hemofiltration. Renal 39.95
dialysis
399 Total body perfusion. Code also substance perfused (99.21 -99.29) 39.96
400 Other perfusion. Perfusion NOS. Perfiision, local [regional] of: carotid 39.97
artery, coronary artery. Head, lower limb, Neck, upper limb
401 Control of hemorrhage, not otherwise specified. Angiotripsy. Control of 39.98
postoperative hemorrhage NOS. Venotripsy
402 Other operations on vessels 39.99
403 Operations on lymphatic system 40
404 Incision of lymphatic structures 40.0
405 Diagnostic procedures on lymphatic structures 40.1
406 Biopsy of lymphatic structure 40/11
407 Other diagnostic procedures on lymphatic structures 40.19
408 Simple excision of lymphatic structure 40.2
409 Excision of deep cervical lymph node 40.21
410 Excision of internal mammary lymph node • 40.22
411 Eksisi limf node aksiler 40.23
412 Eksisi limf node inguinal 40.24
413 Simple excision of other lymphatic structure. Excision of: cystic hygroma, 40.29
lymphangioma. Simple lymphadenectomy
414 Regional lymph node excision. Extended regional lymph node excision. 40.3
Regional lymph node excision with excision of lymphatic drainage area
including skin, subcutaneous tissue, and fat
to - Berita Acara PP H B T K V I dan PP I K A B I I 129

415 Eksisi radikal limf node leher*. Reseksi limf node servikal hingga otot 40.4
dan fasia dalam
416 Diseksi leher radikal 40.40
417 Diseksi leher radikal, unilat 40.41
418 Diseksi leher radikal, bilat 40.42
419 Radical excision of other lymph nodes 40.5
420 Radical excision of lymph nodes, not otherwise specified. Radical 40.50
(lymph) node dissection NOS
421 Radical excision of axillary lymph nodes 40.51
422 Radical excision of periaortic lymph nodes 40.52
423 Radical excision of iliac lymph nodes 40.53
424 Radical groin dissection 40.54
425 Radical excision of other lymph nodes 40.59
426 Operations on thoracic duct 40.6
427 Carmulation of thoracic duct 40.61
428 Fistulization of thoracic duct 40.62
429 Closure of fistula of thoracic duct 40.63
430 Ligation of thoracic duct 40.64
431 Other operations on thoracic duct 40.69
432 Other operations on lymphatic structures. Anastomosis o f peripheral 40.9
lymphatics. Dilation of peripheral lymphatics. Ligation of peripheral
lymphatics. Obliteration of peripheral lymphatics
Reconstruction of peripheral lymphatics. Repair of peripheral lymphatics.
Transplantation of peripheral lymphatics. Correction of lymphedema of
limb, NOS
433 Operations on bone marrow and spleen 41
434 Operasi Pada Esofagus (Servikal dan Torakal) 42
435 Esofagotomi 42.0
436 Insisi Web esofagus 42.01
437 Insisi lain - lain pada esofagus (Unclasified) 42.09
438 Esofagostomi 42.1
439 Esofagostomi (unclasified) 42.10
440 Esofagostomi Servikal 42.11
441 Eksteriorasi kantong esofagus 42.12
442 Esofagostomi Torakal 42.19
443 Prosedur diagnostik pada esofagus 42.2
444 Esofagoskopi operatif melalui insisi 42.21
445 Esofagoskopi melalui stoma artifisial 42.22
446 Esofagoskopi lain - lain 42.23
447 Biopsi tertutup esofagus (endoskopik) 42.24
Sikatan atau cuci spesimen, esofagoskopi dengan biopsi, biopsi hisapan
pada esofagus
448 Biopsi esofagus terbuka 42.25
449 Prosedur diagnostik lain pada esofagus 42.29
450 Eksisi lokal/destruksi lesi pada esofagus 42.3
451 Eksisi divertikulum esofagus 42.31
452 Eksisi lokal pada lesi atau jaringan lain pada esofagus 42.32 . j.

453 Eksisi atau destruksi pada lesi atau jaringan pada esofagus secara 42.33
endoskopik
Pendekatan endoskopik pada: ablasi neoplasma esofagus, kontrol -^f-
perdarahan esofagus, polipektomi esofagus, varisesesofagus, injeksi
varises esofagus
454 Destruksi lesi atau jaringan lain - lain pada esofagus 42.39
455 Esofagektomi Parsial 42.41
456 Esofagektomi Total 42.42
457 Rekonstruksi (anastomosis) esofagus intratorakal 42.5
458 Rekonstruksi (anastomosis) esofagus antesternal 42.6
459 Esofagomiotomi 42.7
460 Insersi Tube Permanen Esofagus 42.81
461 Repair laserasi esofagus 42.82
462 Tutup esofagostomi 42.83
463 Repair fistula esofagus 42.84
464 Repair striktur esofagus 42.85
465 Repair hernia diafragma trans torasik 53.8
466 Repair hernia diafragma melalui torakotomi, repair hernia diafragma 53.80
torako abdominal
467 Plikasi difragma 53.81
468 Repair hernia para sternal 53.82
469 Repair hernia diafragma laparoskopik, approach toraks 53.83
470 Repair terbuka lainnya pada hernia diafragma melalui toraks 53.84
471 Amputasi ekstemitas atas, Amputasi ekstemitas bawah 84.0, 84.1
472 Ganglion simpatektomi 05.2
473 Lumbal Simpatektomi 05.23
474 Peri arterial Simpatektomi 05.25
475 Torakal simpatektomi 05.29
476 Injeksi bahan neurolitik pada nervus simpatikus 05.32
477 Lain - lain
478 Ultrasound Terapetik 00.0
479 Ultrasound Terapetik untuk pembuluh darah kepala & leher. Ultrasound 00.01
anti restenotik. Ultrasound intra vaskular nonablatif
480 Ultrasound Terapetik untuk jantung. Ultrasound anti restenotik. 00.02
Ultrasound intra vaskular non ablatif
481 Ultrasound Terapetik untuk pembuluh darah perifer. Ultrasound anti 00.03
restenotik. Ultrasound intra vaskular non ablatif
482 Obat-obatan* 00.1
483 Pemberian Nitric Oxide Inhalasi 00.12
484 Injeksi atau infus antibiotik kelas oksazolidinon (Linezolid) 00.14
485 Terapi bertekanan pada graft bypass dengan bahan farmokologis 00.16
486 Pemberian obat - obat vasopresor 00.17
487 Imaging Pembuluh darah intra vaskular. USG endo vaskular. USG intra 00.2
vaskular. Imaging pembuluh darah intra vaskular dengan USG
488 Imaging intra vaskular pembuluh darah cerebral ekstra kranial, Pembuluh 00.21
darah karotis komunis dan cabangnya. USG intra vaskular, pembuluh
darah cerebral ekstra kranial

