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TABEL MANFAAT PEMBEDAHAN

SURGERY BENEFIT TABLE

Lampiran I
Appendix I
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Pembedahan Klasifikasi Pembedahan Klasifikasi


SEC. A. GENERAL SURGICAL OPERATION Tongue
1. HEAD and NECK Diathermy to growth of tongue (or mouth) Kecil
Arteries Epithelioma of tongue with radical operation on Besar
glands
Carotic aneurysm Kompleks Glossectomy Besar
Carotid endarterectomy Kompleks Partial glossectomy Sedang
Carotid body tumour Kompleks 2. BREAST
Operation on the carotid, subclavian or vertebral Besar Excision of cyst or benign tumour or segmental Sedang
arteries resection
Gynaecomastia (male) – Unilateral Sedang
Bilateral Besar
Check Incision and drainage of abcess Kecil
Cyst benign tumour of cheek (or mouth) Kecil Microchodectomy Sedang
Radical operation for malignant growth of cheek Besar Mastectomy with breast reconstruction Sedang
Submucour cyst Kecil Partial removal of breast Sedang
Jaws- See Section F. Oral Surgical Operations Removal of breast tissue for biopsy
by drill biopsy or needle Kecil
otherwise Sedang
Reconstruction involving latissimus dorst flap Besar
Lips Total removal of breast Besar
Cyst or benign tumour of lip, excision of Kecil
Resection of lip with excision of glands Besar 3. ABDOMEN and PELVIS
Wedge resection of the lip for malignancy Sedang Abdominal Wall and Peritoneum
Wedge resection of the lip for malignancy with Besar Division of adhesions Besar
repair – by Abbe-estlander flap
Drainage of abdominal abscess Besar
Neck Drainage of pelvic abscess (per rectum) Sedang
Block dissection of lymph glands of neck Besar Drainage of subphrenic abscess (transperitioneal or Besar
transthoracic)
Brachial cyst or pouch, excision of Sedang Exploratory laparotomy Besar
Brachial fistula, excision of Besar Laparoscopy/peritoneoscopy Sedang
Cervical rib, or Scalenus Anticus Syndrome Besar Paracentesis abdominis Kecil
Curettage of tuberculous caseous glands or Kecil Repair or injury (penetrating wound) Besar
sinuses
Excision of cyst or tuberculous glands of neck – Sedang Secondary suture of abdominal wall Sedang
(deep to deep fascia)
Thyroglossal cyst, excision of Sedang Adrenal glands
Thyroglossal fistula, excision of Besar Adrenalectomy Besar
Bilateral Besar
Palate Excision of phaeochromocytoma Besar
Cleft palate repair (or other plastic repair) Besar
Excision or diathermy for leucoplakia Sedang Arteries and Veins
Palatal fenestration for malignancy Sedang Adrenalectomy Besar
Radical operation for malignant growth of palate Besar Any operation on :
Aorta Khusus
Parathyroid Glands Iliac arteries Besar
Operation for tumour or other disorders Besar Arterial disobliteration Besar
Bilateral Besar
Salivary Glands Arterial graft insertion Besar
Abcess of salivary gland : incision and drainage Kecil Aortic bifurcation graft Besar
Dilation of parotid or submandibular duct Kecil Arteriectomy Sedang
Excision of parotid tumour Besar Arteriectomy (including embolectomy) Sedang
Bilateral Besar
Excision of submandibular salivary gland Sedang Embolisation of vessels Sedang
Parotidectomy (superficial or total, with Besar Inferior Vena Cava, ligation Besar
preservation of facial nerve)
Repair of fistula of salivary duct Besar Intra-arterical injection Kecil
Salivary calculus, removal of Sedang Ligation of major vessels Sedang
Sialography Kecil Meso-cava anastomosis Besar
Stricture of duct, excision Sedang Other vascular by-pass procedures (including Khusus
unruptured aortic aneurysm)
Thyroid Gland Phenol block Sedang
Ligation of thyroid arteries Besar Portacaval anastomosis Khusus
Thyroidectomy (all forms including partial, subtotal, Besar Ruptured aortic aneurysm Besar
radical or hemi)
Thyroid nodule excision Sedang Splenorenal anastomosis Khusus

