Gabung KODING 10072021

KODING
ICD X - ICD IX-CM

DEPARTEMEN/SMF BEDAH TORAKS, KARDIAK, DAN VASKULAR
RSUD DR. SOETOMO SURABAYA 2021
CODING
KARDIAK
PEDIATRI
Atrial Septal Defect (Q21.1)
(Termasuk defek sinus koronarius dan PFO)
Repair of atrial septal defect with prosthesis. open technique (35.51)
Repair of atrial septal defect with prosthesis. closed technique (35.52)
Pada 2 tindakan ini terdapat top Up Prosthesis sebesar 48.292.200 (TIPE A) 21.337.800 (TIPE B)
(Harap dipastikan tindakan betul menggunakan prosthesis bukan graft (graft tidak dapat top up))
Kode INA - TIPE A TIPE B
Deskripsi INA-CBG
CBG Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
Prosedur Kardiotorasik lain
I-1-06-I 48.292.200 57.950.600 67.609.100 21,337,800 25,605,400 29,872,900
(Ringan )
I-1-06-II 69.955.200 83.946.200 97.937.300 30,909,500 37,091,400 43,273,400
(Sedang)
I-1-06-III 83.469.500 100.163.400 116.857.300 36,880,800 44,256,900 51,633,100
(Berat)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus sy
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0). VT (I47.2)
Atrial Septal Defect (Q21.1)
(Termasuk defek sinus koronarius dan PFO)
Repair of atrial septal defect with tissue graft (35.61)

Other and unspecified repair of atrial septal defect 35.71

Deskripsi INA-CBG
I-1-06-I 48.292.200 57.950.600 67.609.100 21,337,800 25,605,400 29,872,900
(Ringan )
I-1-06-II 69.955.200 83.946.200 97.937.300 30,909,500 37,091,400 43,273,400
(Sedang)
I-1-06-III 83.469.500 100.163.400 116.857.300 36,880,800 44,256,900 51,633,100
(Berat)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus synd
(E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1), ), Stenosis of pulmonary artery (Q25.6), Patent Du
Ventricle Septal Defect (Q21.0)
• Repair of ventricular septal defect with prosthesis. open technique 35.53

• Repair of ventricular septal defect with prosthesis. closed technique 35.55
• Pada 2 tindakan ini terdapat top Up Prosthesis sebesar 48.292.200 (TIPE A) 21.337.800 (TIPE B)
(Harap dipastikan tindakan betul menggunakan prosthesis bukan graft (graft tidak dapat top up))
Kode INA TIPE A TIPE B

Deskripsi INA-CBG
-CBG Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
I-1-06-I 48.292.200 57.950.600 67.609.100 21,337,800 25,605,400 29,872,900
(Ringan )
I-1-06-II 69.955.200 83.946.200 97.937.300 30,909,500 37,091,400 43,273,400
(Sedang)
I-1-06-III 83.469.500 100.163.400 116.857.300 36,880,800 44,256,900 51,633,100
(Berat)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus
Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Patent Ductus Arteriosus(Q25.0)
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0). VT (I47
Ventricle Septal Defect (Q21.0)
Repair of ventricular septal defect with tissue graft 35.62
Other and unspecified repair of ventricular septal defect 35.72

Deskripsi INA-CBG
I-1-06-I 48.292.200 57.950.600 67.609.100 21,337,800 25,605,400 29,872,900
(Ringan )
I-1-06-II (Sedang) 69.955.200 83.946.200 97.937.300 30,909,500 37,091,400 43,273,400
I-1-06-III (Berat) 83.469.500 100.163.400 116.857.300 36,880,800 44,256,900 51,633,100
Comorbid :
pulmonary artery(Q25.5), Congenital insufficiency of aortic valve (Q23.1), Pulmonary heart disease, unspecified (I27.9), Other congen
Tetralogy Of Fallot (Q21.3)
Modified Blalock-Taussig (BT) Shunt (39.0)

Deskripsi INA-CBG
PROSEDUR PEMBULUH DARAH
I-1-12-I 16.202.500 19.443.000 22.683.600 11,689,300 14,027,100 16,365,000
TORASIK KOMPLEKS (RINGAN)
I-1-12-II 26.462.000 31.754.400 37.046.800 18,518,200 22,221,900 25,925,500
TORASIK KOMPLEKS (SEDANG)
I-1-12-III 34.814.800 41.777.700 48.740.700 24,363,500 29,236,200 34,108,900
TORASIK KOMPLEKS (BERAT)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sin
Tetralogy Of Fallot (Q21.3)
Reparasi TOF (35.81)
Pada tindakan ini terdapat top Up Prosthesis sebesar 16.938.500 (TIPE A) 7.259.700 (TIPE B)
Kode TIPE A TIPE B

INA - Deskripsi INA-CBG
OPERASI KARDIOTORASIK KOMPLEKS
I-1-03-I 33,876,900 40,652,300 47,427,600 14,519,400 17,423,200 20,327,10
PADA JANTUNG ANOMALI (RINGAN)
I-1-03-II 46,960,400 56,352,500 65,744,500 20,126,800 24,152,200 28,177,600
PADA JANTUNG ANOMALI (SEDANG)
I-1-03-III 59,596,300 71,515,600 83,434,900 26,332,500 31,599,000 36,865,500
PADA JANTUNG ANOMALI (BERAT)
Comorbid :
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0). VT (I47.2
AVSD (Q21.2)
37.99 (Pulmonary Artery (PA) Banding)

Deskripsi INA-CBG
I-1-06-I 48.292.200 57.950.600 67.609.100 21,337,800 25,605,400 29,872,900
(Ringan )
I-1-06-II 69.955.200 83.946.200 97.937.300 30,909,500 37,091,400 43,273,400
(Sedang)
I-1-06-III 83.469.500 100.163.400 116.857.300 36,880,800 44,256,900 51,633,100
(Berat)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC
(I49.1). sick sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia
(E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) ), Stenosis of pulmonary artery
(Q25.6) Patent Ductus Arteriosus(Q25.0), Congenital pulmonary valve stenosis(Q22.1), Atresia of pulmonary
artery(Q25.5), Congenital insufficiency of aortic valve (Q23.1), Pulmonary heart disease, unspecified (I27.9), Other
congenital malformations of aorta (Q25.4), Pulmonary infundibular stenosis (Q24.3), Nonrheumatic tricuspid (valve)
insufficiency (I36.1), Tricuspid insufficiency (I07.1), Partial anomalous pulmonary venous connection (Q26.3), Aortic
(valve) insufficiency (I35.1), Pulmonary valve atresia (Q22.0), Congenital tricuspid stenosis (Q22.4)
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49.
0). VT (I47.2)
AVSD (Q21.2)
35.54 (Complete Atrioventricular Septal Defect (CAVSD) Repair)
Kode TIPE A TIPE B

I-1-03-I 33,876,900 40,652,300 47,427,600 14,519,400 17,423,200 20,327,10
I-1-03-II 46,960,400 56,352,500 65,744,500 20,126,800 24,152,200 28,177,600
I-1-03-III 59,596,300 71,515,600 83,434,900 26,332,500 31,599,000 36,865,500
Comorbid :
Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) ), Stenosis of pulmonary artery (Q25.6), Patent Ductus Arte
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0).
VT (I47.2)
Patent Ductus Arteriosus(Q25.0)
38.85(Ligasi PDA)

Deskripsi INA-CBG
PROSEDUR SISTIM PEREDARAN
I-1-20-I 20,675,700 24,810,900 28,946,000 14,916,500 17,899,700 20,883,000
DARAH LAIN‐LAIN (RINGAN)
I-1-20-II 25,829,700 30,995,600 36,161,600 18,634,700 22,361,700 26,088,600
DARAH LAIN‐LAIN (SEDANG)
I-1-20-III 25,829,700 30,995,600 36,161,600 19,589,000 23,506,800 27,424,600
DARAH LAIN‐LAIN (BERAT)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC
(I49.1). sick sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia
(E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1), ), Stenosis of pulmonary artery
(Q25.6), Congenital pulmonary valve stenosis(Q22.1), Atresia of pulmonary artery(Q25.5), Congenital insufficiency of
aortic valve (Q23.1), Pulmonary heart disease, unspecified (I27.9), Other congenital malformations of aorta (Q25.4),
Pulmonary infundibular stenosis (Q24.3), Nonrheumatic tricuspid (valve) insufficiency (I36.1), Tricuspid insufficiency
(I07.1), Partial anomalous pulmonary venous connection (Q26.3), Aortic (valve) insufficiency (I35.1), Pulmonary valve
atresia (Q22.0), Congenital tricuspid stenosis (Q22.4)
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF
(I49. 0). VT (I47.2)
Transposition of Great Arteries (Q25.9)
Total correction of transposition of great vessels, not elsewhere classified 35.84
(Fontan Procedure / Total Cavo-Pulmonary Connection (TCPC)) 35.94
Kode TIPE A TIPE B

I-1-03-I 33,876,900 40,652,300 47,427,600 14,519,400 17,423,200 20,327,10
I-1-03-II 46,960,400 56,352,500 65,744,500 20,126,800 24,152,200 28,177,600
I-1-03-III 59,596,300 71,515,600 83,434,900 26,332,500 31,599,000 36,865,500
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2).
PAC (I49.1). sick sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/
Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) ), Stenosis of
pulmonary artery (Q25.6), Patent Ductus Arteriosus(Q25.0), Congenital pulmonary valve stenosis(Q22.1), Atresia
of pulmonary artery(Q25.5), Congenital insufficiency of aortic valve (Q23.1), Pulmonary heart disease, unspecified
(I27.9), Other congenital malformations of aorta (Q25.4), Pulmonary infundibular stenosis (Q24.3), Nonrheumatic
tricuspid (valve) insufficiency (I36.1), Tricuspid insufficiency (I07.1), Partial anomalous pulmonary venous
connection (Q26.3), Aortic (valve) insufficiency (I35.1), Pulmonary valve atresia (Q22.0), Congenital tricuspid
stenosis (Q22.4)
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3).
VF (I49. 0). VT (I47.2)
39.0 (Modified Blalock-Taussig (BT) Shunt)