NO JENIS TINDAKAN
489 Imaging intra vaskular pembuluh darah intra toraks, aorta dan arkus aorta.
USG intra vaskular, pembuluh darahintra toraks, vena kava superior dan
inferior
490 Imaging intra vaskular pembuluh darah perifer. Imaging pembuluh darah
tangan, kaki. USG intra vaskular pembuluh darah perifer
491 Imaging intra vaskular pembuluh darah koroner. USG intra vaskular,
pembuluh darah koroner
492 Imaging intra vaskular pembuluh darah renal. U S G intra vaskular,
pembuluh darah renal, arteri renalis
493 Imaging intra vaskular pembuluh darah, spesifikasi lain
494 Imaging intra vaskular pembuluh darah, tidak terspesifikasi
495 Pembedahan dengan bantuan komputer
496 Prosedur sistem vaskular (selain koroner)
497 Prosedur pada satu pembuluh darah
498 Prosedur pada dua pembuluh darah
499 Prosedur pada tiga pembuluh darah
500 Prosedur pada empat atau lebih pembuluh darah
501 Prosedur pada pembuluh darah bifurkasio
502 Insersi satu sten vaskular
503 Insersi dua sten vaskular
504 Insersi tiga sten vaskular
505 Insersi empat atau lebih sten vaskular
506 Prosedur kardiovaskular lainnya
507 Impiantasi pacemaker resinkronisasi jantung tanpa defibrilasi,total sistem
(CRT-P). Pacemaker biventrikuier. Pacing biventrikuler tanpa delibrilator
jantung internal
508 Impiantasi defibrilator jantung. resinkronisasi, total sistem (CRT-
D). BiV defibrilator Biventrikuler defibrilator. Pacing biventrikuler
dengan defibrilator jantung internal, BiV ICD, BiV pacemaker dengan
defibrilator
509 Impiantasi atau penggantian elektroda transvenus ke dalamsistem vena
koroner ventrikel kiri
510 Impiantasi atau penggantian pacemaker Resinkronisasi jantung, hanya
perangkat generator (CRT-P). Impiantasi perangkat CRT-P dengan
pengangkatan perangkat pacemaker CRT-P lainnya.
511 Impiantasi atau penggantian defibrilator resinkronisasi jantung, hanya
perangkat generator (CRT-D). Impiantasi perangkat CRT-D dengan
pengangkatan perangkatpacemaker CRT-D lainnya
512 Insersi drug eluting stent pada pembuluh darah perifer Endograft, graft
endovaskular, stent Graft
513 Insersi atau penggantian sensor tekanan implantable untuk
monitoringhemodinamik intra kardiak
514 Impiantasi atau penggantian perangkat subkutan untuk monitoring
hemodinamik intra kardiak
Impiantasi alat monitoring dengan bentukan kantung subkutan dan
koneksinya dengan sensor tekanan intra kardiak
515 Prosedur pada pembuluh darah
516 Angioplasti perkutan atau atherektomi pembuluh darah precerebral
(ekstra kranial)Basilar, Carotid, Vertebral

517 Insersi sten arteri karotis perkutan. Termasuk perangkat proteksi emboli, 00.63
perangkat proteksi distal, filter atau sistem pemasangan sten, non drug
eluting sten
518 Insersi perkutan sten arteri precerebral (ekstra kranial) lainnya. 00.64
Termasuk perangkat proteksi emboli, perangkat proteksi distal, filter atau
sistem pemasangan sten, non drug eluting sten pada basilar, vertebral
519 USG Diagnostik 88.7
520 USG diagnostik pada jantung. Ekokardiografi, TEE 88.72
521 USG diagnostik pada tempat lain pada Toraks. USG arkus aorta, USG 88.73
paru
522 USG sistem vaskular perifer. USGDVT, Mapping varises 88.77
523 Injeksi atau inflis bahan terapetik dan profilaksis lain 99.2
524 Injeksi antibiotik 99.21
525 Injeksi anti infektifyang lain 99.22
526 Insersi Chemoport (Port A Catheter) 3B.93

PERHIMPUNAN D O K T E R S P E S I A L I S B E D A H INDONESIA
IKABI
Jl. Kramat Raya 160. Jakarta Pjsat 1O430. Telp & Fax, 021 - 3916774

Periode 2012-2014
BERITA ACARA
Pfwan PgrtimtMnflan
Prof. Dr Sjamsuhidajal. SpB SpB-KBD
Dr. Soerarso Hardjowasito, SpB SpBTKV Yang bertanda tangan dibawah ini
Itajelis Etik t Pwawhal Nama : Dr Asrofi S. Surachman, SpBP-RE, MARS
Prol. Dr. Muchlis Ramli. SpB(K)-Onk
Jabatan : Ketua PERAPI
Ketua Prwidium
Prol. DR. Dr. Paul Tahalele, SpB.SpBTKV Periode 2012-2015
WakilKeluafltetuaTBrpilih
Dr. R. Sjhartono, SpBKBV
Menyerahkan 1 berkas naskah asii daftar kewenangan klinis profesi PERAPI
Prof DR Or. Sunaryo Hardjo*idjolo, Spfl SpU
kepada:
Ketua Pum«
Prof. DR. Dr. Siwandi Sugandi, SpQ SpU