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Pembedahan Klasifikasi Pembedahan Klasifikasi
Biliary Tract Penetrating abdominal wound, involving laparotomy, Besar
with multiple visceral or vascular injuries
Gall Bladder and Bile Ducts Plastic repair of anal canal Besar
Anastomosis of gall bladder or bile ducts, including Besar Prolapse of rectum (partial) Sedang
cholecysttenterotomy
Cholecystectomy Besar Rectal or sigmoid polyp
Drainage of gall bladder Besar Biopsy Kecil
Removal by operating sigmoidoscope Besar
Exploration of common bile duct, biliary fistula, etc. Besar Rectal fistula, closure or repair Sedang
Operation on Sphincter of Oddi involving Besar Recto-vagina or vesical fistula Besar
laparotomy
Operation on Sphincter of Oddi by duodenoscope Sedang Sigmoidoscopy Kecil
Operation on extract stone from CBD by Sedang Stricture of rectum, dilation of Volvulus Kecil
duodenoscope
Residual stone extraction from CBD way of T tube Sedang Stomach and Duodenum
in situ
Any duodenal operation including
Closure of perforated ulcer Besar
Liver Duodenectomy Besar
Excision of duodenal diverticulum Besar
Hepatic artery, ligation and perfusion of liver Besar Any gastric operation including
Hydatid of liver, marsulialisation or other operation Besar Abdomino-thoracic Khusus
Liver abscess, incision and drainage Besar Antrectomy Besar
Liver transplant (Refer) Khusus Closure of perforated ulcer Besar
Needle biopsy of liver Kecil Gastrectomy (all forms) Khusus
Partial hepatectomy or resection Khusus Gastroenterostomy and vagotomy Besar
Gastrostomy Besar
Gastrointestinal Tract Oesophagogastrostomy Khusus
Appendix Pylorectomy Besar
Any operation for acute appendicitis (including Besar Pyloroplasty and vagotomy Besar
appendicectomy or drainage of appendix abscess)
Interval appendicectomy Sedang Ramstedt’s operation Besar
Transaction, Devone’s operation Besar
Jejunum and Ileum Selective vagotomy, etc Besar
Any operation involving intestinal suture including : Gastroscopy Kecil
Resection and anastomosis Besar Duodenoscopy Kecil
Jejunostomy Besar
Ileostomy Besar Hernia
Ileosigmoidostomy Besar Complicated hernia (strangulated, irreducible, or Besar
Ilecolostomy Besar repair including fascial graft, at any site)
Closure of faecal fistula Besar Diaphramagtic or hiatus hernia (abdominal or Besar
Enterotomy Besar thoracic)
Intestinal Obstruction (including Intussusception) Besar Other abdominal herniae (paraduodenal, obturator, Besar
sciatic, perneal, lumbar or other)
Large Intestine Recurrent hernia Besar
Anal fissure dilation of anus for Kecil Simple hernia (inguinal, fermoral, umbilical, ventral, Sedang
Anal fissure, radical operation for Sedang paraumbilical incsional or fatty pigastric)
Anal warts or papillae, removal of Kecil
Caecostomy Besar Male Genital tract
Closure of caecostomy or colostomy Sedang Penis
Complicated fistula Besar Amputation of penis (partial or total) Besar
Colectomy (all forms including hemicolectomy) Besar Ciscumcision (if patients ages under 12 months- Sedang
Colonoscopy Sedang minor)
Colotomy Besar Dorsal incision of prepuce Kecil
Colostomy Besar Maetotomy Sedang
Complicated fistula Besar Penile splint insertion
Diverculitis Besar Solid splint Sedang
Epithelioma of anus, excision of Besar Inflatable splint Besar
Excision of rectum : all forms including :
Abdominoperineal Khusus Prostate
Perineoabdominal Khusus Abscess of prostate Sedang
Perineal Khusus Prostatectomy, all forms including Freyer’s, Millin’s Besar
Anterior resection Besar Perineal and Transurethral
Combines synchoronous Khusus Prostatectomy (total sometimes for early carcinoma) Khusus
Fistula in ano, excition Sedang
Haemorrhoidectomy Sedang Spermatic Cord
Haemorrhoids, non-operative treatment Kecil Tosion of testicle
High para-rectal fistula Besar Unilateral Sedang
Imperforate anus – depends on staging but usually Besar Bilateral fixation Besar
Ischiorectal abscess, incision and drainage Kecil Varicocele Sedang
Laparotomy with colostomy Besar Epididymo-vasotomies Sedang
Pan procto-colectomy Khusus

