NO KODE INA-CBG DESKRIPSI KODE INA-CBG KODE Tindakan

ICD-10
1 U-1-10-II PROSEDUR KOMPLEKS LARING
2 U-1-11-II PROSEDU KOMPLEK LEHER DAN KEPALA LAIN-LAIN
3 U-1-11-III PROSEDUR KOMPLEK LEHER DAN KEPALA LAIN-LAIN (BERAT)
DISLOKASI RAHANG
Dislocation of jaw
FRAKTUR WAJAH
Fracture of malar and maxillary bones
Fracture of mandible
Multiple fractures involving skull and facial bones
Fractures of other skull and facial bones
Fractures of skull and facial bones
Fracture of Nasal Bones
Fracture of orbital Floor
3 U-1-12-II PROSEDUR MASTOID DAN SINUS Kanaloplasty/meatoplasty
4 U-1-13-II PROSEDUR KELENJAR LUDAH
5 U-1-14-II OPERASI BIBIR SUMBING & LANGIT-LANGIT MULUT
6 U-1-15-II PROSEDUR TONSIL & ADENOID
7 U-1-20-II PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN
TELINGA LAIN-LAIN
8 U-1-30-II PROSEDUR MULUT
U-2-22-0 Prosedurbesar lain lain pada kepala dan leher
PLASTIK REKONSTRUKSI
Blefaroplasty
Rekonstruksi palpebra superior
Rekonstruksi palpebra inferior
Otoplasti pada makrotia
Aurikuloplastimikrotiatahap 1
Aurikuloplastimikrotiatahap 2
Aurikuloplastimikrotiatahap 3
Aurikuloplastirekonstruksi
Rekonstruksidauntelingaputus
Reseksihidung
Submukosareseksi septum (SMR)
Reduksi fraktur nasal terbuka
Fistulektomi nasolabial/nasofaringeal/oronasal
Rekonstruksi ala nasi
ekstirpasisilikonoma
Ekstirpasi&rekonstruksisilikonoma
Rinoplastirekonstruksi
Rinoplastirevisi
Rinoplastiaugmentasi
Open septorhinoplasty
Septoplasti
Repair perforasi septum hidung
pemasangan Arch bar
Revisi Arch bar
Buka Arch bar
Labioplasti pada celahbibir
Full-thickness skin graft pada bibir dan mulut
LokalFlap pada wajah
Attachment of pedicle or Flap graft pada bibir dan mulut
Palatoplasty
Palatoplasti pada celahpalatum
Revisipalatoplasti pada celahpalatum
Uvuloplasty
Faringoplasti
Osteotomi medialis
Osteotomi paramedial
Osteotomipercutaneus
Rekonstruksi fraktur ramus mandibula
Augmentasi mental
Reduksiterbuka fraktur malar dan zigoma
Rekonstruksi fraktur zygoma
Rekonstruksi malar
Reduksiterbuka fraktur maksila
 Reposisi fraktur osmaksila le Fort 1
Intermaksilarifixation
Reposisi fraktur osmaksila le Fort 2
Reduksiterbuka fraktur mandibula
Rekonstruksi fraktur sympisis mandibula
Rekonstruksi fraktur condylus
Rekonstruksi tripod fraktur
Rekonstruksipanfacial fraktur
Rekonstruksi fraktur palatum durum
Costal graft
Insersiimplansintetik di tulangwajah
STSG
conchal graft
FTSG 86.63 Ritidectomy
Pengangkatanalatfiksasi mandibula
Hectinglukakepalaleher
Pengangkatanalatterapetik di kepalaleher
U-4-10-II NEOPLASMA TELIGA, HIDUNG, MULUT DAN
TENGGOROKAN (SEDANG)
TUMOR JINAK
lip
tongue
floor of mouth
unspecified part of mouth
tonsil
oropharynx
nasopharynx
hypopharynx
parotid gland
sublingual, submandibular glands
middle ear, nasal cavity and accessory sinus
larynx
thymus
 lipomatous
hemangioma
9 U-4-10-III NEOPLASMA TELIGA, HIDUNG, MULUT DAN
TENGGOROKAN (BERAT)
Bibir
Malignant Neoplasm of Lip unspecified inner
aspect
Malignant Neoplasm of Lip unspecified inner
aspect
Carcinoma in situ of Lip Oral Cavity and Pharynx
Carcinoma in situ of Lip Oral Cavity and Pharynx
Benign Neoplasm of Lip