KibitJKIBI Jabatan : Sekretaris Jenderal IKABI
Prol. Dr. Errol U. Hulagalur)g. SpB SpOT Periode 2012-2014
Preiidium
Dr Unp Murledio. SpB PGD Pal Med. ECU
Dr. Rizal Pohan, SpB SpOT Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis
Or Sonar Soni Panigoro, SpB K.Onk
Dr Patriot Muslim, SpU Bedah Indonesia.
Dr. R Suhartono. SpBKBV
Dr. Setyowidi Nugroho, SpB SpBS
Dr Nurhayat Usman, SpB KBD Jakarta,
Dr Maizjl Anwar SpB TKV
Dr. bhandono Dachlan. Msc. SpB, 5p6P-RE(K) 11 Februari 2013
Sekretarii Jenderal
Dr. Drm Dannadiaja. SpB MARS
tm^m
Dr, Agung Prasmono. SpB SpBTKV.MARS
Bfioilitiaca
Dr Balian Sutedja. SpB
Komlel OrflanlMti. Leîslasi dan Advokwl Dr Asrofi S. Surachman, SpBP-RE, MARS Dr. DjoniiDarmadjaja, SpB.MARS
Dr HN Nazar. SpB
Dr Cnandra Svaras. SpB Ketua PERAPI KAI
Sekjen IKABI
Komtol Pfofeel Bedah. Aiuntwi dan
PtrMJaKan
Dr Era*an Wiradisuna, SpB K8D
Dr InztaArbi, SpB
Komlil Gtobalitati A Pa»ar Beba»

Or dr Fathema D Rachmat. SpB SpBTKV
Or Hunlal Simamora. SpBP-RE
KomitI KomjnIkatI dan Pul>ll>tati

DR. Dr Yefta Munadjai. SpB SpBP-RE(K)
Prof. DR. Dr. Sn Maliawan, SpBS (K)
Dr. Iskandar Budianta. SpB SpBA
KomitI Hubjngan Dalam Meêfi

Prof. DR. Dr AndiAsadul Islam, SpBS
Dr BoyVe Sumantri, SpU
Dr Emir T Pasaribu SpB Onk
Komlel Paiayanan Ambulance 118

Dr. ZA Isma. SpB
Or Agi Satna, SpB KBD
KomttI Trauma
DR Dr Achmad Hidayat. SpB
DrB Sunoko. SpB
DR. Dr Triwahyu Mumi, SpB SpBTKV

DAFTAR KOMPETENSI
DAN
KEWENANGAN KLINIS
DOKTER SPESIALIS BEDAH PLASTIK

REKONSTRUKSI DAN E S T E T I K
(PERAPI)
137
DAFTAR KOMPETENSI DAN KEWENANGAN K L I N I S
D O K T E R SPESIALIS BEDAH P L A S T I K REKONSTRUKSI DAN E S T E T I K
I PERAPI ]
NO PROSEDUR I C D 9-CM
PEMBEKALAN TINDAKAN DASAR
1 Preparasi Luka 86.71
2 Menjahit Luka- — Fascia (83.65), hand (82.46), skin (86.59)
3 Photograpy
4 Membaca Imaging Radiologi
5 EKG 89.52
6 Trakeostomi 31.1
7 Fasciotomi/Escharotomi 83.14, 86.22
8 Eksisi Lesi/Tumor
9 Anestesi Ringan, Anestesi Local (Blok,lnfiltrasi
Tumescent
10 Tindakan Emergency dan ATLS
11 Pembedahan Minor
12 Skleroterapi-Kemoterapi ^ 39.92, 99.25
13 Injeksi Kortikosteroid :^ '
14 Biopsi Jaringan
GRAFTING/TANDUR JARINGAN
15 Split -Thickness Skin Grafting 86.69
16 Full-Thickness Skin Grafting 86.63
17 Composite Graft
18 Graft (Kulit, Fat, Fascia, Tendon, Saraf, Otot, Kartilago, 86.69, 86.89, 83.82, 83.81, 04.5, 83.82,
Tulang) 78.00
KULIT DAN JARINGAN LUNAK
19 Eksisi Parut 86.3 (skin)
20 Release Contracture 86.84
21 W-plasty 86.89
22 Z-Plasty With excision (86,3),without excision
(86.84)
23 Penanganan parut non Bedah
24 Mengelola Luka Bakar Fase Akut Debridement + skin graft (86.28+86.6)
25 Mengelola Luka Bakar Fase Sub Akut Debridement + skin graft (86.28+86.6)
26 Mengelola Luka Bakar Fase lanjut Debridement + skin graft (86.28+86.6)
27 Mengelola Trauma Inhalasi
28 FlapAcak
29 Flap axial
30 Flap Bebas
31 Tes vitalitas Jaringan
32 Mengelola Avulsi /Degloving
33 Debridement/Eksisi Tangantial (ET)
34 Wound Management (Luka Akut dan Kronik)
35 Penanganan Trauma Jaringan Lunak
36 Penanganan Infeksi Jaringan Lunak
37 Pengelolaan Ulcus Decubitus
38 Penanganan Operatif/ Non Operatif Congenital/Naevi
t l - PERAPI I 139
LESI JINAK DAN LESI GANAS KULIT & MUKOSA DAN JARINGAN LUNAK
39 Ekstirpasi, Eksisi Wide Eksisi 86.3
40 Rekonstruksi pasca Ablasi Tumor 86.89
41 Deseksi Kelenjar (Inguinal. Aksila, Leher)
KELAINAN KONGENITAL PEMBULUH DARAH HEMANGIOMA DAN MALFORMASI
VASKULER
42 Terapi Non Bedah,Eksisi dan Rekonstruksi Non bedah: sclerotherapy (39.92),
embolisasi (38.82). Bedah: 86.3/86.89
KRANIOFACIAL
43 Debridement dan Rekonstruksi Trauma jaringan lunak 86.28 + 86.89
44 Reposisi dan Fiksasi Temporo Mandibular Joint 76.5
Reposisi dan Fiksasi (Wiring Arch bar,Mini Plate and
45 Screw) Fraktur Mandibula 76.75 (closed), 76.76 (open)
Reposisi Bone Graft dan Fiksasi Wiring,Arch bar,Mini
46 Plate and Screw (Fraktur Maksila) 76.73 (closed), 76.74 (open)
Reposisi dan Fiksasi Nasal (Splinting,Mini Plate and
47 Screw,Tampon) Fraktur Nasal 21.71 (closed), 21.72 (open)
48 Penanganan non Bedah Fraktur Zygoma
49 Reposisi Bone Graft dan Fiksasi Wiring,Arch bar,Mini 76.71 (closed)
Plate and Screw (Fraktur Zygoma) 76.72 (open)
50 Reposisi Bone Graft dan Fiksasi (Wiring, Arch bar.
Mini Plate, and Screw) Fraktur Naso-Orbito-Etmoidalis
(NOE) 76.78 (closed), 76.79 (open)
51 Reposisi Bone-Cartilage Graft. Mesh Plate, Polyctilene,