Deskripsi INA-CBG
I-1-12-I 16.202.500 19.443.000 22.683.600 11,689,300 14,027,100 16,365,000
I-1-12-II 26.462.000 31.754.400 37.046.800 18,518,200 22,221,900 25,925,500
TORASIK KOMPLEKS (SEDANG)
I-1-12-III 34.814.800 41.777.700 48.740.700 24,363,500 29,236,200 34,108,900
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus syn
of pulmonary artery (Q25.6), Patent Ductus Arteriosus(Q25.0), Congenital pulmonary valve stenosis(Q22.1), Atresia of pulmonary artery
39.2 (Bidirectional Cavopulmonary Shunt (BCPS))

Deskripsi INA-CBG
I-1-12-I 16.202.500 19.443.000 22.683.600 11,689,300 14,027,100 16,365,000
I-1-12-II TORASIK KOMPLEKS (SEDANG) 26.462.000 31.754.400 37.046.800 18,518,200 22,221,900 25,925,500
I-1-12-III 34.814.800 41.777.700 48.740.700 24,363,500 29,236,200 34,108,900
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus s
of pulmonary artery (Q25.6), Patent Ductus Arteriosus(Q25.0), Congenital pulmonary valve stenosis(Q22.1), Atresia of pulmonary arte
37.99 (Pulmonary Artery (PA) Banding)

Deskripsi INA-CBG
I-1-06-I 48.292.200 57.950.600 67.609.100 21,337,800 25,605,400 29,872,900
(Ringan )
I-1-06-II (Sedang) 69.955.200 83.946.200 97.937.300 30,909,500 37,091,400 43,273,400
I-1-06-III 83.469.500 100.163.400 116.857.300 36,880,800 44,256,900 51,633,100
(Berat)
Comorbid :
Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2).
Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) ), Stenosis of
pulmonary artery (Q25.6), Patent Ductus Arteriosus(Q25.0), Congenital pulmonary valve stenosis(Q22.1),
Atresia of pulmonary artery(Q25.5), Congenital insufficiency of aortic valve (Q23.1), Pulmonary heart disease,
unspecified (I27.9), Other congenital malformations of aorta (Q25.4), Pulmonary infundibular stenosis (Q24.3),
Nonrheumatic tricuspid (valve) insufficiency (I36.1), Tricuspid insufficiency (I07.1), Partial anomalous
pulmonary venous connection (Q26.3), Aortic (valve) insufficiency (I35.1), Pulmonary valve atresia (Q22.0),
Congenital tricuspid stenosis (Q22.4)
Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3).
VF (I49. 0). VT (I47.2)
Wound Dehiscence
 Disruption of operation wound ICD X T81.3
 Nonexcisional debridement of wound, infection, or burn ICD IX 86.28
Kode INA- RS Tipe A RS Tipe B

Deskripsi
CBGs
Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
Komplikasi dari Penatalaksanaan
S-4-13-I 4,135,600 4,962,700 5,789,800 2,894,100 3,472,900 4,051,700
Pasien (ringan)
S-4-13-II 7,336,800 8,804,200 10,271,500 5,134,300 6,161,200 7,188,100
Pasien (sedang)

S-4-13-III 11,908,600 14,209,300 16,672,000 8,333,700 10,000,400 11,667,100
Pasien (berat)
 Comorbid:
o Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2).
Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes
Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke ( I63.9)
o Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3).
VF (I49. 0). VT (I47.2)
Tindakan Ventilator > 96 Jam (4x24 Jam)
Tindakan :
 Continuous invasive mechanical ventilation for 96 consecutive hours or more ICD IX 96.72
Kode RS Tipe A RS Tipe B
INA- Deskripsi
CBGs
J‐1‐ Ventilasi Mekanikal Long Term 62,342,100 87,278,900 28,008,100 33,609,700 39,211,300
02‐I Tanpa Trakeostomi (Ringan) 74,810,500
J‐1‐ Ventilasi Mekanikal Long Term 94,396,300 110,129,000
02‐II Tanpa Trakeostomi (Sedang) 78,663,600 38,998,300 46,798,000 54,597,700
J‐1‐ Ventilasi Mekanikal Long Term 110,430,300 128,835,300 64,399,600 77,279,500 90,159,400
02‐III Tanpa Trakeostomi (Berat) 92,025,200
 Comorbid:
o Sev. II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick
sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis
(E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke ( I63.9)
o Sev. III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0). VT
(I47.2) Disruption of operation wound (T81.3)
Tindakan Ventilator < 96 Jam (4x24 Jam)
Tindakan :
 Continuous invasive mechanical ventilation for less tahn 96 consecutive hours ICD IX 96.71
Kode INAC RS Tipe A RS Tipe B

BGS Deskripsi
J‐1‐ Prosedur Sistem Pernapasan Non-
20‐I Kompleks (Ringan) 33,481,700 40,178,000 46,874,300 14,544,200 17,453,000 20,361,900
J‐1‐ Prosedur Sistem Pernapasan Non- 35,059,800 42,071,800 49,083,700 18,318,800 21,982,600 25,646,300
20‐II Kompleks (Sedang)
20‐III Kompleks (Berat)
 Comorbid:
CATATAN
FOKUS INA pada ICD IX, Jika diagnosis berubah tapi tindakan tetap, MAKA Penentu INA di ICD IX
Cardiopulmonary resuscitation, not otherwise specified (99.60)

Atrial cardioversion(99.61)
Other electric countershock of heart(99.62)
Closed chest cardiac massage(99.63)
Carotid sinus stimulation(99.64)
Other conversion of cardiac rhythm(99.69)
Extracorporeal circulation auxiliary to open heart surgery (39.61)
Incision of chest wall (34.01)
Pada koding ICD IX-CM diatas hanya ditambahkan untuk membuktikan adanya tindakan tersebut pada suatu kondisi tapi ke 6
koding tersebut tidak mempengaruhi Nominal INACBGs di kelas dan kasus manapun.
KETENTUAN KODING PEDIATRI
 AV blok(I44.-) : Harap EKG dan pembacaan disertakan
 Supraventricular tachycardia (I47.1) : termasuk pola AV nodal, junctional, atrial
 HF (I50.0) : HF yang congestive / RV failure
 HF (I50.1) : HF dengan tanda-tanda oedema paru / LV Failure
 Bradikardi (R00.1)
 Penyakit jantung tiroid (I43.8 + E05.9)
KETENTUAN KODING UMUM

 CPR (99.60)
 Angkat jahitan sesuai dengan region
 Rehab medic disesuaikan dengan modalitas yang digunakan
 Sepsis dengan tanda-tanda syok R57.2
 Sepsis dengan syok kardiogenik = R57.0
 Hipertensi
o I10 jika hipertensi saja tanpa ada komplikasi
lain o I11 jika ada komplikasi jantung
 I11.0 Hypertensive heart disease dan HF dengan tanda-tanda edema paru
 I11.9 Hypertensive heart disease dan HF tanpa tanda-tanda edema paru o I12
jika ada komplikasi ginjal
o I13 jika ada komplikasi ginjal dan jantung bersamaan
 Cardiac Arrest (I46.9) bisa dikoding jika bukan kasus DOA dan DNR
 Pada koding elektrolit imbalans seperti hiponatremi, hipernatremi dan hipo/hiper kalemi mohon disertakan terapi dan
lab pendukung
CODING
KARDIAK
DEWASA
CABG
Diagnosis :
• Other forms of chronic ischaemic heart disease ICD X I25.8
• Atherosclerotic heart disease ICD X I25.1
• Chronic Ischemic heart disease, unspecified ICD X I25.9
• Presence of aortocoronary bypass ICD X Z95.1
Tindakan :
• Coronary Arthery Bypass Graft (CABG)
o 1 graft ICD IX 36.11
o single mammary ICD IX 36.15
o double mammary ICD IX 36.16
o other bypass anastomosis ICD IX 36.19
• Kateterisasi Jantung ICD IX 88.56
• Other heart revascularization ICD 36.39
• Aortocoronary bypass for heart revascularizaton ICD IX 36.10
• Interview and evaluation, described as comprehensive ICD IX 89.03
INA- Deskripsi
CBGs Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
I-1- Pembedahan Bypass Pembuluh Koroner

84,564,000 101,476,800 118,389,600 53,044,200 63,653,000 74,261,800
05-I Dengan Kateterisasi Jantung (Ringan)

103,356,000 124,027,200 144,698,400 53,044,200 63,653,000 74,261,800
05-II Dengan Kateterisasi Jantung (Sedang)

140,940,000 169,128,000 197,316,000 88,407,000 106,088,400 123,769,700
05-III Dengan Kateterisasi Jantung (Berat)
• Comorbid :
o Sev. II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1).
sick sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6)
Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke (
I63.9)
o Sev. III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0).
VT (I47.2) Disruption of operation wound (T81.3)
CABG
Diagnosis :
• Other forms of chronic ischaemic heart disease ICD X I25.8
• Atherosclerotic heart disease ICD X I25.1
• Chronic Ischemic heart disease, unspecified ICD X I25.9
• Presence of aortocoronary bypass ICD X Z95.1
Tindakan :
• Coronary Arthery Bypass Graft (CABG)
o single mammary ICD IX 36.15
o double mammary ICD IX 36.16
o other bypass anastomosis ICD IX 36.19
• Other heart revascularization ICD 36.39
• Aortocoronary bypass for heart revascularizaton ICD IX 36.10
• Interview and evaluation, described as comprehensive ICD IX 89.03
Kode RS TIpe A RS Tipe B
INA- Deskripsi
I-1- Prosedur Bypass Koroner Tanpa

75,844,500 91,013,400 106,182,300 47,574,700 57,089,700 66,604,600
04-I Kateterisasi Jantung (Ringan)
04-II Kateterisasi Jantung (Sedang) 94,805,600 113,766,800 132,727,900 59,468,400 71,362,100 83,255,800