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Pembedahan Klasifikasi Pembedahan Klasifikasi
Testicle Renal transplant Khusus
Epididymectomy Sedang Urethra
Hydrocele, radical operation Sedang Meatotomy Besar
Hydocele (tapping) Kecil Plastic operation on urethra Besar
Imperfectly descended testicle Sedang Rupture of urethra
Orchidectomy Sedang Stricture
Bilateral Besar Urethroplasty Besar
Orchidopexy Sedang Internal urethrotomy Besar
Bilateral Besar Urethral dilation Kecil
Spermatocele or spermatic cyst Sedang Vaginal urethroplasty Besar

Pancreas 4. LIMBS
Pancreatectomy Khusus Arteries
Pseudopancreatic cyst drainage Besar Aneurysm repair Besar
Aortic bifurcation graft Khusus
Spleen Arterial bypass operation Besar
Splenectomy Besar Arterial disobliteration Besar
Splenic puncture Sedang Arterial graft insertion Besar
Arteriectomy Sedang
Urinary Tract Arteriovenousfistula, correction Sedang
Bladder Arteriography Sedang
Cystectomy Arteriotomy (including embolectomy) Besar
Partial Besar Embolisation of vessels Sedang
Total Khusus Intra-arterial Injection Kecil
Cystectomy with construction of intestinal conduit Khusus Ligation of Inferior Vena Cava Besar
or baldder
Cystoscopy with intravesical operation Sedang Ligation of major vessels Sedang
Diathermy to bladder tumour Sedang Major vascular bypass in replacement surgery Khusus
Diverticulum of bladder Besar (other then Heart or Coronary arteries)
Electrical implant Sedang Phenol Block (in intermittent claudication) Sedang
Implatation of radium or Radon Seeds in bladder Besar
Litholapaxy Besar Lymphatics
Plastic operation on bladder Besar Block dissection of axillary or inguinal lymph nodes Besar
Resection of bladder neck (TUR) Sedang Incision of abscess of axillary or inguinal lymph Kecil
Open Besar nodes
Rupture of bladder Besar Lymphography Kecil
Sling procedures (including Marshall-Marchetti Besar
Krantz Colposuspension)
Suprapublic cystostomy Sedang Muscles
Vesicocolic or suprapubic fistula Besar Manipulation and stretching of muscle Kecil
Myectomy Kecil
Investigations Repair and suture of muscle Sedang
Cystoscopy Kecil
Cystoscopy and Meatotomy Sedang Merves
Cystoscopy with ureteric catheterization including Sedang Local excision of neuroma Sedang
Retrograde Phylography Primary nerve repairs Sedang
Cystoscopy (including extreme intravesical Besar Secondary nerve suture (including grafting and Besar
Procedures)
Cystometry Kecil anastomosis)
Ureteroscopy Sedang
Urethroscopy Kecil Symphatetic Nervous System
Lumbar ganglion block Sedang
Ureter Sympathectomy (including any operation on the Besar
Any operation on ureter including Symphathetic Trunks)
Closure of ureteric fistula Besar Sympathectomy-chemical Sedang
Transplantation of ureter Khusus
Ureterolithotomy Besar Tendons
Kidney De Quervain’s syndrome Sedang
Any operation on kidney including Incision of tendon sheath Sedang
Division of aberrant vessels Besar Primary tendon repairs Sedang
Nephrectomy Besar Repair of complicated tendon injuries Besar
Nephrolithotomy Besar Tendon transplantation Sedang
Pyelolithotomy Besar Tenotomy Kecil
Pyeloplasty Besar Tendon grafting Besar
Pyelotomy Besar
Exploration and drainage of perinephric tissues Besar Veins
Use of artificial kidney Besar Varicose Veins (one leg) – ligation or stripping Sedang
Nephro-ureterectomy Sedang Both legs Besar
ESWL Sedang Compression sclerotherapy (Fegan method) Kecil
Nephrotomy Besar Bilateral Sedang
Percutaneous nephrolithotomy Besar
Partial nephrectomy Besar Formation of AV shunt for dialysis Sedang