Nylon Sheet dan Fikasasi (Wiring, Mini Plate, and Screw)
76.78 (closed), 76.79 (open)
Fraktur Dasar Orbita
52 Reposisi Fiksasi Fraktur Procesus Alveolaris
53 Reposisi Fiksasi Fraktur Nasofrontal
54 Rekonstruksi Fraktur Lama
55 Kranioplasti 02.0
56 Reposisi Fiksasi Fraktur Sinus Frontalis
57 Reposisi Fiksasi Fraktur Orbita
58 Osteotomi Fronto-Orbita
59 Distraksi Osteogenesis
60 Pembedahan Kraniosinostosis dan Disostosis
61 Cranial Vault Remodelling
62 Pembedahan Orthognatik
63 Koreksi Hipertelorisme Orbita
64 Koreksi Meningoensefalokel
65 Pembedahan TM Joint 76.5
66 Pembedahan Trauma Kraniomaksilofasial
67 Rekonstruksi Telinga
68 Rekonstruksi Kelopak Mata, Socket, Duktus
Nasolakrimal
69 Pembedahan Nyeri Kepala Migraine
KELAINAN KRANIOFACIAL KONGENITAL

70 Rekonstruksi Bertahap Kraniosynostosis 02.06, with flap (02.03), with graft
(02.04)
71 Rekonstruksi Ensefalokel Frontalis dan Nasofrontalis

72 Rekonstruksi Hemifacial Microsomia Excisi skin tag (18.29)
Commisuroplasty (35.10)
Mandibular distraksi ()
Bone graft (78.00)
Free flap untuk augmentasi soft tissue ()
Osteotomy maxilla LF 1 (76.65)
Rekonstruksi Makrostomia dan Microstomia
Rekonstruksi Craniofacial Cleft
Pembedahan Organik Retrognatia, Prognatia, Macrognatia,
dan Micrognatia
Labioplasty 27.54
Palatoplasty 27.6
Alveolar Bone Graft 78.00
Pharingoplasty (With Silastic Implant; 29.4. For Cleft
palate: 27.62)
Revisi Labioplasti
Labiorhinoplasty
Tutup Fistel Palatoplasty
Osteotomi Le Fort 1,11, III 76.65
Pembedahan Hemifasial Mikrosomia
Rekonstruksi Kraniofasial Cleft
86 Eksisi & Rekonstruksi Tumor

87 Tumor Tulang Wajah
88 Tumor Perlu Rekonstruksi
89 Maxilektomi 76.39
90 Reseksi Mandibula, Mandibulektomi 76.31 (partial), 76.42 (total)
91 Condilektomi dan Coronoidektomi 77.8
92 Salivary Gland Disorder
MATA
93 Eksisi dan Jahit Primer/ Flap Xanlelasma
94 Pembebasan Ektropion dan Skin Graft /Flap 08.69
95 Koreksi Palpebra Superior dengan Skin Graft atau Flap
pada Lagoftalmus
96 Koreksi Ptosis Palpebra
HIDUNG
97 Koreksi Deformitas dan Rekonstruksi Hidung Akibat 21.83
Trauma. Pasca Ablasi Tumor dan Kelainan Kongenitai
TELINGA
98 Eksplorasi dan Fistulektomi Preauricular Synus and Cyst (Eksplorasi middle ear: 20.23)
(Fistulectomy middle ear: 19.9. drum:
19.4)
99 Rekonstruksi Congenital and Acquired Absence o f (external auricle: 18.71. external auditory
Earlobe canal/meatus: 18.6. ossicles: 19.3.
prominent/protruding: 18.5)
100 Eksisi dan Jahit Primer Tragus Ascsorius
101 Rekonstruksi Makrotia dan Microtia/Anotia
102 Rekonstruksi/Otoplasty Stahl's Ears. Prominent Ear. Otoplasty: external (18.79). auditory canal
Constricted Ear. or meatus (18.6). auricles (18.9). cartilage
(18.79). prominent or protruding (18.5).
103 Labuloplasty Labuloskizis
11 - PERAPI I 141
104 Replantasi Amputasi Telinga Traumatic 18.72
PAYUDARA/BREAST SURGERY
105 Reduksi Pay udara Gigantomastia Unilateral (85.31). bilateral (85.32).
106 Rekonstruksi Amasia dan Pembuatan Puling Atelia Breast-total (85.7), repair nipple (85.87)
107 Koreksi Ginekomastia 85.31 (unilateral), 85.32 (bilateral)
108 Bedah Onkoplastik
109 Congenital and Breast Disorder
110 Pembedahan Asimetrik & Profilaktik Payudara
111 Rekonstruksi Payudara Breast-total (85.7), repair nipple (85.87)
112 Eksisi Mammae Abberans dan Politelia 85.24
GENITALIA EKSTERNA
113 Release Chordee Hipospadia 64.42
114 Urethroplasty Hipospadia 58.49
115 Rekonstruksi Urethra Epispadia 58.46
116 Rekonstruksi Short Urethra. Buried Penis. Genitalia 58.46, 64.44
Ambigu
117 Revaskularisasi dan Replantasi Amputasi Penis Replantasi penis (64.45)
Traumatik
118 Vaginoplasty Atresia Vaginalis 70.79
119 Sirkumsisi Laki-laki (64.0). wanita (71.4).
120 Rekonstruksi Genetalia 64.43 (penis), 70.61 (vagina)
EKSTREMITAS
121 Revakularisasi, replantasi. Rekonstruksi dan Repair Stump Replantasi extremity (84.29). ankle (84.27).
Amputasi Ekstremitas arm (84.24). finger (84.22). thumb/leg
(84.21). foot (84.26) forcearm/hand/wrist
(84.23). thigh (84.28). toe (84.25)
122 Penanganan non Operatif Limfedema Excisi (40.29)
123 Penanganan Paronikia dan Nailplasty Ingrowing Nail
124 Amputasi 84.07 (above elbow), 84.17 (above knee),
84.15 (below knee)
125 Bone Graft 78.00
126 Rekonstruksi Lesi Pleksus Brakhialis Traumatika/
Obstetrikal
127 Rekonstruksi Kaki, Ankle, Kruris, 81.47 (knee)
128 Rekonstruksi Extremitas Atas
129 Rekonstruksi Pasca ablasi tumor
130 Pembedahan Crush Injury dan Traumatic Amputasi
BEDAH TANGAN
131 Repair Tendon Fleksor 82.86
132 Repair Tendon Ekstensor 82.86
133 Penanganan non Bedah Fraktur dan Dislokasi Falang . Casting (for immobilization) (93.53)
Metakarpal dan MCP
134 Percutaneous Wires Fraktur/ Dislokasi Falang. Metacarpal
dan MCP
135 ORIF Fraktur/ Dislokasi Falang Metakarpal dan MCP Phalang: foot (79.18.79.08/79.38.79.
28) Hand(79.04.79.14./79.24.79.34).
metacarpal (79..03.79.13/79.23.79.33).
MCP (79.09.79.19/79.29.79.39
142 I Kewenangan Tindak Medik Dokler Slsesialis Bedah Indonesia