04-III Kateterisasi Jantung (Berat) 142,208,500 170,650,200 199,091,800 89,202,600 107,043,200 124,883,700
 Comorbid :
o Sev. II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1).
sick sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6)
Acidosis / Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke (
Mitral Valve Replacement/repair
Diagnosis:
 Rheumatic mitral valve diseases ICD X I05.-
 Mitral stenosis ICD X I05.0
 Mitral stenosis with insufficiency ICD X I05.2
 Mitral (valve) insufficiency ICD X I34.0
 Mitral (valve) prolapse ICD X I34.1
 Nonrheumatic mitral (valve) stenosis ICD X I34.2
 Rheumatic mitral Insuffiency ICD X I05.1
 Rheumatic heart disease unspecified ICD X I09.9
 Nonrheumatic mitral valve disorder ICD X I34.9
Tindakan:
 Open heart valvuloplasty of mitral valve without replacement ICD IX 35.12
 Open and other replacement of mitral valve with tissue graft ICD IX 35.23
 Open and other replacement of mitral valve ICD IX 35.24
 Closed heart valvotomy, mitral valve ICD IX 35.02
 Open and other replacement of unspecified heart valve, elsewehere ICD IX 35.20
 Diagnostic ultrasound of heart ICD IX 88.72
 Interview and evaluation, described as comprehensive ICD IX 89.03
INA- Deskripsi
I-1- Prosedur Katup Jantung Tanpa

51,050,600 61,260,700 71,470,900 22,556,600 27,067,900 31,579,200
80,571,700 96,686,000 112,800,300 35,600,400 42,720,500 49,840,600
04-II Kateterisasi Jantung (Sedang)

128,712,700 154,455,200 180,197,800 56,871,400 68,245,700 79,620,000
04-III Kateterisasi Jantung (Berat)
 Comorbid :
(I47.2) Acute amd subacute endocarditis (I33.-) Disruption of operation wound (T81.3)
Aortic Valve Replacement/repair
Diagnosis :
o Rheumatic aortic valve diseases ICD X I06.-
o Aortic stenosis ICD X I35.0
o Aortic (valve) insufficiency ICD X I35.1
o Aortic (valve) stenosis with insufficiency ICD X I35.2
o Rheumatic Aortic Stenosis with insufficiency ICD X I06.2
o Aortic aneurysm and dissection ICD I71.-
o Aortic aneurysm of unspecified site ICD 71.8
Tindakan :
o Open heart valvuloplasty of aortic valve without replacement ICD IX 35.11
o Open and other replacement of aortic valve with tissue graft ICD IX 35.21
o Open and other replacement of aortic valve ICD IX 35.22
o Diagnostic ultrasound of heart ICD IX 88.72
o Interview and evaluation, described as comprehensive ICD IX 89.0
INA- Deskripsi
I-1- Prosedur Katup Jantung

Tanpa
04-I Kateterisasi Jantung (Ringan) 51,050,600 61,260,700 71,470,900 22,556,600 27,067,900 31,579,200

Tanpa

Tanpa
 Comorbid :
o Sev II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus
syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis
o Sev III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0). VT (I47.2)
Acute and subacute endocarditis (I33.-) Disruption of operation wound (T81.3)
Double Valve Replacement
Diagnosis :
 Mitral (valve) Disease  Aortic (valve) Disease
oRheumatic mitral valve diseases ICD X I05.- o Rheumatic aortic valve diseases ICD X I06.-
oMitral stenosis ICD X I05.0 o Aortic stenosis ICD X I35.0
oMitral stenosis with insufficiency ICD X I05.2 o Aortic (valve) insufficiency ICD X I35.1
oMitral (valve) insufficiency ICD X I34.0 o Aortic (valve) stenosis with insufficiency ICD X I35.2
o Mitral (valve) prolapse ICD X I34.1 o Rheumatic Aortic Stenosis with insufficiency ICD X I06.2
o Nonrheumatic mitral (valve) stenosis ICD X I34.2
o Rheumatic mitral
heart disease unspecified ICD
ICDXX
I09.9
Tindakan :
 Mitral (valve) Procedure
o Open and other replacement of mitral valve with tissue graft ICD IX 35.23
o Open and other replacement of mitral valve ICD IX 35.24
o Closed heart valvotomy, mitral valve ICD IX 35.02
 Aortic (valve) procedure
o Open and other replacement of aortic valve with tissue graft ICD IX 35.21
o Open and other replacement of aortic valve ICD IX 35.22
INA- Deskripsi

04-I Kateterisasi Jantung (Ringan) 51,050,600 61,260,700 71,470,900 22,556,600 27,067,900 31,579,200


 Comorbid :
sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6) Acidosis /
Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke ( I63.9)
(I47.2) Acute and subacute endocarditis (I33.-) Disruption of operation wound (T81.3)
LA/RA Myxoma
Diagnosis :
 Benign Neoplasm of the heart ICD X D15.1
Tindakan :
 Incision of heart, not otherwise specified ICD IX 37.10
 Excision or destruction of other lesion or tissue of heart, open ICD IX 37.33
Interview
Diagnosticand evaluation,
ultrasound described as comprehensive
of heart ICD
ICDIXIX89.03

INA- Deskripsi
I–1–
Prosedur Kardiotorasik Lain (Ringan) 50.706.800 60.848.200 70.989.500 21,337,800 25,605,400 29,872,900
06–I
I–1–
Prosedur Kardiotorasik Lain (Sedang) 73.453.000 88.143.600 102.834.200 30,909,500 37,091,400 43,273,400
06–II
I–1–
Prosedur Kardiotorasik Lain (Berat) 87.642.900 105.171.500 122.700.100 36,880,800 44,256,900 51,633,100
06–III
 Comorbid :
o Sev. II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus
syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis
Fistula Koroner
Diagnosis :
 Malformation of coronary vessels ICD X Q24.5
Tindakan :
 Other operations on vessels of heart ICD IX 36.99
 Interview and evaluation, described as comprehensive ICD IX
INA- Deskripsi
I–1–
Prosedur Kardiotorasik Lain (Ringan) 50.706.800 60.848.200 70.989.500 21,337,800 25,605,400 29,872,900
06–I
I–1–
Prosedur Kardiotorasik Lain 73.453.000 88.143.600 102.834.200 30,909,500 37,091,400 43,273,400
06–II
(Sedang)
I–1–
06–III
 Comorbid :
Ruptur Sinus Valsava
Diagnosis :
 Ventricular septal defect ICD X Q21.0
 Ventricular septal defect as current complication following acute myocardial infarction ICD X I23.2
 Rupture of cardiac wall without haemopericardium ICD X I23.3
Tindakan :
 Repair of ventricular septal defect with prosthesis, open technique ICD IX 35.53
 Repair of ventricular septal defect with prosthesis, closed technique ICD IX 35.55
 Other operations on septa of heart ICD IX 35.98
Top Up : Prosthesis sebesar 48.292.200
INA- Deskripsi
I–1–
06–I Prosedur Kardiotorasik Lain (Ringan) 50.706.800 60.848.200 70.989.500 21,337,800 25,605,400 29,872,900
I–1–
06–II
I–1–
06–III
 Comorbid:
Ruptur Sinus Valsava
Diagnosis :
 Ventricular septal defect ICD X Q21.0
 Aortic aneurysm and dissection ICD X I71.-
 Aortic aneurysm of unspecified site ICD X 71.8
Tindakan :
 Repair of ventricular septal defect with prosthesis, open technique ICD IX 35.53
 Other Replacement of aortic valve ICD IX 35.22
 Other repair of aneurysm ICD IX 39.52

INA-
Deskripsi

04-I 51,050,600 61,260,700 71,470,900 22,556,600 27,067,900 31,579,200
Kateterisasi Jantung (Ringan)

 Comorbid:
o Sev. II : Pulmonary Hypertension (I27.1/ I27.2 ) . HF (I50.9/ I50.1). Atrial Fibrilasi (I48). Junctional rhytm (I49.2). PAC (I49.1). sick sinus
syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis (E87.2 /
E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke (I63.9)
o Sev. III : Shock Cardiogenik (R57.0). Cardiac Arrest (I46.0/I46.9) . effusi pleura (J90/J91). pneumonia. PVC (I49.3). VF (I49. 0). VT (I47.2)
Disruption of operation wound (T81.3)
Hyperthropic Obstructive Cardiomyopathy (HOCM)
Diagnosis :
 Cardiomyopathy ICD X I42
neurysm
A of heart ICD X I25.3
Intracardiac thrombosis, not elsewhere classified ICD X I51.3
Tindakan :
 Other and unspecified repair of unspecified septal defect of heart ICD IX 35.70
 Other operations on septa of heart ICD IX 35.98

INA- Deskripsi
I–1– 21,337,800 25,605,400 29,872,900

Prosedur Kardiotorasik Lain (Ringan) 50.706.800 60.848.200 70.989.500
06–I
I–1– 30,909,500 37,091,400 43,273,400
Prosedur Kardiotorasik Lain (Sedang) 73.453.000 88.143.600 102.834.200
06–II 44,256,900 51,633,100
I–1–
Prosedur Kardiotorasik Lain (Berat) 87.642.900 105.171.500 122.700.100 36,880,800
06–III
 Comorbid:
sinus syndrome (I49.5). SVT (I47.1). Anemia (D64.9) . effusi perikardium(I31.3). Hiper/ Hipokalemia (E87.5/E87.6) Acidosis /
Alkalosis (E87.2 / E87.3). Hiper/ Hiponatremia ( E87.0/ E87.1) Diabetes Mellitus ( E11.8/ E10.8) CKD (N18.-) Stroke ( I63.9)
Penyakit Perikardium
Diagnosis :
 Acute nonspecific idiopathic pericarditis ICD X I30
 Chronic adhesive pericarditis ICD X I31.0
 Pericarditis in bacterial diseases classified elsewhere ICD X I32
 Haemopericardium ICD X I31.2
 Other specified diseases of pericardium ICD X I31.8
 Pericardial effusion (noninflammatory) ICD X I31.1
Tindakan :
 Pericardiocentesis ICD IX 37.0
 Pericardiectomy ICD IX 37.31
 Control of hemorrhage, not otherwise specified ICD IX 39.98
 Pericardiotomy ICD IX 37.12
INA- Deskripsi
I–1– 21,337,800 25,605,400 29,872,900