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Pembedahan Klasifikasi Pembedahan Klasifikasi
5. SKIN and SUBCUTANEOUS TISSUES Aural toilet under general anaesthesia including Kecil
Acanthoma Kecil removal polyp
Extensive Sedang Excision of lesion or external ear Sedang
Any condition treated by surgical diathermy Kecil Excision of pinna Sedang
under general anaesthetic other than mouth or Eustachio catheterization Kecil
tongue or bladder Facial nerve decompression Besar
Aspiration of abscess, Cyst or tumour Kecil Grommet insertion Sedang
Burns and sclads, treatment under anaesthesia Sedang Incision of external ear Kecil
Carbon dioxide snow application Kecil Mastoidectomy – simple or radical Besar
Corns, excision of Kecil Meatoplasty Sedang
Curretage of wounds and sinuses Kecil Myringotomy (Bilateral) Kecil
Dermabrasion Kecil Opertion for complications of suppurative otitis Besar
Excision of keloid other scar Kecil Media (including lateral sinus thrombosis)
Excision of simple tumours: (including lipomas) Kecil Operation on the temporal bone (exclusive of emple Besar
of skin or subcutaneous tisuess mastoidectomy)
Free graft Kecil Operation for the ultrasonic treatment of Meniere’s Besar
Implantation of radium or of radon seeds for Kecil Disease
treatment of skin tumour Operation for complication of CSOM Besar
Incision and drainage or removal or foreign body Kecil Otoscopy ( including removal foreign body) Kecil
Liquid nitrogen application Kecil Plastic operation on the ear Besar
Laser skin application Sedang Preauricular sinus Sedang
Malignant melanoma : radical operation Besar Pinnaplasty Sedang
Naevi (except inserve case) Kecil Reconstuction of Pinna Besar
Pilonidal sinus or Cyst Sedang Removal of adenoids and or tonsil with myringotomy Sedang
Plastic operations requiring tube graft Sedang and Grommet insertion
Removal of needles from hand or foot or elsewhere Kecil Total petrosectomyl Besar
When deep Sedang
Rodent ulcer not involving eye or bane Sedang Nose and Accessory Sinuses
Sebaceous cyst, excition of Kecil Antral puncture (Antrotomy) Kecil
Skin biopsy Kecil Antral wash out Kecil
Skin grafting (Theirsch, split, skin) Sedang Antrostomy Sedang
Suture or excision and suture of wounds Kecil Aspiration of accessory sinuses Kecil
Transplantation of skin flaps Sedang Closure of oral-anral fissure
By modified apicedomy approach Sedang
6. THE HAND By Caldwell Luc approach Besar
Dupuytren’s Contracture (all cases) Besar Dacryocystorhinostomy Besar
Ganglion of hand Sedang Ethmoidectomy Transantral
Nail : Avulsion Kecil Internal Sedang
Nail : radical operation for removal Sedang External Besar
Trigger finger Sedang Extensive operative treatment of malignat disease Besar
Whitlow : incision and drainage Kecil Frontral sinuses – obliteration by osteoplastic flap Besar
Hypophysectomy (by any route) Khusus
7. MISCELLANEOUS Intubation or inflation of Eutachian Tube Kecil
Blood transfution (grouping and expenses of donor Kecil Maxillectomy or major excision Besar
extra) Nasal bone : Reduction of recent fracture Kecil
Electrical counter shock or defibrillation Kecil Nose of fascial bones : Reduction of langstanding Sedang
Epidural injection Kecil fracture
Examination under anaesthetic Kecil Nose : Incision, Packing, Cauterization Kecil
Implantation of radium or seeds in cranium, chest, Besar Open operation on Accessory Sinuses (including Besar
abdomen, or bladder Caldwell Luc)
Implantation of radium or radon seeds except Sedang Operative treatment of malignant disease involving Sedang
where specified as MAJOR or MINOR skin and face only
Intraperitoneal or intrapleural injection of cytotoxic Kecil Rhinoplasty Besar
drug-or a course of cytotoxic injections Rhinoscopy (including removal of foreign body or Kecil
Replacement transfusion Sedang Polyp)
Temporal artery biopsy Kecil Septoplasty Sedang
Sphenoidectomy Sedang
SEC. B. EAR, NOSE & THROAT OPERATIONS Simple removal of nasal polyp Kecil
Ear Submucous resection of nasal septum Sedang
Any operation on the inner ear including Turbinectomy Kecil
Acoustic neuroma Khusus Turbinate-Cautery, diathermy, cryotherapy Kecil
Cochlear impant Khusus Throat – Larinx and Pharynx Kecil
Labyrinthectomy Besar Adenoidectomy Kecil
Labyrinthotomy Besar Bronchoscopy (including laryngoscopy) Sedang
Saccus decompression Besar Cricopharyngeal myotomy Besar
Any Operation on the middle ear and contents incl. Diathermy treatment of pharyngeal pouch Sedang
Excision of Ossicles Besar Epiglottopexy Besar
Fenestration Besar Examination of Nasopharynx or Pharynx under – Kecil
Mobilisation of Stapes Sedang general anaesthesia and or bopsy
Stapedectomy Besar Excision of submandibular calculus Kecil
FESS Besar