RonggaMulut
Malignant Neoplasm of Base of Tounge

Malignant Neoplasm of Base of Tounge

Malignant Neoplasm of Dorsal Surface of Tounge
Malignant Neoplasm of Border of Tounge
Malignant Neoplasm of Border of Tounge
Malignant Neoplasm of Ventral Surface of
Tounge
Malignant Neoplasm of Anterior 2/3 of Tounge
Malignant Neoplasm of Anterior 2/3 of Tounge
Malignant Neoplasm of Lingual Tonsil
Malignant Neoplasm of Lingual Tonsil
Malignant Neoplasm of Overlapping Sites of
Tounge
Malignant Neoplasm of Tounge, Unspecified
Malignant Neoplasm of Anterior Floor of Mouth
Malignant Neoplasm of Lateral Floor of Mouth
Malignant Neoplasm of Overlapping Sites of Floor
of Mouth
Malignant Neoplasm of Floor of Mouth,
unspecified
Malignant Neoplasm of Hard Palate

Malignant Neoplasm of Hard Palate

Malignant Neoplasm of Soft Palate
Malignant Neoplasm of Soft Palate
Malignant Neoplasm of Uvula
Malignant Neoplasm of Uvula
Malignant Neoplasm of Overlapping Sites of
Palate

Malignant Neoplasm of Palate, unspecified

Malignant Neoplasm of Overlapping Sites of Parts
of Mouth
Malignant Neoplasm of Overlapping Sites of Parts
of Mouth
Malignant Neoplasm of Mouth, unspecified
Malignant Neoplasm of Mouth, unspecified
Carcinoma in situ of Oral Cavity, unspecified site
Carcinoma in situ of Oral Cavity, unspecified site

Benign Neoplasm of Tounge

Benign Neoplasm of Floor of Mouth
Benign Neoplasm of unspecified part of mouth
Benign Neoplasm of others parts of mouth
KelenjarLiur

Malignant Neoplasm of Parotid Gland

Malignant Neoplasm of Submandibular Gland
Malignant Neoplasm of Submandibular Gland
Malignant Neoplasm of Sublingual Gland
Malignant Neoplasm of Sublingual Gland
Malignant Neoplasm of Major Salivary Gland
Malignant Neoplasm of Major Salivary Gland
Benign Neoplasm of Parotid Gland
Benign Neoplasm of Other Major Salivary Gland
Benign Neoplasm of Major Salivary Gland,
unspecified

Orofaring

Malignant Neoplasm of Tonsillar Fossa

Malignant Neoplasm of Tonsillar Pillar (anterior)
Malignant Neoplasm of Overlapping sites of
Tonsil

Malignant Neoplasm of Tonsil, unspecified

Nasofaring

Malignant Neoplasm of Superior Wall of Nasopharynx

Malignant Neoplasm of Posterior Wall of Nasopharynx

 Malignant Neoplasm of Lateral Wall of Nasopharynx

Malignant Neoplasm of Anterior Wall of Nasopharynx

Malignant Neoplasm of Overlapping Sites of Nasopharynx

Malignant Neoplasm of Nasopharynx, unspecified
Benign Neoplasm of Nasopharynx
Benign Neoplasm of Nasopharynx

Hipofaring

Malignant Neoplasm of Pyriform Sinus

Malignant Neoplasm of Postcricoid
Malignant Neoplasm of Aryepiglottic Fold, Hypopharyngeal Aspect