Prosedur Kardiotorasik Lain (Ringan) 50.706.800 60.848.200 70.989.500
06–I
I–1–
06–II
I–1–
06–III
 Comorbid:
Implantasi Pacemaker
Diagnosis:
 Atrioventricular and left bundle-branch block ICD X I44
A rioventricular block, complete ICD X I44.2
 Presence of cardiac pacemaker ICD X Z95.0
 A rial Fibrillation and flutter ICD X I48
Tindakan:
 Insertion of permanent pacemaker, initial or replacement, type of device not specified ICD IX 37.8
 Revision or removal of pacemaker device ICD IX 37.89
 Removal of foreign body, not otherwise specified ICD IX 98.20
INA- Deskripsi
Penggantian Alat Defibrilator dan
I-1- 15,640,000 18,768,000 21,896,000 11,283,500 13,540,100 15,796,800
30-I Pacemaker Jantung (Ringan)
I-1- Penggantian Alat Defibrilator dan
32,534,700 39,041,700 45,548,600 23,472,100 28,166,500 32,860,900
30-II Pacemaker Jantung (Sedang)
I-1- Penggantian Alat Defibrilator dan
50,417,100 60,500,600 70,584,000 36,373,300 43,648,000 50,922,600
30-III Pacemaker Jantung (Berat)
 Comorbid:
Tricuspid Valve Replacement/repair
Diagnosis:
 Mitral stenosis ICD X I05
 Rheumatic aortic stenosis ICD X I06
 Rheumatic tricuspid valve diseases ICD X I07
 Tricuspid insufficiency ICD X I07.1
 Disorders of both mitral and aortic valves ICD X I08
 Other rheumatic heart diseases ICD X I09
 Nonrheumatic tricuspid (valve) stenosis ICD X I36
 Tricuspid valve disorders in diseases classified elsewhere ICD X I39.2
Tindakan:
 Open heart valvuloplasty of tricuspid valve without replacement ICD IX 35.14
INA- Deskripsi

51,050,600 61,260,700 71,470,900 22,556,600 27,067,900 31,579,200
80,571,700 96,686,000 112,800,300 35,600,400 42,720,500 49,840,600
04-II Kateterisasi Jantung (Sedang)

128,712,700 154,455,200 180,197,800 56,871,400 68,245,700 79,620,000
04-III Kateterisasi Jantung (Berat)
 Comorbid:
Emboli Arteri Pulmonal
Diagnosis:
 Pulmonary embolism ICD X I26
 Other pulmonary heart diseases ICD X I27
 Other diseases of pulmonary vessels ICD X I28
Tindakan:
 Ligation and stripping of varicose veins, unspecified site ICD IX 38.50
 Ligation and stripping of varicose veins, other thoracic vessels ICD IX 38.5
 Interview and evaluation, described as comprehensive ICD IX
INA- Deskripsi
I-1- Prosedur Pembuluh Darah

16.202.500 19.443.000 22.683.600 11,689,300 14,027,100 16,365,000
12-I Torasik Kompleks (ringan)
26.462.000 31.754.400 37.046.800 18,518,200 22,221,900 25,925,500
12-II Torasik Kompleks(sedang)
34.814.800 41.777.700 48.740.700 24,363,500 29,236,200 34,108,900
12-III Torasik Kompleks (berat)
 Comorbid:
Wound Dehiscence
Diagnosis :
 Disruption of operation wound ICD X T81.3
Tindakan :
 Nonexcisional debridement of wound, infection, or burn ICD IX 86.28

INA- Deskripsi
S-4- Komplikasi dari Penatalaksanaan Pasien

4,135,600 4,962,700 5,789,800 2,894,100 3,472,900 4,051,700
13-I (ringan)
7,336,800 8,804,200 10,271,500 5,134,300 6,161,200 7,188,100
13-II (sedang)
11,908,600 14,209,300 16,672,000 8,333,700 10,000,400 11,667,100
13-III (berat)
 Comorbid:
Tindakan Ventilator > 96 Jam (4x24 Jam)
Tindakan :
 Continuous invasive mechanical ventilation for 96 consecutive hours or more ICD IX 96.72
J‐1‐ Ventilasi Mekanikal Long Term 87,278,900 28,008,100 33,609,700 39,211,300

02‐I Tanpa Trakeostomi (Ringan) 62,342,100 74,810,500
J‐1‐ Ventilasi Mekanikal Long Term
78,663,600 94,396,300 110,129,000 38,998,300 46,798,000 54,597,700
02‐II Tanpa Trakeostomi (Sedang)
J‐1‐ Ventilasi Mekanikal Long Term
92,025,200 110,430,300 128,835,300 64,399,600 77,279,500 90,159,400
02‐III Tanpa Trakeostomi (Berat)
 Comorbid:
Tindakan Ventilator < 96 Jam (4x24 Jam)
Tindakan :
 Continuous invasive mechanical ventilation for less tahn 96 consecutive hours ICD IX 96.71
Kode INAC RS Tipe A RS Tipe B

BGS Deskripsi
J‐1‐ Prosedur Sistem Pernapasan Non-
20‐I Kompleks (Ringan) 33,481,700 40,178,000 46,874,300 14,544,200 17,453,000 20,361,900
20‐II Kompleks (Sedang)
20‐III Kompleks (Berat)
 Comorbid:
OTHERS
Diagnosis
HIV disease resulting in other viral infection ICD X B20.3
 Presence of prostethic heart valve ICD X Z95
 Other specified complications of cardiac and vascular prosthetic devices, implants and grafts ICD X T82.8
Comorbid :
Sev-I
 Hypertensive heart disease without (congestive) heart failure (I11.9) Cardiomegaly ( I51.7) Benign neoplasm: heart
(D15.1)
Prosedur
 Extracorporeal circulation auxiliary to open heart surgery ICD IX 39.6

 Incision of chest wall ICD IX 34.01
 Insertion of intercostal catheter for drainage ICD IX 34.04
 Cardioplegia ICD IX 39.63
KETENTUAN KODING DEWASA
 AV blok(I44.-) : Harap EKG dan pembacaan disertakan

 Supraventricular tachycardia (I47.1) : termasuk pola AV nodal, junctional, atrial
 HF (I50.0) : HF yang congestive / RV failure
 HF (I50.1) : HF dengan tanda-tanda oedema paru / LV Failure
 Bradikardi (R00.1)
 Penyakit jantung tiroid (I43.8 + E05.9)

 CPR (99.60)
 Hipertensi
 Pada koding elektrolit imbalans seperti hiponatremi, hipernatremi dan hipo/hiper kalemi mohon disertakan terapi dan lab
pendukung
CODING
THORAKS
HEMOTHORAKS TRAUMATIK
ICD X: ICD IX :
• Traumatic haemothorax S27.1 • Insertion of intercostal catheter for drainage 34.04
• Removal of thoracotomy tube or pleural cavity drain 97.41
KODE RS. TIPE A RS. TIPE B

DESKRIPSI
INACBGS
KELAS 3 KELAS 2 KELAS 1 KELAS 3 KELAS 2 KELAS 1
PLEURAL EFUSI DAN

J‐4-20-I 5,160,800 6,192,900 7,225,100 4,505,300 5,406,400 6,307,500
PNEUMOTORAK (RINGAN)
PLEURAL EFUSI DAN
J‐4‐20‐II 7,150,800 8,580,900 10,011,100 6,242,600 7,491,100 8,739,700
PNEUMOTORAK (SEDANG)
PLEURAL EFUSI DAN
J‐4‐20‐III 8,382,900 10,059,500 11,736,100 7,544,600 9,053,600 10,562,500
PNEUMOTORAK (BERAT)
Severity II : Pulmonary Hypertension (I27.1/ I27.2 ) , Heart Failure (I50.9/ I50.1), Atrial Fibrilasi (I48), Junctional rhytm
(I49.2), PAC (I49.1), sick sinus syndrome (I49.5), SVT (I47.1), Anemia (D64.9) , effusi perikardium(I31.3), Hiper/ Hipokalemia
(E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3), Hiper/ Hiponatremia ( E87.0/ E87.1)
Severity III : Shock Cardiogenik (R57.0), Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC (I49.3), VF
(I49. 0), VT (I47.2)
PNEUMOTHORAKS TRAUMATIK
ICD X: ICD IX :
• Traumatic pneumothorax S27.0 • Insertion of intercostal catheter for drainage 34.04

DESKRIPSI
INACBGS
PLEURAL EFUSI DAN

J‐4-20-I 5,160,800 6,192,900 7,225,100 4,505,300 5,406,400 6,307,500
PLEURAL EFUSI DAN
J‐4‐20‐II 7,150,800 8,580,900 10,011,100 6,242,600 7,491,100 8,739,700
PLEURAL EFUSI DAN
J‐4‐20‐III 8,382,900 10,059,500 11,736,100 7,544,600 9,053,600 10,562,500
PNEUMOTORAK (BERAT)
(I49. 0), VT (I47.2)
HEMOPNEUMOTHORAKS TRAUMATIK
ICD X: ICD IX :
• Traumatic haemopneumothorax S27.2 • Insertion of intercostal catheter for drainage 34.04