NO PROSEDUR
136 Release Otot Intrinsic. Fleksor synovectomy. Lateral band Release otot (82.11). synovectomy (80.74)
transfer. Artoplasty. antrodesis arthroplasty (81.72). with prostetik
implant (81.71) arthrodesis finger (81.28)
interphalangeal finger (81.28). MCC
(81.26). MCP (81.27)
137 Synovectomy. Dynamic splinting. Pemendekatan ventral 82.11
slip,tenotomy ekstensor,Reposisi lateral Band.Arthroplasty.
Arthrodesis boutonnierre deformity.
138 Penanganan operatif dan Non Operatif Malet Finger
139 Revaskularisasi atau Replantasi Amputasi Jari dan Tangan 84.22, Thumb (84.21)
Traumatik
140 Reparasi Saraf Perifer 04.79
141 Penanganan Operatif dan Non Operatif Carpal Tunnel Release otot (82.11), synovectomy
Syndrome, Trigger Finger.De Quervain's Syndrome (80.74)
Arthroplasty (81.72), with prostetik implan
(81.71)
Arthrodesis finger (81.28), interphalangeal
finger (81.28), MCC (81.26), MCP
(81.27)
142 Rekonstruksi Finger Tip Injury Rhinoplasty tip (21.86)
143 Rekonstruksi Blast Injury Tangan Repair Hand (82.89)
144 Separasi Jari Syndactily 86.85
145 Rekonstruksi (Ligasi/Amputasi) Polydactily Amputasi finger (84.01). thumb (84.02)
146 Reseksi (Debulking) Macrodactily 82.83
147 Penanganan Operatif dan Non OperatifCampodactily
148 Rekonstruksi Jari Clinodactily Osteotomy + pinning (77.34 + 78.54)
149 Rekonstruksi Jari Thumb Hipoplasia 82.69
150 Release Constrintion Band
151 Penanganan Operatif dan Non Operatif Radial Club Hand,
Ulnar Club Hand, Median Claw Hand, Ulnar Claw Hand
152 Penanganan Operatif dan Non Operatif Ganglion
153 Reposisi Fiksasi Fraktur Tangan
154 Artroplasty, Artrodesis Tangan 81.72
155 Repair Tendon 83.88
156 Tendon Transfer 83.75
157 Rekonstruksi Kelainan Kongenitai Tangan
158 Pembedahan Trauma Tangan
159 Transfer Jari 82.61,82.81 (thumb)
160 Infeksi Tangan
161 Nailplasty/Roserplasty
ESTETIK
162 Blepharoplasty 08.70, 08.44
163 Rhinoplasty 21.85
164 Genioplasty 76.68
165 Fat Grafting 86.89
166 Face Lifting
167 Thread Lifting, Filler, Botox, Laser
168 Mammaplasty 85.89
169 Liposuction
170 Abdominoplasty Repair abdominal wall (54.72)
I I - PERAPI I 143
171 Augmentasi/implantasi Silikon Breast: unilateral (85.53), bilateral
(85.54)
Skin for augmentation (86.89)
172 Penanganan Operatif dan Non Operatif Hiperhidrosis
173 Hair Transplant Eyebrow/eyelid (08.63), scalp (86.64)
174 Vaginoplasty, Labiaplasty, Clitoroplasty, Hymenoplasty, Vaginoplasty (70.79)
Release/Separasi Labia, Sinekia Vagina Labiaplasty (27.54)
Clitoroplasty (71.4)
Hymenoplasty (70.76)
Repair Labia/Vulva (71.7)
Repair Vagina (70.5)
175 Transexual 64.5
176 Eksisi, Reduksi Granuloma Silikon
177 Estetik Craniofacial
178 Penggunaan Biomaterial dan Rekayasa Jaringan
179 Pemasangan Implan dan Tissue Expander
180 Bedah Endoplastik
181 Rhinoplasti 21.85
182 Forehead Reju Venation
183 Periorbital Rejuvenation
184 Genioplasty 76.68
185 Malarplasty
186 Neck Rejuvenation
187 Breast Augmentation 85.50
188 Breast Reduction 85.32 (bilateral), 85.31 (unilateral)
189 Body Countering, Lipoplasty, Liposculture, Liposuction
190 Autologus Fat Graft
191 Penyesuaian Kelamin
BEDAH MIKRO
192 Flaps Surgery
193 Bedah Mikrovaskular, Mikroneural, Flap Bebas
194 Replantasi
195 Transplantasi (Jaringan dan Organ)
196 Rekonstruksi Mandibula 76.43
197 Rekonstruksi Maksila-Midface
198 Rekonstruksi Hipopharing
199 Rekonstruksi Bibir dan Mulut 27.59 (mouth)
200 Rekonstruksi Hidung 21.83
201 Rekonstruksi O r b i t a , Kelopak Mata, Duktus 16.89
Nasolakrimalis
202 Rekonstruksi Kalvaria dan Scalp
203 Rekonstruksi Skull Base
204 Rekonstruksi Prostetik - ^ ;
205 Flap Omentum
206 Flap Jejunum
207 Reaminasi Wajah Fasial Paralisis
208 Rekonstruksi Endoplastik
209 Deseksi Kelenjar (inguinal, aksila, leher)
210 Rekonstruksi lidah dan mulut 25.59 + 27.59
211 Rekonstruksi esoftiagus 42.89
212 Rekonstruksi Anal-Perianal 49.79