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Pembedahan Klasifikasi Pembedahan Klasifikasi
Excision of Papilloma or cyst of Larynx Sedang Excision of Bartholin’s or Skene’s Gland Sedang
Excision of pharyngeal puch or diverticulum Besar Excision of simple cyst or tumours of the vulva Besar
Direct of Laryngoscopy/Microlaryngoscopy and Sedang Excision of simple cyst or tumours of the vagina Sedang
biopsy and removal of papilloma Enterocele repair (hernia of pouch of Douglas) Sedang
Oesophageal Bouginage under anaethesia Sedang Examination under general anaethesia (in isolation) Kecil
Oesophagoscopy Sedang Fenton’s procedure Sedang
Laryngectomy Besar Gaillard Thomas operation Besar
Laryngosfissure Besar Hymenotomy Kecil
Lateral Pharyngectomy Besar Marsupialisation of Bartholin’s cyst Sedang
Pharyngectomy Khusus Pelvic floor repair Besar
Pharyngolaryngectomy Khusus Procidentia, repair Besar
Opening of Quinsies Kecil Prolapse and hernia through vaginal vault, repair Besar
Palatal fenestration Sedang Radical excision of vulva and glands Khusus
Parotidectomy Besar Relief of atresia vaginae (including dilatation of Khusus
Parotidectomy with preservation of facial nerve Besar vulva and vagina)
Plastic operation on pharynx Besar Removal of caruncle Kecil
Removal of tonsil and adenoids Sedang Repair of vaginal fistulae Besar
Retropharyngeal abscess : incision and drainage Sedang Stress incontinence, operation for, and pelvic floor Besar
(internal pharyngotomy) repair
Removal of foreign body from larynx and pharynx Kecil Urethral Prolapse Sedang
Submadibular gland excision Sedang Vaginal hysterectomy Besar
Teflon injection into vocal cord Sedang Vulva and perineum : plastic repair Besar
Tracheotomy, Tracheostomy or Laryngotomy Sedang Vulvectomy (simple) Besar