DESKRIPSI
INACBGS
PLEURAL EFUSI DAN

J‐4-20-I 5,160,800 6,192,900 7,225,100 4,505,300 5,406,400 6,307,500
PLEURAL EFUSI DAN
J‐4‐20‐II 7,150,800 8,580,900 10,011,100 6,242,600 7,491,100 8,739,700
PLEURAL EFUSI DAN
J‐4‐20‐III 8,382,900 10,059,500 11,736,100 7,544,600 9,053,600 10,562,500
PNEUMOTORAK (BERAT)
(I49. 0), VT (I47.2)
TENSION PNEUMOTHORAKS
ICD X: ICD IX:
• Spontaneous tension pneumothorax J93.0
• Thoracentesis 34.91
• Insertion of intercostal catheter for drainage 34.04
RS. TIPE A RS. TIPE B

KODE
DESKRIPSI
INACBGS
PLEURAL EFUSI DAN

J‐4-20-I 5,160,800 6,192,900 7,225,100 4,505,300 5,406,400 6,307,500
PLEURAL EFUSI DAN

J‐4‐20‐II 7,150,800 8,580,900 10,011,100 6,242,600 7,491,100 8,739,700
PLEURAL EFUSI DAN

J‐4‐20‐III 8,382,900 10,059,500 11,736,100 7,544,600 9,053,600 10,562,500
PNEUMOTORAK (BERAT)
PERICARDIAL EFFUSION (NON INFLAMATORIK)
ICDX:
• Pericardial effusion (noninflammatory) I31.3 Primer
• Pleural effusion, not elsewhere classified J90 Sekunder
ICD IX :
 Insertion of intercostal catheter for drainage 34.04
 Exploratory thoracotomy 34.02
 Pericardiotomy 37.12

DESKRIPSI
INACBGS
PROSEDUR KARDIOTORASIK LAIN (RINGAN)

PROSEDUR KARDIOTORASIK LAIN (SEDANG) 48,292,200 57,950,600 67,609,100 21,337,800 25,605,400 29,872,900
PROSEDUR KARDIOTORASIK LAIN I-1-06-IIII-1-06-III
(BERAT)
69,955,200 83,946,200 97,937,300 30,909,500 37,091,400 43,273,400
83,469,500 100,163,400 116,857,300 36,880,800 44,256,900 51,633,100
(I49. 0), VT (I47.2)
TRAUMA THORAKS RINGAN
ICDX:
• Contusion of thorax S20.2/ S20.3
• Superficial injury of other and unspecified parts of thorax S20.8
• Open wound of thorax, part unspecified S21.9
ICD IX :
• Suture of skin and subcutaneous tissue of other sites 86.59
TRAUMA PADA KULIT, JARINGAN

L-4-13-I 2,511,500 RS. TIPE A
3,013,800 3,516,100 2,314,400 RS. TIPE B
BAWAH
KODE KULIT DAN PAYUDARA (RINGAN)
DESKRIPSI
INACBGS
TRAUMA PADA KULIT, JARINGAN KELAS 3 KELAS 2 KELAS 1 KELAS 3 KELAS 2 KELAS 1
J‐4‐13‐II 4,091,400 4,909,700 5,727,900 2,720,000
BAWAH
KULIT DAN PAYUDARA (SEDANG)
TRAUMA PADA KULIT, JARINGAN
2,777,200 3,240,100
Severity II : Pulmonary Hypertension (I27.1/ I27.2 ) , Heart Failure (I50.9/ I50.1), Atrial Fibrilasi (I48), Junctional rhytm (I49.2), PAC
(I49.1), sick sinus syndrome (I49.5), SVT (I47.1), Anemia (D64.9) , effusi perikardium(I31.3), Hiper/ Hipokalemia (E87.5/E87.6)
3,264,000 Acidosis /
3,808,000
Alkalosis (E87.2 / E87.3), Hiper/ Hiponatremia ( E87.0/ E87.1)
4,803,000 5,603,500
Severity III : Shock Cardiogenik (R57.0), Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC (I49.3), VF (I49. 0), VT
(I47.2)
FRAKTUR COSTA
ICD X: ICD IX:
• Multiple fractures of ribs, closed S22.40 Internal fixation of bone without fracture reduction on
scapula, clavicle, and thorax (ribs and sternum) 78.51
• Flail chest, open S22.51
• Flail chest, closed S22.50
• Contusion of thorax S20.2
Top up: Exploratory thoracotomy (34.02) Rp.
10,142,700 pada RS tipe A (Rp 7,097,900 tipe B)

KODE
DESKRIPSI
INACBGS
PROSEDUR SISTEM PERNAFASAN

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)
J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
KOMPLEKS (SEDANG)
J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
Severity III : Shock Cardiogenik (R57.0), Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC
(I49.3), VF (I49. 0), VT (I47.2)
FRAKTUR STERNUM
ICD X: ICD IX:
Fracture of sternum S22.2 Primer Internal fixation of bone without fracture reduction on scapula,
Disruption of operation wound, not elsewhere classified T81.3 clavicle, and thorax (ribs and sternum) 78.51 Application of
Sekunder pressure dressing 93.56
Application of external fixation device, scapula, clavicle, and
thorax (ribs and sternum)78.11
Top up: Exploratory thoracotomy (34.02) Rp.
10,142,700 pada RS tipe A (Rp 7,097,900 tipe B)

DESKRIPSI
INACBGS

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)

J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
KOMPLEKS (SEDANG)

J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
Severity III : Shock Cardiogenik (R57.0), Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC (I49.3),
VF (I49. 0), VT (I47.2)
INJURY OF TRACHEA
ICDX:
Injury of thoracic trachea, with open wound into thoracic cavity S27.51 Primer
ICD IX :
Suture of laceration of trachea 31.71
Insertion of intercostal catheter for drainage 34.04

KODE
DESKRIPSI
INACBGS
PROSEDUR SISTEM PERNAPASAN

J‐1‐20‐I NON-KOMPLEKS (RINGAN) 33,481,700 40,178,000 46,874,300 14,544,200 17,453,000 20,361,900
J‐1‐20‐ PROSEDUR SISTEM PERNAPASAN 35,059,800 42,071,800 49,083,700 18,318,800 21,982,600 25,646,300
II NON-KOMPLEKS (SEDANG)
J‐1‐20‐ PROSEDUR SISTEM PERNAPASAN 28,287,200 33,944,600 39,602,100
39,455,200 47,346,300 55,237,300
III NON-KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
INJURY OF BRONCUS
ICD X: ICD IX:
Injury of bronchus Other repair and plastic operations on bronchus 33.48
S27.4 Insertion of intercostal catheter for drainage 34.04
Interstitial emphysema Other and unspecified ablation of lung lesion or tissue 32.26
J98.2 Exploratory thoracotomy 34.02
Removal of thoracotomy tube or pleural cavity drain 97.41

KODE
DESKRIPSI
INACBGS

J‐1‐10‐I SANGAT KOMPLEKS (RINGAN) 12,153,800 14,584,600 17,015,400 8,505,300 10,206,400 11,907,400

J‐1‐10‐II 24,593,400 29,512,000 34,430,700 17,210,500 20,652,600 24,094,700
SANGAT KOMPLEKS (SEDANG)
J‐1‐10‐III 25,558,600 30,670,300 35,782,000 18,439,200 22,127,000 25,814,800
SANGAT KOMPLEKS (BERAT)
Severity II : Pulmonary Hypertension (I27.1/ I27.2 ) , Heart Failure (I50.9/ I50.1), Atrial Fibrilasi (I48), Junctional rhytm (I49.2),
PAC (I49.1), sick sinus syndrome (I49.5), SVT (I47.1), Anemia (D64.9) , effusi perikardium(I31.3), Hiper/ Hipokalemia
(I49. 0), VT (I47.2)
INJURY OF INTRATHORACIC ORGAN
ICDX:
• Injury of other specified intrathoracic organs, without open wound into thoracic cavity S27.80
ICD IX :
• Repair of diaphragmatic hernia with thoracic approach, not otherwise 53.80
specified

KODE
DESKRIPSI
INACBGS

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)

J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
KOMPLEKS (SEDANG)

J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
EMFISEMA INTERSTITIAL
ICD X: ICD IX :
• Emphysema interstitial J98.2 • Other incision with drainage of skin & SC tissue 86.04

DESKRIPSI
INACBGS
PLEURAL EFUSI DAN

J‐4-20-I 5,160,800 6,192,900 7,225,100 4,505,300 5,406,400 6,307,500
PLEURAL EFUSI DAN
J‐4‐20‐II 7,150,800 8,580,900 10,011,100 6,242,600 7,491,100 8,739,700
PLEURAL EFUSI DAN
J‐4‐20‐III 8,382,900 10,059,500 11,736,100 7,544,600 9,053,600 10,562,500
PNEUMOTORAK (BERAT)
(I49. 0), VT (I47.2)
MALIGNANT NEOPLASMA OF BRONCUS AND LUNG ( ) 1
ICDX: ICD IX :
Malignant neoplasm, bronchus or lung, unspecified C34.9 • Insertion of intercostal catheter for drainage 34.04
• Other and unspecified ablation of lung lesion or tissue 32.26
• Exploratory thoracotomy 34.02
• Other and unspecified segmental resection of lung 32.39
• Thoracoscopic segmental resection of lung 32.30
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700 pada RS tipe A • Other local excision or destruction of lesion or tissue of lung 32.29
(Rp 7,097,900 tipe B) • Thoracoscopic excision of lesion or tissue of lung 32.20

INACBGS DESKRIPSI

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)
J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
KOMPLEKS (SEDANG)
J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
ICDX: ICD IX :
Malignant neoplasm, bronchus or lung, unspecified C34.9 • Insertion of intercostal catheter for drainage 34.04
• Thoracoscopic pneumonectomy 32.50
• Other and unspecified pneumonectomy 32.59
• Thoracoscopic lobectomy of lung 32.41
• Other lobectomy of lung 32.49

KODE
INACBGS DESKRIPSI
KELAS 3 KELAS 2 KELAS 1 KELAS 3 KELAS 2KELAS 1
J‐1‐10‐IPROSEDUR SISTEM PERNAFASAN 12,153,800 14,584,600 17,015,400 8,505,300 10,206,400 11,907,400