Lampiran 1
PROFIL PP IKABI
VISI, MISI, NILAI, AZAS DAN TUJUAN IKABI
Visi IKABI
IKABI menjadi organisasi profesi kedokteran Indonesia yang terdepan & terkemuka baik di tingkat Nasional
maupun Intemasional tahun 2014.
Misi IKABI:
1. Mewujudkan tercapainya kesetaraan hasil pendidikan pelatihan dan penelitian Dokter Spesialis Bedah
Indonesia yang memenuhi standar dan dapat bersaing di dalam kancah intemasional.
2. Mewujudkan pelayanan bedah paripuma demi kesejahteraan rakyat Indonesia dan anggota IKABI.
3. Mewujudkan eksistensi profesi dokter spesialis bedah berdasarkan kompetensi masing-masing dan
membangun komunikasi efektif antar anggota IKABI serta kerjasama dengan institusi terkait.
Nilai Budaya Organisasi

Dokter Spesialis Bedah Indonesia memiliki nilai budaya: Kolegialitas untuk kesejahteraan, Profesionalisme,
Pengabdi sepenuh hati, menjunjung Kejujuran, Etis bermoral dan sebagai Teladan (1967, Prof. R. Moenadjat
Wiralmadja: Sutiksna Husada Sudharma Marga, Buku Sejarah Ilmu Bedah Indonesia 2004, modifikasi)
Azas IKABI
Berazaskan Pancasila
Tujuan I K A B I :
1. Memelihara, memupuk, meningkatkan dan mendorong perkembangan Ilmu Bedah dalam arti seluas-luasnya
untuk diamalkkan demi meningkatkan derajat kesehatan masyarakat.
2. Meningkatkan kebersamaan dan pemberdayaan anggota.
12 - Lampiran I 145
Lampiran 2
CONTOH
SURAT PENUGASAN
KESEPAKATAN K L I N I K ( C L I N I C A L APPOINTMENT)
No /SMF 1. Bedah/RS I.J /2013
Yang bertanda tangan di bawah ini Direktur RS :
Nama :
NIR :
setelah melakukan evaluasi bersama Komite Medis RS ,
atas usul Ketua SMF Ilmu Bedah RS yang telah diverifikasi oleh panitia
kredensial, maka diputuskan kepada Staf Medis yang tersebut di bawah ini:
Nama :
NIR :
diberi kewenangan klinis untuk melakukan tindak medik sesuai dengan ketetapan Organisasi Profesi Kedokteran.
(contoh IKABDI) berdasarkan substansi kajian dan tingkat kompetensi Nasional Pendidikan Dokter Spesialis
Bedah yang dikeluarkan oleh Kolegium Ilmu Bedah Indonesia tahun 2012 dan Katalog Pendidikan Ilmu Bedah
Digestif yang dikeluarkan oleh Kolegium Ilmu Bedah Digestif Indonesia tahun 2012. Dokter yang bersangkutan
telah mempunyai pengetahuan dan ketrampilan dalam bidang Ilmu Bedah dan Konsultan Bedah Digestif seperti
dalam daftar terlampir.
Demikian, Surat Pemyataan ini dibuat untuk dilaksanakan secara bertanggungjawab dan berlaku dari tgl-bln-thn
s.d tgl-bln-thn serta di .. (poliklinik, UGD, kamar operasi, dll). Apabila terdapat kekeliruan dalam penetapan
jenis tindak medik ini, akan diperbaiki dikemudian hari.
Surabaya, Maret 2013

Yang membuat kesepakatan Klinik {Clinical Appointment)
Direktur RS Dokter yang bersangkutan
12 - Lampiran I 147
Contoh
KESEPAKATAN KEWENANGAN TINDAK M E D I K

D O K T E R SPESIALIS BEDAH - KONSULTAN BEDAH DIGESTIF
I. Menangani penderita dengan kelainan bedah pada Gastro intestinal Tract

a. Mengegakkan diagnosis penderita dengan cara:
- Melakukan anamnesa dan pemeriksaan fisik yang terarah
Meminta dan menginterpretasi pemeriksaan penunjang (laboratorium, pencitraan, dan biopsi)
b. Memberikan terapi, termasuk merencanakan terapi penunjang
c. Melakukan perawatan pre-operatif dan post-operatif
d. Mendeteksi komplikasi post-operatif dan menanganinya
e. Melakukan follow-up penderita dan KIE pada penderita/keluarga
I I . Melakukan operasi penderita dengan kelainan bedah pada Gastro-intestinal Tract
III. Jenis kasus/kelainan penderita bedah Gastro-intestinal Tract seperti dalam label berikut:
B E D A H UMUM
No Jenis Tindalt Medik Yang disepal(ati
1 : Proktoskopi dan Rekloskopi
2 : Appendektomi terbuka
3 : Fistulotomi dan fislulectomi
4 \ Hemoroidektomi
5 ! Hemiotomi
6 : Splenektomi dan splenorapi pada trauma lien
7 ! Reseksi dan anastomosis usus ^
8 : Eksterioriasi
9 \ Sigmoidostomi
10 i Kolostomi
11 ; Penutupan perforasi usus
12 1 Penanggulangan cedera hepar
13 I Drainase pankreatitis ^
14 i Pankreateklomi distal
15 1 Laparotomi dan torako-laparotomi ? •
16 1 Repair Hernia Diafragmatika
17 ; Gastrostomi
18 : Gastrostomi Parsial
19 ; Gastroenterostomi Pinlas (by Pass) ^
20 i Divertikulektomi Meckel's
21 ! Hemikoleklomi ^
22 : Reseksi Anterior, sigmoidektomi. Low Reseseki ^
Anterior
23 i By pass entera-enterostomi
24 \ Reposisi (milking) pada invaginasi saluran pencemaan
25 : Ileostomi
26 1 Penutupan stoma (tutup kolostomi/ileostomi)
27 1 Appendektomi laparoskopi ^
28 1 Drainase abses apendik