SEC. C. GYNAECOLOGICAL OPERATIONS SEC. D. NEUROSURGICAL OPERATIONS


Cervix Brain and Meninges
Amputation of cervix Sedang Crainotomy for :
Cauterisation of cervix Kecil Brain abscess Khusus
Colposcopy (with or without cervical biopsy) Kecil Brain tumour (cerebral glioma) and excision Khusus
Cone biopsy of cervix of cervix Sedang Brain tumour (cerebral glioma) and biopsy Besar
Plastic operation on cervix Sedang Aneurysm or vascular malformation Khusus
Removal of cervical polyp Kecil Meningioma Khusus
Repair or laceration Sedang Pituitary Gland (hypophysis) including Ytrium Rod Khusus
insertion
Uterus and Adnexa Posterior fossa craniectomy for aneurysm, acoustic Khusus
Alexander Adam’s operation Besar neuroma trigeminal Rhizotomy, ther cranical
Bilateral Oophorectomy Besar nerve rhizotornies
Biopsy of endometrium Kecil
Cyst of broad ligament, excision of Besar Burr hole for :
Dilation and/or curettage Kecil Abscess Besar
Dilation with intrauterine operation (including Sedang Tumour biopsy Besar
therapeutic curettage) Ventricular tap Besar
Drainage of tubo-ovarian abscess (per vaginam) Sedang Cisternal puncture Kecil
Drainage of tubo-ovarian abscess (per abdomen) Besar Lumbar puncture Kecil
Gilliam’s operation Besar Hydrocephalus
Hysterectomy (subtotal, total or Wertheim,s) Besar - Shunt Besar
Hysterosalpingogram Kecil - Revision of shunt Sedang
Hysterotomy Besar
Induction of radiation menopause Kecil Crania Nerves
Laparoscopy Sedang Hypoglosso-facial anastomosis Besar
Marshall Marchetti’s operation Besar Injection or coagulation of Gasserian Ganglion Sedang
Myomectomy Besar Operation on Trigeminal nerve root (middle fossa Besar
Ovarian cyst, excision of Besar approach)
Ovariotomy, oophorectomy (involving laparotomy) Besar Perpheral neurectomy of the infra-orbital nerve, Sedang
Pelvic excenteration Khusus the lingual nerve, or the inferior dental nerve at
Progesterone implant Kecil the mental foramen
Salpingectomy or Salpingostomy (bilateral) Besar
Salpingography Sedang Scalp
Ventrosuspension by Gilliam’s operation Besar Suture of laceration Kecil

Vulvovaginal Skull
Abscess of Bartholin’s or Skene’s Gland, incision Kecil Cranioplasty Besar
and drainage Operation for fractured skull including compound Khusus
Anterior and posterior colpoperineorrhaphy Besar and depressed fracture
Anterior and posterior colporraphy with amputation Besar
of cervix (Manchester or Fothergill operation) Spinal or Cauda Equina
Anterior and posterior colporraphy Besar Any operation on spinal Cord, Cauda Equina or
Any vaginal operation combined with coeliotomy Besar Sipnal Meninges including :
Baldy Webster operation Besar Corotomy Khusus
Cauterisation of cervix Kecil Decompression of Spinal Cord or Cauda Equina Khusus
Colporrhaphy and/or rectocele (repair) Besar Exploration of Spinal Cord or Cauda Equina Khusus