SANGAT KOMPLEKS (RINGAN)
J‐1‐10‐IIPROSEDUR SISTEM PERNAFASAN SANGAT KOMPLEKS (SEDANG)
J‐1‐10‐IIIPROSEDUR SISTEM PERNAFASAN SANGAT24,593,400 29,512,000
KOMPLEKS (BERAT) 34,430,700 17,210,500 20,652,600 24,094,700
25,558,600 30,670,300 35,782,000 18,439,200 22,127,000 25,814,800
(I49. 0), VT (I47.2)
ICDX :
Malignant neoplasm, bronchus or lung, unspecified C34.9
ICD IX
: • Thoracentesis 34.91

KODE
INACBGS DESKRIPSI
KELAS 3 KELAS 2 KELAS 1 KELAS 3KELAS 2 KELAS 1
J‐4‐14‐I TUMOR PARU (RINGAN) 6,124,600 7,349,500 8,574,400 4,286,000 5,143,200 6,000,400
J‐4‐14‐II TUMOR PARU (SEDANG) 9,966,500 11,959,800 13,953,100 7,190,300 8,628,300 10,066,400
J‐4‐14‐III TUMOR PARU (BERAT) 11,791,400 14,149,600 16,507,900 8,506,800 10,208,200 11,909,600
(I49. 0), VT (I47.2)
TUMOR MEDIASTINUM ( ) 1
ICDX : ICD IX :
Neoplasm of uncertain or unknown behaviour of Mediastinum D38.3 • Biopsy of thymus 07.16
• Thymectomy, not otherwise specified 07.80
• Partial excision of thymus 07.81
• Total excision of thymus 07.82
• Other and unspecified thoracoscopic operations on thymus 07.98
Kode Deskripsi RS TIPE A RS TIPE B

INACBGII : Pulmonary Hypertension (I27.1/ I27.2
Severity KELAS) ,3HeartKELAS 2 (I50.9/
Failure KELASI50.1),
1 KELAS
Atrial3Fibrilasi
KELAS 2 Junctional
(I48), KELAS 1 rhytm (I49.2),
PACD‐1‐20‐I
(I49.1), PROSEDUR PADA
sick sinus DARAH DAN
syndrome 7.164.500
(I49.5), SVT (I47.1), 8.597.400 10.030.300
Anemia (D64.9) 5.013.800
, effusi 6.016.500
perikardium(I31.3), 7.019.300
Hiper/ Hipokalemia
ORGAN PEMBENTUK DARAH LAIN-
(E87.5/E87.6)LAINAcidosis / Alkalosis (E87.2 / E87.3), Hiper/ Hiponatremia ( E87.0/ E87.1)
(RINGAN)
D‐1‐20‐II PROSEDUR PADA DARAH DAN 19.744.300 23,693,200 27,642,100 13.817.200 16,580,600 19,344,000
Severity III : ORGAN
Shock Cardiogenik (R57.0),
PEMBENTUK DARAH Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC (I49.3), VF
LAIN-
(I49. 0), VT (I47.2)
LAIN (SEDANG)
D‐1‐20‐III PROSEDUR PADA DARAH DAN 31.320.300 37.584.400 43.848.400 21,918,100 26,301,700 30,685,300
ORGAN PEMBENTUK DARAH LAIN-
LAIN (BERAT)
TUMOR MEDIASTINUM ( ) 2
ICD X : Neoplasm of uncertain or unknown behaviour of Mediastinum ICD IX :

D38.3 • Mediastinoscopy 34.22
Benign neoplasm, mediastinum D15.2 • Biopsy of chest wall 34.23
• Open mediastinum biopsy 34.26
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700 pada RS tipe • Other diagnostic procedures on mediastinum 34.29
A(Rp 7,097,900 tipe B) • Excision or destruction of lesion or tissue of mediastinum 34.3

INACBG KELAS 3 KELAS 2 KELAS 1 KELAS 3 KELAS 2 KELAS 1
J‐1‐30‐I PROSEDUR SISTEM PERNAFASAN 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)
J‐1‐30‐II PROSEDUR SISTEM PERNAFASAN 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 15,429,300
KOMPLEKS (SEDANG)
J‐1‐30‐III PROSEDUR SISTEM PERNAFASAN 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
KARSINOMA ESOFAGUS ( ) 1
ICD X : Malignant neoplasm, thoracic part of oesophagus ICD IX :

C15.1 • Incision of esophageal web 42.01
• Other incision of esophagus 42.09
• Cervical esophagostomy 42.11
• Other external fistulization of esophagus 42.19
• Other esophagoscopy 42.23
• Open biopsy of esophagus 42.25
• Local excision of other lesion or tissue of esophagus 42.32

INACBG KELAS 3 KELAS 2 KELAS 1 KELAS 3 KELAS 2 KELAS 1
K‐1‐30‐I PROSEDUR DUODENUM, ESOFAGUS & 9,689,200 11,627,000 11,627,000 11,627,000 8,388,300 9,786,300
LAMBUNG NON KOMPLEKS (RINGAN)
K‐1‐30‐II PROSEDUR DUODENUM, ESOFAGUS & 17,207,800 20,649,300 24,090,900 12,042,100 14,450,500 16,858,900
LAMBUNG NON KOMPLEKS (SEDANG)
K‐1‐30‐III PROSEDUR DUODENUM, ESOFAGUS & 23,678,100 28,413,800 33,149,400 17,082,500 20,499,000 23,915,500
LAMBUNG NON KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
KARSINOMA ESOFAGUS ( ) 2
ICDX : ICD IX :
Malignant neoplasm, thoracic part of oesophagus C15.1 • Partial esophagectomy 42.41
• Total esophagectomy 42.42
• Intrathoracic esophageal anastomosis with other interposition
42.58
• Other antesternal esophageal anastomosis with interposition
42.68

KODE
INACBGS DESKRIPSI
PROSEDUR INTESTINAL KOMPLEKS

K‐1‐20‐I 16,383,700 19,660,400 22,937,100 11,819,900 14,183,900 16,547,900
(RINGAN)
K‐1‐20‐II 22,884,300 27,461,200 32,038,000 16,509,800 19,811,800 23,113,700
(SEDANG)
PROSEDUR INTESTINAL KOMPLEKS (BERAT)
K‐1‐20‐III 33,413,500 40,096,200 46,778,900 24,106,10028,927,300 33,748,500
(I49. 0), VT (I47.2)
MALIGNANT PLEURAL EFFUSION ( ) 1
ICDX:
• Secondary malignant neoplasm of pleura C78.2 PRIMER
• Pleural effusion, not elsewhere classified J90
ICD IX :

KODE
INACBGS DESKRIPSI
KELAS 3 KELAS 2 KELAS 1 KELAS 3KELAS 2 KELAS 1
J‐4‐14‐I TUMOR PARU (RINGAN) 6,124,600 7,349,500 8,574,400 4,286,000 5,143,200 6,000,400
J‐4‐14‐II TUMOR PARU (SEDANG) 9,966,500 11,959,800 13,953,100 7,190,300 8,628,300 10,066,400
J‐4‐14‐III TUMOR PARU (BERAT) 11,791,400 14,149,600 16,507,900 8,506,800 10,208,200 11,909,600
ICDX: ICD IX :

• Secondary malignant neoplasm of pleura C78.2 PRIMER • Insertion of intercostal catheter for drainage 34.04
• Pleural effusion, not elsewhere classified J90 • Decortication of lung 34.51
• Scarification of pleura 34.6

KODE
DESKRIPSI
INACBGS KELAS 3 KELAS 2 KELAS 1 KELAS 3 KELAS 2 KELAS 1
PROSEDUR SISTEM
J‐1‐10‐I 12,153,800 14,584,600 17,015,400 8,505,300 10,206,400 11,907,400
PERNAFASAN SANGAT KOMPLEKS (RINGAN)
PROSEDUR SISTEM
24,593,400 29,512,000 34,430,700 17,210,500 20,652,600 24,094,700
J‐1‐10‐IIPERNAFASAN SANGAT
KOMPLEKS (SEDANG)
PROSEDUR SISTEM
J‐1‐10‐IIIPERNAFASAN SANGAT 25,558,600 30,670,300 35,782,000 18,439,200 22,127,000 25,814,800
KOMPLEKS (BERAT)
ICDX:
 ICD IX :
• Secondary malignant neoplasm of pleura C78.2 PRIMER
• Pleural effusion, not elsewhere classified J90 • Thoracoscopic pleural biopsy 34.20
• Transpleural thoracoscopy 34.21
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700 pada RS tipe
A(Rp 7,097,900 tipe B)

KODE
DESKRIPSI
INACBGS

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)

J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
KOMPLEKS (SEDANG)

J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
MALIGNANT NEOPLASMA OF
ICD X: THYMUS ICD IX:
• Malignant neoplasm of thymus C37 Incision of chest wall 34.01
Thoracoscopic excision of lesion or tissue of lung 32.20
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700pada RS tipe A (Rp 7,097,900 tipe B)
KODE DESKRIPSI RS TIPE A RS TIPE B

KOMPLEKS (RINGAN)
KOMPLEKS (SEDANG)
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
BENIGN LIPOMATOUS NEOPLASMA
ICD X: ICD IX:
• Benign lipomatous neoplasm, unspecified D17.9 Excision of lesion of other soft tissue 83.39

M‐1‐50‐I PROSEDUR JARINGAN LUNAK 7,174,800 8,609,800 10,044,800 5,176,300 6,211,500 7,246,800
(RINGAN)
M‐1‐50‐II PROSEDUR JARINGAN LUNAK 11,906,600 14,287,900 16,669,200 8,590,000 10,307,900 12,025,900
(SEDANG)
M‐1‐50‐III PROSEDUR JARINGAN LUNAK 19,555,800 23,466,900 27,378,100 14,108,500 16,930,100 19,751,800
(BERAT)
Severity III : Shock Cardiogenik (R57.0), Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC
(I49.3), VF (I49. 0), VT (I47.2)
BENIGN NEOPLASMA, LOWER JAW BONE
ICDX:
• Benign neoplasm, lower jaw bone D16.5
ICD IX :
• Excision of bone for graft, scapula, clavicle, and thorax (ribs and sternum) 77.71