29 1 Abdomino-perineal resection Operasi Miles ^
30 ^ Operasi Hartmann
31 1 Kolesistektomi terbuka
32 \ Kolesistektomi laparoskopik
33 Eksisi luas tumor dinding abdomen pada tumor Demois
i & dinding abdomen
34 ; Adhesiolisis
35 1 Repair burst abdomen
36 i Repair burst abdomen
KONSULTAN BEDAH DIGESTIF

No Jenis Tindak Medik Yang isepakati
UPPER GASTROINTESTINAL
1 1 Oesophageal Surgery
: Oesophagectomy,gastric interposition 1
: Oesophagectomy, colonic interposition 1
; Oesophagectomy, free jejunal graft 1
; Heller procedur (Oesophageal myotomy) 1
1 Oesophageal (Reflux/motility)
: Fundoplication
\ Para-oesophageal Hemia Repair ^
\ Epiphrenic diverticulectomy 1
; Oesophageal myotomy + fiindoplasty 1
: Zenker's diverticulectomy (Open) 1
2 \ Gastric Surgery
Total Gastrectomy (DI node dissection)
Total Gastrectomy (D2 node dissection)
: Distal Gastrectomy (DI node dissection)
Distal Gastrectomy (D2 node dissection)
; Proximal Gastrectomy
{D\ node dissection)
\ Proximal Gastrectomy
; (D2 node dissection)
\ Gastric tumour, Local excision
3 1 Laparoscopy
1 Oesophagectomy
\ Gastrectomy
\ Fundoplication
\ Oesophageal myotomy + ftindoplasty
4 : Endoscopy
Diagnostic Upper GI endoscopy
i Endoscopy with biopsy 1
Therapeutic Upper GI endoscopy
12 - Lampiran I 149
5 i Bariatric Surgery and Other
i Gastric Band (Laparoscopic) 1
! Gastric Band (Removal) ^
\ Gastric Band (Revision) >/
\ Tube Gastrectomy T'

\ (Laparoscopic or Open)
1 Roux en Y Gastric Bypass (laparoscopic) 1
A/' •
i Roux en Y Gastric Bypass (open)
\ Roux en Y Gastric Bypass (revisional) 1
\ Splenectomy ^
i Jejunostomy/Gastrostrostomy
6 1 Adjunctive Thoracic Operations

; Thoracoscopy
: Thoracotomy for gut interposition
\ Conventional right thoracotomy T '
COLORECTAL (lanjutan)
7 \ Colonoscopy/flexible sigmoidoscopy
: Diagnostic colonoscopy
i Colonoscopy and Sigmoidoscopy
i Polypectomy
Colonoscopic decompression of volvulus A/
i or pseudobstruction
i Colonoscopic dilatation and/or metal
i Stent insertion
1 Colonoscopic endomucosal resection of
! Tumour
8 1 Segmental colonic or ileo-colic resection

i Ileocolic resection
i Right hemi colectomy
; Transverse colectomy
i Wedge colon resection
i Left hemi colectomy
i Sigmoid colectomy 1
i Hartmann's resection
9 i Anterior Resection
: Anterior resection of rectum for benign
i and neoplastic disease
1 Rectal resection as part of abdomino-
i perineal resection of rectum

Lampiran 3. ; ^sîi/ii'/ { K V . I H »t I ,L!;t:'3:o
CONTOH (MODIFIKASI) RINCIAN KEWENANGAN K L I N I S
RINCIAN KEWENANGAN KLINIS (CLINICAL PRIVILEGE)
SMF:
RUMAH SAKIT
Nama Dokter: Spesialisasi: Tanda Tangan
Saya menyatakan bahwa saya kompeten untuk menangani kasus-kasus yang saya minta di bidang spesialisasi saya,
termasuk melayani konsultasi dari dokter- dokter lain. Saya juga menyatakan kompeten untuk melakukan tindakan medik
seperti yang tercantum di bawah ini yang merupakan kewenangan klinis (Clinical Privilege) berdasarkan status kesehatan
saya saat ini, pendidikan dan atau pelatihan yang telah saya jalani, serta penâlaman yang saya miliki.
Sertifikasi
Sertifikat/ljazah : Tanggal dikeluarkan : Instansi (tempat ijasah spesialisasi
dikeluarkan):
No. Ijasah Spesialisasi:
Surat Rekomendasi Kolegium Tanggal: Kolegium

No:
Pelatihan (3 tahun lerakhir) 2010 - 2012 Tanggal Institusi
Surat Tanda Registrasi Konsil Kedokteran Indonesia

Spesialisasi : Berlaku Hingga Tanggal
Petunjuk:
Untuk Dokter: Untuk Mitra Bestari:
Tulisan kode untuk dokter menurut permintaan sejawat Mohon melakukan telaah pada setiap kategori dan
sesuai daftar - " Kode untuk Dokter " yang tersedia. Setiap Kewenangan Klinis yang diminta oleh setiap dokter sesuai
kategori yang ada dan atau Kewenangan Klinis yang dengan kode yang tersedia. Cantumkan persetujuan yang
diminta harus tercantum kodenya. Pengisian harus lengkap tersedia. Persetujuan Mitra Bestari kepada Komite Medik
untuk seluruh Kewenangan Klinis yang tercantum. Tanda untuk pemberian penugasan klinis (Clinical Appoinment) dari
tangan dicantumkan pada akhir bagian 1 (Kewenangan Direktur Rumah Sakit Bubuhkan tanda
Klinis). Jika terdapat revisi atau perbaikan. setelah daflar tangan Mitra Bestari pada akhir bagian 11 (rekomendasi Mitra
Kewenangan Klinis ini disetujui, maka harus mengisi Bestari)
kembali formulir yang baru.
Kode Untuk Dokter Kode untuk Mitra Bestari