Malignant Neoplasm of Posterior Wall of Hypopharynx

Malignant Neoplasm of Overlapping Sites of Hypopharynx

Malignant Neoplasm of Hypopharynx, unspecified
Benign Neoplasm of Hypopharynx
Benign Neoplasm of Hypopharynx

Oesophagus

Malignant Neoplasm of Upper 1/3 of Oesophagus

Carcinoma in Situ of Oesophagus
Benign Neoplasm of Esophagus
Sinonasal

Malignant Neoplasm of Nasal Cavity

Malignant Neoplasm of Nasal Cavity

Malignant Neoplasm of Maxillary Sinus

Malignant Neoplasm of Maxillary Sinus
Malignant Neoplasm of Ethmoidal Sinus
Malignant Neoplasm of Frontal Sinus
Malignant Neoplasm of Sphenoid Sinus

Malignant Neoplasm of Overlapping Sites of Accessory Sinuses

Malignant Neoplasm of Accessory Sinus, unspecified

Laring

Malignant Neoplasm of Glottis

Malignant Neoplasm of Glottis

Malignant Neoplasm of Glottis

Malignant Neoplasm of Supraglottis
Malignant Neoplasm of Supraglottis

Malignant Neoplasm of Supraglottis

Malignant Neoplasm of Subglottis
Malignant Neoplasm of Subglottis
 Malignant Neoplasm of Subglottis
Malignant Neoplasm of Laryngeal Cartilage
Malignant Neoplasm of Laryngeal Cartilage

Malignant Neoplasm of Laryngeal Cartilage

Malignant Neoplasm of Overlapping Sites of Larynx

Malignant Neoplasm of Overlapping Sites of Larynx

Malignant Neoplasm of Overlapping Sites of Larynx

Malignant Neoplasm of Larynx, unspecified
Malignant Neoplasm of Larynx, unspecified

Malignant Neoplasm of Larynx, unspecified

Trakeobronkial

Malignant Neoplasm of Trachea

Malignant Neoplasm of unspecified Main

Bronchus

Carcinoma in situ of Trachea

Carcinoma in situ of unspecified bronchus

Benign Neoplasm of Trachea

 Benign Neoplasm of unspecified Bronchus

KulitKepalaLeher

Malignant Neoplasm of Connective and Soft Tissue of Head, face, and Neck

Carcinoma in situ of Skin of other and unspecified parts of face

Hemangioma of Skin and Subcutaneous Tissue

Thyroid Gland

Malignant Neoplasm of Thyroid Gland

Carcinoma in situ of Thyroid and other endocrine
glands
Benign Neoplasm of Thyroid Gland

LIMFOMA

Hodgkin lymphoma
Follicular lymphoma
Non Follicular lymphoma
Mature T/NK-cell lymphoma
Non Hodgin Lymphoma

Leher

Benign Neoplasm of Lymph Nodes

 Malignant Neoplasm of Lymp Nodes

10 U-4-11-II DYSEQUILIBRIUM Sudden deafness

11 U-4-12-II EPISTAKSIS/PERDARAHAN HIDUNG
12 U-4-13-II PERADANGAN EPIGLOTIS, TELINGA TENGAH, ISPA
DAN LARINGOTRAKEITIS
13 U-4-14-II PENYAKIT MULUT DAN GIGI
14 U-4-15-II PENYAKIT TELINGA, HIDUNG, MULUT DAN TENGGOROKAN LAIN-LAIN
Herpes zoster dengankomplikasi, OMK dengankomplikasi