KODE
DESKRIPSI
INACBGS

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
KOMPLEKS (RINGAN)

J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
KOMPLEKS (SEDANG)

J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
BENIGN NEOPLASM OF RIBS, STERNUM AND CLAVICLE
ICDX: ICD IX :
• Benign neoplasm of ribs, sternum and clavicle D16.7 •
MALIGNANT NEOPLASM OF RIBS, STERNUM AND CLAVICLE
ICDX: ICDIX:
• Malignant neoplasm of ribs, sternum and clavicle •
C41.3
FOREIGN BODY IN RESPIRATORY SYSTEM
ICDX: ICD IX :
• Foreign body in bronchus T17.5 • Exploratory thoracotomy 34.02
• Foreign body in other and multiple parts of respiratory • Other operations on bronchus 33.98
tract T17.8 • Insertion of intercostal catheter for drainage 34.04
• Foreign body in respiratory tract, part unspecified • Removal of thoracotomy tube or pleural cavity drain 97.41
T17.9

KODE
INACBGS DESKRIPSI
KELAS 3 KELAS 2 KELAS 1KELAS 3 KELAS 2 KELAS 1
J‐1‐10‐IPROSEDUR SISTEM PERNAFASAN 14,584,600 17,015,400 8,505,300 10,206,400 11,907,400

12,153,800
J‐1‐10‐IIPROSEDUR SISTEM PERNAFASAN SANGAT KOMPLEKS (SEDANG)
J‐1‐10‐IIIPROSEDUR SISTEM PERNAFASAN SANGAT24,593,400 29,512,000
KOMPLEKS (BERAT) 34,430,700 17,210,500 20,652,600 24,094,700
25,558,600 30,670,300 35,782,000 18,439,200 22,127,000 25,814,800
(I49. 0), VT (I47.2)
CONGENITAL MALFORMATIONS OF LUNG ( ) 1
ICDX : ICD IX :
• Other congenital malformations of lung Q33.8 • Insertion of intercostal catheter for drainage 34.04
• Ectopic tissue in lung Q33.5 • Other and unspecified ablation of lung lesion or tissue 32.26
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700 • Thoracoscopic segmental resection of lung 32.30
pada RS tipe A (Rp 7,097,900 tipe B) • Other local excision or destruction of lesion or tissue of lung 32.29
• Thoracoscopic excision of lesion or tissue of lung 32.20

KOMPLEKS (RINGAN)
KOMPLEKS (SEDANG)
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
ICDX: ICD IX :
• Other congenital malformations of lung Q33.8 • Insertion of intercostal catheter for drainage 34.04
• Ectopic tissue in lung Q33.5 • Thoracoscopic pneumonectomy 32.50

(I49. 0), VT (I47.2)
ICDX: ICD IX :
• Other congenital malformations of lung Q33.8 • Thoracentesis 34.91
• Ectopic tissue in lung Q33.5 • Insertion of intercostal catheter for drainage 34.04
KODE
DESKRIPSI RS TIPE A RS TIPE B
GEJALA, TANDA DAN DIAGNOSIS 2,948,500 3,538,200 4,127,800 2,717,000 3,260,400 3,803,800
J‐4‐21‐I SISTEM PERNAFASAN LAIN-LAIN
(RINGAN)
J‐4‐21‐II SISTEM PERNAFASAN LAIN-LAIN
(SEDANG)
J‐4‐21‐III SISTEM PERNAFASAN LAIN-LAIN
(BERAT)
(I49. 0), VT (I47.2)
KELAINAN DIAFRAGMA (HERNIA DAN
EVENTRASIO DIAFRAGMA)
ICDX: ICD IX :
• Diaphragmatic hernia without obstruction or gangrene • Repair of diaphragmatic hernia with thoracic approach, not otherwise

K44.9 PRIMER specified 53.80
• Disorders of diaphragm • Plication of the diaphragm 53.81
J98.6 • Repair of parasternal hernia 53.82
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700 pada RS • Laparoscopic repair of diaphragmatic hernia ith thoracic approach
w
tipe A 53.83 acic approach
• Other and open repair of diaphragmatic hernia, with
thor
53.84

KODE
INACBGS DESKRIPSI
PROSEDUR SISTEM PERNAFASAN KOMPLEKS

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
(RINGAN)
J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,800 15,429,300 18,000,900
(SEDANG)
J‐1‐30‐III PROSEDUR SISTEM PERNAFASAN KOMPLEKS (BERAT) 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
(I49. 0), VT (I47.2)
ACHALASIA ESOFAGUS, DIVERTIKULUM ESOFAGUS,
STRIKTUR ESOFAGUS
ICD X : Achalasia of cardia K22.0
ICD IX :
• Esophagomyotomy 42.7
• Local excision of esophageal diverticulum 42.31
• Suture of laceration of esophagus 42.82
• Repair of esophageal fistula, not elsewhere classified 42.84
• Repair of esophageal stricture 42.85
DESKRIPSI

K‐1‐20‐I 16,383,700 19,660,400 22,937,100 11,819,900 14,183,900 16,547,900
(RINGAN)
K‐1‐20‐II 22,884,300 27,461,200 32,038,000 16,509,800 19,811,800 23,113,700
(SEDANG)
K‐1‐20‐III 33,413,500 40,096,200 46,778,900 24,106,100 28,927,300 33,748,500
(BERAT)
(I49. 0), VT (I47.2)
SIMPLE PENUMOTORAKS
ICD X: ICD IX :
• Pneumothorax, unspecified J93.9 • Thoracentesis 34.91

DESKRIPSI
INACBGS
PLEURAL EFUSI DAN

J‐4-20-I 5,160,800 6,192,900 7,225,100 4,505,300 5,406,400 6,307,500
PLEURAL EFUSI DAN
J‐4‐20‐II 7,150,800 8,580,900 10,011,100 6,242,600 7,491,100 8,739,700
PLEURAL EFUSI DAN
J‐4‐20‐III 8,382,900 10,059,500 11,736,100 7,544,600 9,053,600 10,562,500
PNEUMOTORAK (BERAT)
(I49. 0), VT (I47.2)
PERICARDIAL EFFUSION INFLAMATORIK
ICDX:
• Disease of pericardium, unspecified I31.9
ICD IX :
 Exploratory thoracotomy 34.02
 Pericardiotomy 37.12

KODE
DESKRIPSI
INACBGS
I-1-06-I PROSEDUR KARDIOTORASIK LAIN

48,292,200 57,950,600 67,609,100 21,337,800 25,605,400 29,872,900
(RINGAN)
I-1-06-II PROSEDUR KARDIOTORASIK LAIN

69,955,200 83,946,200 97,937,300 30,909,500 37,091,400 43,273,400
(SEDANG)
PROSEDUR KARDIOTORASIK LAIN

I-1-06-III 83,469,500 100,163,400 116,857,300 36,880,800 44,256,900 51,633,100
(BERAT)
(I49. 0), VT (I47.2)
PYOTHORAX (1)
ICD X : Pyothorax without fistula J86.9 / Benign neoplasm, mesothelial tissue of pleura D19.0
ICD IX :
• Other local excision or destruction of lesion or tissue of lung 32.29
Top up: Exploratory thoracotomy (34.02) Rp. 10,142,700 pada RS tipe A (Rp 7,097,900 tipe B)
KODE
DESKRIPSI
INACBGS
KELAS 3 KELAS 2 KELAS 1 KELAS 3KELAS 2KELAS 1

J‐1‐30‐I 10,142,70012,171,20014,199,8007,097,900 8,517,500 9,937,100
(RINGAN)
J‐1‐30‐II 18,373,40022,048,00025,722,700 12,857,80015,429,300 18,000,900
(SEDANG)
PROSEDUR SISTEM PERNAFASAN KOMPLEKS (BERAT)
J‐1‐30‐III 53,034,100 63,640,900 74,247,700 37,113,400 44,536,100 51,958,800
(I49. 0), VT (I47.2)
PYOTHORAX ( )
ICD X : Pyothorax without fistula J86.9 / Benign neoplasm, mesothelial tissue of pleura
2
D19.0
ICD IX :
• Decortication of lung 34.51
• Thoracoscopic decortication of lung 34.52

KODE
DESKRIPSI
INACBGS
PROSEDUR SISTEM PERNAFASAN 24,593,400 29,512,000 34,430,700 17,210,500 20,652,600 24,094,700
J‐1‐10‐II
SANGAT KOMPLEKS
(SEDANG)
Severity II : Pulmonary Hypertension (I27.1/ I27.2 ) , Heart Failure (I50.9/ I50.1), Atrial Fibrilasi (I48), Junctional rhytm (I49.2), PAC (I49.1), sick sinus
syndrome (I49.5), SVT (I47.1), Anemia (D64.9) , effusi perikardium(I31.3), Hiper/ Hipokalemia (E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3), Hiper/
Hiponatremia ( E87.0/ E87.1)
Severity III : Shock Cardiogenik (R57.0), Cardiac Arrest (I46.0/I46.9) , effusi pleura (J90/J91), pneumonia (J18.9), PVC (I49.3), VF (I49. 0), VT (I47.2)
PYOTHORAX ( ) 3
ICD X : Pyothorax without fistula J86.9 / Benign neoplasm, mesothelial tissue of pleura D19.0
ICD IX
: • Thoracentesis 34.91

KODE
DESKRIPSI
INACBGS
PERADANGAN DAN INFEKSI 4,431,800 5,318,100 6,204,500 4,210,200 5,052,200 5,894,300

J‐4‐15‐I
PERNAPASAN (RINGAN) PERADANGAN DAN INFEKSI
J‐4‐15‐II 7,339,100 8,806,900 10,274,700 5,030,000 6,036,000 7,042,000