5
Pembedahan Klasifikasi Pembedahan Klasifikasi
with removal lesion Lacrimal Apparatus
Spinal Meningioma or Neurofibroma Khusus
Cloward’s Procedure for cord or nerve root Khusus Denervation of lacrimal glands Besar
decompression Lacrimal abscess Sedang
Decompression of Spinal Nerve Root for disc Lacrimal duct, exploration or dilation Kecil
lesions : Lacrimal gland, excision Besar
Cervical Khusus Lacrimal sac, excision Sedang
Thoracic Besar Lacrimal sac, incision Kecil
Lumbo-sacral Besar Dacryoscystorhinostomy Besar
Epidural injection Kecil With canaliculoplasty Besar
Percutabeous spinal cordotomy Besar
Rhizotomy Besar Lens
Spinal Stenosis (degenerative, cervical or lumbar) Khusus Capsulotomy by discussion Kecil
Spondylolisthesis Besar Capsulotomy by laser Sedang
Spina bifida cystica Besar Dislocated lens Besar
Occulta Discission of lens Besar
- Extradural Sedang Extraction of lens Besar
- Intradural Khusus Extraction of acrylic lens Kecil
Extraction of senile cataract Besar
Neuro – Radiological Procedures With lens implant Besar
Air encephalography Sedang Needling of juvenile cataract Besar
Cerebral angiography Sedang Needling of lens capsule after senile cataract Kecil
Cisternal/cervical myelography Sedang Secondary lens insetion Besar
Lumbar readiculography Kecil
Spina manipulation under general anaethesia Sedang Orbit
Venticulography Sedang Decompression of orbit Besar
Excision of Basalioma Sedang
SEC. E. OPTHALMIC OPERATIONS Excenteration of orbit Besar
Conjunctiva Exploration of orbit, during biopsy Sedang
Conjunctivoplasty Kecil Injection into retrobulbar or retro-ocular space Kecil
Excision of conjunctival lesion Kecil Orbital abscess, incision and drainage Sedang
Removal of foreign body from conjunctiva Kecil Radon or Cobal application for neoplasm Besar
Removal of foreign body from orbit Besar
Cornea Removal tumour from orbit Besar
Application of radio-active strontium for neo Sedang
vascularisation Retina
Corneal grafting Besar Detachment of retina Besar
Corneal tattoing Sedang Fluorescence Angiography Kecil
Corneal ulcer, cauterization Kecil Laser coagulation
Conjunctival flap of cornea Sedang - Simple application Sedang
Paracentesis Sedang - Several application Besar
Removal of foreign body from cornea Kecil Prophylactic cryotheraphy Sedang
Removal of foreign body from sclera Kecil Retina detachment with vitreos surgery Khusus
Radiotheraphy for other superficial corneal lesion, Sedang Vitrectomy Besar
e.g. recurrent erosions
Radial Keratotomy Sedang SEC. F. ORAL SURGICAL OPERATION
Jaws
Eyelids Bimaxillary osteotomy Besar
Blepharoplasty (eyelid reconstruction) Besar Coronoidectomy Besar
Chalazion Kecil Excision or resection of maxilla Besar
Ectropion / Entropion (simple correction) Kecil Excision or resection of mandible Besar
Ectropion / Entropion (plastic correction) Sedang Mandibular osteotomy for prognathism Besar
Epilation (INTER when many) Besar Maxillary oseteotomy Besar
Epicanthus (plastic procedure) Kecil Mandibular or maxillary resection for malignancy Khusus
Excision of Pterygium Sedang Mandibular or maxillary fractures open reduction - Besar
Injury to eyelid, suturing (depending on extent) Kecil with direct wiring or pining, or plating
Papiloma of eyelid Kecil Mandibular or maxillary fractures involving alveolus Kecil
Removal of superficial dermoid Sedang Mandibular, zygomatic or other maxillary fractures Sedang
Tarsorrhaphy Sedang Open operation involving the Temporo-Mandibular Besar
joint
Globe
Any operation for glaucoma (trabeculectomy, Besar SEC. G. ORTHOPAEDIC OPERATIONS
Peripheral iridectomy, sclerectomy, sclerostomy, Amputation and Disarticulations
sclerotomy, Scheie’s operations) Ankle joint Besar
Evisceration of eye Besar Arm Besar
Enucleation or eye Besar Digits (thumbs, fingers, or toes) Sedang
Removal of intraocular foreign body Besar Elbow joint Besar
Forearm Besar
Iris Hindquarter Khusus
Iridectomy, Iridotomy Besar Hip joint Besar
Iridoplasty Besar Interscapulathoracic Khusus
Irido-cyclectomy Besar Knee joint (all form) Besar

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Pembedahan Klasifikasi Pembedahan Klasifikasi
Leg Besar Psoas release (in osteo arthritis of hip) Sedang
Metacarpalphalangeal joint Sedang Tarsectomy of triple arthroadesis Besar
Shoulder joint Sedang
Syme’s Amputation Sedang Nerves
Thigh Sedang Anastomosis of nerve Besar
Tarsotarsal or tarsometatarsal (all form) Besar Primary nerve repairs Besar
Wrist joint Besar Secondary nerve sutures Besar