15 U-2-10-0 PROSEDUR BESAR PADA LARING

16 U-2-11-0 PROSEDUR BESAR LAIN-LAIN PADA KEPALA & LEHER
17 U-2-12-0 PROSEDUR PADA SINUS & MASTOID
18 U-2-13-0 PROSEDUR KELENJAR LUDAH
19 U-2-14-0 PROSEDUR OPERASI BIBIR SUMBING & LANGIT-LANGIT MULUT
20 U-2-15-0 PROSEDUR OPERASI TONSIL & AMANDEL
21 U-2-21-0 PROSEDUR BESAR PADA TELINGA, HIDUNG, MULUT DAN TENGGOROKAN
Ekstraksikolesteatomaext
Ekstraksi jar. Granulasi
Insisipseudokista/hematoma
Insisiabsespreaurikular
Jahittelingaluar
Biopsitelingaluar
Biopsitelingatengah
patch/fat miringoplasty
Insisiabsesretroaurikular
CRT
VRT

22 U-2-22-0 PROSEDUR SEDANG PADA TELINGA, HIDUNG, MULUT DAN TENGGOROKAN

Ekstraksibendaasingtelinga
Angkatjahitan
pelepasan grommet
Injeksiintratimpani
Tindiktelinga

23 U-2-23-0 RHINOPLASTY
24 U-2-24-0 PROSEDUR KECIL PADA HIDUNG
25 U-2-25-0 PROSEDUR PADA TELINGA TENGAH
26 U-2-31-0 PROSEDUR BESAR PADA MULUT DAN LIDAH
27 U-2-32-0 PROSEDUR KECIL PADA MULUT DAN LIDAH
28 U-3-10-0 PROSEDUR SEDANG LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN TENGGOROKAN
29 U-3-11-0 PROSEDUR KECIL LAIN-LAIN PADA TELINGA, HIDUNG, MULUT, DAN TENGGOROKAN
Irigasi/ekstraksiserumen
Tampon telinga
Cuciluka
30 U-3-12-0
31 U-3-13-0 PROSEDUR DIAGNOSTIK LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN
OAE
BOA
VRA
COR
CPA
BERA
ASSR
Fitting ABD
Mapping koklea implant
Endoskopitelinga
Mikroskopitelingaluar
Mikroskopitelingatengah
ECoG
Enog
32 U-3-14-0 PROSEDUR TES FUNGSI PADA TELINGA, HIDUNG, MULUT DAN TENGGOROKAN
Tespenala
Tesberbisik
Teskalori
Tes Dix hallpike
Audiometri
Timpanometri
Refleksakustik
Tes ETF
SISI
ABLB
Tone Decay
Refleks decay
Audiometritutur

33 U-3-15-0 PROSEDUR LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN TENGGOROKAN

34 U-3-16-0 PROSEDUR PADA GIGI
35 U-5- RAWAT JALAN BUKAN PROSEDUR
Serumen Prop
Benda AsingTelinga
OE sirkumkripta
Otomikosis
KolesteatomaEksterna
Granuloma telinga
OE Maligna
OE Difusa
Barotrauma
Pseudokista/hematoma
Sinus/absespreaurikular
OMSK benignatenang
OME kronik
OME Adhesiva
Absesretroaurikular
Tinitus
Parese n. fasialis
BPPV
Vertigo perifer
Delayed speech
Gang. Pendengaran Sensorineural
Congenital hearing loss
Presbikusis
Noise Induced hearing loss
Sudden deafness
Herpes zoster
Ramsay Hunt Syndrome
Neuroma Akustik
Stenosis CAE
Eksostosis CAE
OME kronik
OMSK Benignatenang
OMSK Maligna
OMSK benignaaktif
Pasca op. mastoid
Absesretroaurikular
Fistula retroaurikula
Paresis fasialis
Timpanosklerosis
Otosklerosis
Gang. TulangPendengaran
Trauma telinga
Trauma n. fasialis
Tuba patoulus
Sinus preaurikular
TumorJinaktelingatengah
TumorJinakliangtelinga
Tumorganastelinga
Pseudokista/hematoma
OMA
Tindiktelinga
Otalgia
Eksostosisliangtelinga
Oklusi Tuba
Tuba Patulous
OMSK TBC
MiringitisAkut
MiringitisKronik
Caulifrlower ear
Perikondritis
Mikrotia
KSS Telinga KSS Telinga
Basalioma