1. Kompetensi sepenuhnya 1. Disetujui berwenang penuh
2. Memerlukan supervisi 2. Disetujui di bawah supervisi
3. Tidak dimintakan kewenangannya, karena diluar 3. Tidak disetujui, karena bukan kompetensinya
kompetensinya
4. Tidak dimintakan kewenangannya, karena 4. Tidak disetujui, karena fasilitas tidak tersedia
fasilitas tidak tersedia
Tanggal: Mengetahui Ketua SMF
Ketua Peer Group SMF
Tanda Tangan & Nama Terang Tanda Tanjjan & Nama Terang
NIP. NIP
12 - Lampiran I 1
Bagian I. Kewenangan Klinis (Clinical Privilege )
Kategori Kewenangan
Kewenangan Klinis diberikan untuk memberikan pelayanan pengelolaan bidang Bedah
Rekomendasi disetujui oleh

Diminta (yang peer group
Jenis Pelayanan
bersangkutan) Disetujui/Disetujui dengan
Catatan/Tidak Disetujui
Kewenangan Tindak Medik
Bagian 11. Rekomendasi Mitra Bestari
Disetujui: Disetujui dengan Catalan Tidak disetujui
Tanggal:
Catalan:
Daftar Mitra Bestari

No Nama Spesialisasi Tanda Tangan
Bagian I I I . Komite Medlli/Sub Komite Kredensial
Disetujui Disetujui dengan Catatan Tidak Disetujui
Tanggal ;
Catatan: 1
Ketua Komite Medik Ketua Sub-Komite Kredensial
Tanda tangan & Nama Terang Tanda tangan & Nama Terang
NIP NIP

Lampiran 4
CONTOH FORMULIR SARAN, K E L U H A N & LAPORAN PENGADUAN

K E L A L A I A N TINDAK M E D I K
Kepada
Ytii. Pengurus Pusat i K A B I
Gedung Wisma Bhalcti Mulya - lantai 4 - 4 0 1 - C
Jl. Kramat Raya 160 Jakarta Pusat 10430
Telp & Fax. 021 -3916774
Email, ppikabi@yahoo.com, pltahalele@yahoo.com (Ketua), kapuyux@gmail.com (Sekjen),
nazar_finacs@yahoo.co.id (Ketua Komisi Legislasi & Advokasi)
Dengan hormat,
Bersama ini saya sampaikan
Saran :
Keluhan
Laporan pengaduan kelalaian tindak medik:
Data pendukung (bisa dilampirkan secara lengkap):
Data yang mengajukan Saran, Keluhan & Laporan Pengaduan Kelalaian Tindak Medik
Nama :
Alamat pos :
Telp :
HP :
Fax :
Email :
Kedudukan sebagai: pasien/keluarga pasien/dokter/paramedis/
Kola , (tgl^ln/thn)
Materai 6000
Tanda Tangan & Nama Terang
12 - Lampiran I 153

Buku Kewenangan Tindak Medis Dokter Spesialis Bedah Indonesia

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Buku Kewenangan Tindak Medis Dokter Spesialis Bedah Indonesia

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KEWENANGAN TINDAK MEDIK

DOKTER SPESIALIS BEDAH

Tim Editor : Paul L. Tahalele (Ketua)

Penulisan buku ini didasarkan:

Selamat bekerja dan mengabdi

Tim Editor dan (Contributor v

Kata Pengantar vii

Sambutan Ketua Presidium PP IKABI xi

Sambutan Ketua Umum Pengurus Besar Ikatan Dokter Indonesia xii

Sambutan Ketua PERSI xiii

Sambutan Konsil Kedokteran Indonesia xiv

Sambutan Menteri Kesehatan Republik Indonesia xv

Surat Pemyataan Kesepakatan IKABI, Sepuluh OPLB, dan M-KIBI xix

Penyangkalan atau disclaimer 4

Berita Acara PP PABI dan PP IKABI 5

Berita Acara PP IKABDI dan PP IKABI 17

Berita Acara PP PERABOI dan PP IKABI 25

Berita Acara PP PESBEVI dan PP IKABI 37

Berita Acara PP PABOI dan PP IKABI 45

Berita Acara PP I AUi dan PP IKABI 73

Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Urologi (lAUI) 75

Selamat mengabdi dan melayani.

Ketua Presidium PP IKABI

Sambutan Ketua Umum

Salam Sehat Indonesia.

Sambutan Ketua PERSI

Teip. :(021) 31923181, 31923191, 31923193, 31923197. 31923198,Fax.:(021) 31923186

dr. NafsiahlMbUi, Sp.A., M.PH.

Susunan Pengurus PP. IKABI Nomor : 50/PP-IKABI/XI/2012 Jakarta, 27 Oktober 2012

K^tuiPraildlum Kepada Yth.

Prol. Dr. EtTOI U. Hutagalung. SpB SpOT Dengan hormat.

KMIIII globaHsasi & P i w B*b»i

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I xvii

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I X I X

Susunan Pengurus PP. IKABI

Majelis Etik APenaselial

Komisi Globalisasi & Pasar BBIMS

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia B XXI

Susunan Pengurus PP. IKABI

Dr Djoni Darmadjaja, SpB MARS

Dr. Agung Prasmono, SpB SpBTKV.MARS

Dr. Barlian Suledja, Sp8

Komisi Globalisasli Pasar Bebas

Komisi Komunikasi dan Publlkasi

Komisi Hubungan Dalam Negerl

Komisi Pelayanan Ambulance 118

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I xxili

Susunan Pengurus PP IKABI Jakarta, 27 Oktober 2012

WiKIIKilutf<rtuiTtrplllh 1. Ketua PP IKABI Paul Tahalele

Komlii Hubungin Dilam Htgerl

Komisi Pelayanin Amhu^•n^:^ 1 H

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I XXV

Susunan Pengurus PP IKABI Jakarta, 27 Oktober 2012

Wakll Kelua/Ketua Terpllih

Prof. OR. Or Suwandi Sugandi. SpB SpU

Ketua MKIBI PP PERABOI 3 JOM^ S'(fA^i<^i^

Kwnlsl Ofganlsisi. leaislaii dan Advokasi PP PERBANI

Komisi Profeii Bedah. Asuransi dan PP HBTKVI

Komlil Globallsasi A Pilar Bebas

Komisi Komunikasi dan Publikasi

Komlil PetayafMn Ambulanca 118

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I XXVII

Susunan Pengurus PP IKABI

Wakll KetuafKatuaTaroiilh KOLEGIUM ILMU