Bones Spine
Application of POP casts (with or without Kecil Clowards operation (decompression of spine Khusus
Anaesthesia) Discogram Sedang
Closed reduction and fixation of fractures Sedang Dwyer’s operation Khusus
(including joints or shafts of large bones e.g. Enzyme discolysis Besar
Colles and Potts Fractures) Excision of cocoyx Sedang
Closed reduction of fractures with bone traction Sedang Fracture of fracture dislocation of spine :
Excision of exostoses Besar traction or reduction and cast
Large Exostoses around knee Besar Harrington Rod Procedure Khusus
Small exostoses around small joint Kecil Laminectomy Besar
Incision of Bane for osteomyelitis Sedang Spina bifida Besar
Open reduction of fractures with or without internal Besar Spinal fusion Besar
fixation Spinal osteotomy Besar
Osteoplasty Besar The Luque segmental spinal instrumentation Khusus
Osteotomy operation
- Small bone Sedang
- Large bone Besar Tendons
Radical operations for bone tumours Besar Primary tendon repair Sedang
Removal of pins and screws from old fractures Sedang Release of de Quervain’s lesion Kecil
Repair of intricate tendon injuries Besar
Bursae Tendon tranplantations Besar
Excision of bursae communicating with large joints Sedang Tendon shealth incision Sedang
Excision of bursae communicating with smaller Kecil Tendon grafting Besar
joints
Simple manipulation or tenotomy and plaster Kecil Upper Limbs
Acromionectomy Besar
Joints Dupuytren’s contracture
Arthroscopy Sedang - If extensive Besar
Arthroscopy and IA procedure Besar - If extensive Sedang
Arthrogram Kecil Multiple chondromata of digits:excision and bone Besar
Arthrectomy including biopsy Besar graft
Arthrotomy including removal of loose bodies Sedang Operation for Carpal Tunnel Syndrome Sedang
Chondrectomy including removal of meniscus Besar Operation for disease ec injury of supra-spinatus Sedang
of knee joint Tendon
Extradural corticosteroid infiltration Kecil Operation for trigger finger Kecil
Hip or knee replacement Besar Recurrent dislocation of shoulder joint Besar
Intraarticular injection Kecil Shoulder or elbow replacement Besar
Manipulation of joint under anaethesia Kecil Synovioma of finger Sedang
Metacarpalphalangeal protheses Besar
Recontruction operation on bones and joints : General
Arthrodesis POP application Kecil
- Small joint Sedang Nail (s) avulsion Kecil
- Large joint Besar Ganglion excision Sedang
Arthroplasty Cervical rib Besar
- Small joint Sedang Operation for “Tennis Elbow” Besar
- Large joint Besar
Bone grafting Besar SEC. H. THORACIC OPERATIONS
Revision of hip or knee replacement Khusus Lungs
Spinal fractures with cord damage Besar Bronchoscopy Sedang
Spinal fractures without cord damage Sedang Drainage of lung abscess with thoracotomy Besar
Hydatid of lung Besar
Lower Limbs Lobectomy Khusus
Cyst external cartilage of knee Sedang Lung resection with thoractomy Besar
Fracture of neck of femur : pinning or osteotomy Besar Pneumonectomy Khusus
(all
forms)
Internal dearrangement of knee joint Sedang Mediastinum
Menisectomy Besar Angiocardiography Sedang
Patellectomy Sedang Any operation on oesophagus including
Removal of loose bodies Sedang Heller’s operation Besar
Synovectomy Sedang Oesophagectomy Khusus
Mc Murray’s operation Besar Oesophageal anastomosis Khusus

7
Pembedahan Klasifikasi
Repair and short circuit Besar
Vagotomy Besar
Cardiac catherization Sedang
Coronary Angioplasty (percutaneous transluminal) Besar
External trephine or puncture Kecil
Heart and great vessels, any operation on Khusus
Insertion of cardiag pacemaker Sedang
Mediastinoscopy Sedang
Nissen Fundoplication Besar
Oesophagoscopy Kecil
Other mediatinal procedures Besar
Thymectomy Besar

Pleural and Chestwall


Drainage of empyema Sedang
Induction of artificial pneumothorax Kecil
Paracentesis thoracis Kecil
Pleurectomy Besar
Pleural biopsy Kecil
Pleurodesis with thoracoscopy Sedang
Thoracoplasty Besar
Thoracotomy – for biopsy exploration Besar
Toracoscopy Kecil