PERNAPASAN (SEDANG)
PERADANGAN DAN INFEKSI
J‐4‐15‐III 13,329,900 15,995,900 18,661,900 6,767,400 8,120,900 9,474,300
PERNAPASAN (BERAT)
(I49. 0), VT (I47.2)
MEDIASTINITIS
ICDX:
• Diseases of mediastinum, not elsewhere classified J98.5
ICD IX :
• Temporary tracheostomy 31.1
• Mediastinal tracheostomy 31.21
• Other permanent tracheostomy 31.29
KODE
J‐1‐30‐I
KOMPLEKS (RINGAN)
J‐1‐30‐II
KOMPLEKS (SEDANG)
J‐1‐30‐III
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
ABSES PARU ( ) 1
ICD X : Abscess of lung with pneumonia J85.1
ICD IX :
• Other local excision or destruction of lesion or tissue of lung 32.29
KODE
J‐1‐30‐I
KOMPLEKS (RINGAN)
J‐1‐30‐II
KOMPLEKS (SEDANG)
J‐1‐30‐III
KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
ABSES PARU ( ) 2

ICD IX :

DESKRIPSI
INACBGS
(E87.5/E87.6) Acidosis / Alkalosis (E87.2 / E87.3), Hiper/ Hiponatremia (E87.0/ E87.1)
(I49. 0), VT (I47.2)
ABSES PARU ( ) 3

ICD IX :
• Thoracentesis 34.91

KODE
DESKRIPSI
INACBGS

J‐1‐30‐I 10,142,700 12,171,200 14,199,800 7,097,900 8,517,500 9,937,100
(RINGAN)
J‐1‐30‐II 18,373,400 22,048,000 25,722,700 12,857,80015,429,30018,000,900
(SEDANG)
J‐1‐30‐III PROSEDUR SISTEM PERNAFASAN KOMPLEKS (BERAT) 53,034,100 63,640,900 74,247,700 37,113,40044,536,10051,958,800
(I49. 0), VT (I47.2)
INFEKSI DAERAH OPERASI (IDO)
ICDX:
Infection following a procedure, not elsewhere classified T81.4 Primer
ICD IX :
Excisional debridement of wound, infection, or burn 86.22

KODE
DESKRIPSI
INACBGS
A-4-11-I INFEKSI SESUDAH OPERASI &

4,263,700 5,116,500 5,969,200 3,197,800 3,837,300 4,476,900
TRAUMA (RINGAN)
A-4-11-II INFEKSI SESUDAH OPERASI &

TRAUMA (SEDANG) 6,068,500 7,282,200 8,495,900 4,551,400 5,461,700 6,371,900
A-4-11- INFEKSI SESUDAH OPERASI &

III TRAUMA (BERAT) 8,399,400 10,079,200 11,759,100 6,299,500 7,559,400 8,819,300
(I49. 0), VT (I47.2)
TINDAKAN VENTILATOR > 96 JAM (4X24
ICD IX :
JAM)
Continuous invasive mechanical ventilation for 96 consecutive hours or more 96.72

KODE
DESKRIPSI
INACBGS
VENTILASI MEKANIKAL LONG
J‐1‐02‐I TERM TANPA TRAKEOSTOMI 62,342,100 74,810,500 87,278,900 28,008,100 33,609,700 39,211,300
(RINGAN)

J‐1‐02‐ TERM TANPA TRAKEOSTOMI 78,663,600 94,396,300 110,129,000 38,998,300 46,798,000 54,597,700
II (SEDANG)
J‐1‐02‐ 64,399,600 77,279,500 90,159,400
TERM TANPA TRAKEOSTOMI 92,025,200 110,430,300 128,835,300
III (BERAT)
(I49. 0), VT (I47.2)
TINDAKAN VENTILATOR < 96 JAM (4X24
ICD IX :
JAM)
Continuous invasive mechanical ventilation for less tahn 96 consecutive hours 96.71
KODE
J‐1‐20‐I
NON-KOMPLEKS (RINGAN)
J‐1‐20‐II
NON-KOMPLEKS (SEDANG)
J‐1‐20‐III
NON-KOMPLEKS (BERAT)
(I49. 0), VT (I47.2)
KETENTUAN KODING TORAKS
 TB dengan pneumonia bisa dikoding terpisah jika terbukti terinfeksi pada episode yang berbeda
 TB + HIV = B20.0
 Pada TB anak P37.0
 Sepsis dengan Pneumonia = A40.3
 Effusi pleura dengan positif sel kanker dari analisa cairan pleura bisa dikoding C78.2
 Pneumonia dengan prasyarat harus ditemukan tampilan fibroinfiltrat di foto rontgen dada disertai keluhan lain yang mendukung. (J18.9)
 Pneumonia + PPOK = J44.0
 Bronkitis pada dewasa (J40); Pada anak2 < 15 th = J20
 Haemopytisis (R04.2) = batuk darah yang tidak diketahui penyebabnya
 hiper kalemi mohon disertakan terapi dan lab pendukung
Foreign body in bronchus T17.5

Foreign body in other and T17.8
multiple parts of respiratory tract
Foreign body in respiratory T17.9
tract, part unspecified
Foreign body in trachea T17.4
Foreign body in larynx T17.3
Foreign body in nostril T17.1
Foreign body in pharynx T17.2
Foreign body in nasal sinus T17.0
 CPR (99.60)
 Hipertensi
 Pada koding elektrolit imbalans seperti hiponatremi, hipernatremi dan hipo/hiper kalemi mohon disertakan terapi dan
lab pendukung
CODING BPJS
VASKULAR
ANEURISMA AORTA
Diagnosis : AAA (I71.4) ; TAA (I71.2 )
Tindakan
• Resection of vessel with replacement, unspecified (38.40)
• Other surgical occlusion of vessels, unspecified site (38.80)
TOP UP :
• EVAR/TEVAR Prosthesis (39.71)  103,378,500 (RS Tipe A); 96,957,300 (RS Tipe B)
Kode INA- Deskripsi TIPE A TIPE B
I-1-20-I Prosedur sistem peredaran darah 20.675.700 24.810.900 28.946.000 14.916.500 17.899.700 20.883.000
lain-lain (ringan)
I-1-20-II Prosedur sistem peredaran darah 25.829.700 30.995.600 36.161.600 18.634.700 22.361.700 26.088.600
lain-lain (sedang)
I-1-20-III Prosedur sistem peredaran darah 27.152.300 32.582.800 38.013.300 19.589.000 23.506.800 27.424.600
lain-lain (berat)
Comorbid
• Severity I: Hipertensi (I10)
• Severity II: DM (E11.8)/ Anemia (D64.9)/ TB Paru (A16)/ Gagal jantung (I50.9)/ CKD st.V (N18)
• Severity III : Pneumonia (J18.9)/Efusi Pleura (J90)/ Sepsis (A41.8), Coagulopathy (D68.9)/ Disruption of operation
wound (T81.3)
ANEURISMA ARTERI PERIFER
Pilihan diagnosis: Aneurysma of… Pilihan Tindakan
 Artery of upper extremity (ICD X I72.1)  Angiography (88.67) -- tambahan
 Artery of lower extremity (ICD X I72.4)  Angioplasty (39.50)
 Carotid artery (ICD X I72.0)  Clipping of aneurysm (39.51)
 Illiac artery (ICD X I172.3)  Repair pseudoaneurisma (39.59)
 Other specified arteries (ICD X I72.8)  Other repair of aneurysm (39.52)
 Renal artery (ICD X I72.2)
 Unspecified site (ICD X I72.9)

lain-lain (ringan)
lain-lain (sedang)
lain-lain (berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI ARTERI PERIFER ( ) 1
Diagnosis Tindakan
 Occlusion and stenosis of extremities artery (I65.2)  Angiography (88.67)
 Atherosclerosis of other arteries (I70.8)
 Generalized and unspecified atherosclerosis
(I70.9)

Penyakit pembuluh darah
I-4-15-I 4,722,500 5,667,000 6,611,500 4,351,800 5,222,100 6,092,500
perifer dan lain-lain (ringan)
I-4-15-II perifer dan lain-lain 8,905,200 10,686,300 12,467,300 5,920,300 7,104,400 8,288,400
(sedang)
I-4-15-III 10,686,300 12,823,500 14,960,800 7,104,400 8,525,200 9,946,100
perifer dan lain-lain (berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI ARTERI PERIFER ( ) 2
Diagnosis Tindakan
 Atherosclerosis of native arteries of  Angioplasty (39.50)
the extremities (I70.2 )  Endarterectomy, upper limb vessels (ICD IX 38.13)
 Atherosclerosis of other arteries (I70.8)
 Endarterectomy, lower limb vessels (ICD IX 38.18)
 Generalized and unspecified atherosclerosis
(I70.9)  Endarterectomy, unspecified site (ICD IX 38.10)

I-1-20-I Prosedur sistem peredaran 20.675.700 24.810.900 28.946.000 14.916.500 17.899.700 20.883.000
darah lain-lain (ringan)
I-1-20-II Prosedur sistem peredaran 25.829.700 30.995.600 36.161.600 18.634.700 22.361.700 26.088.600
darah lain-lain (sedang)
27.424.600
I-1-20-III Prosedur sistem peredaran 27.152.300 32.582.800 38.013.300 19.589.000 23.506.800
darah lain-lain (berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI ARTERI CAROTID ( ) 1
Diagnosis Tindakan
 Occlusion and stenosis of carotid artery (I65.2)  Angiography (88.67)

G-4-15-I Kecederaan Pembuluh 5,682,800 6,819,400 7,956,000 3,976,900 4,772,200 5,567,600
Darah Otak Non-Spesifik &
Penyumbatan Pre-Cerebral
Tanpa Infark (Ringan)
G-4-15-II Kecederaan Pembuluh 6,782,200 8,138,600 9,459,500 4,746,200 5,695,400 6,644,600
Tanpa Infark (Sedang)
G-4-15-III Kecederaan Pembuluh 9,572,400 11,486,900 13,401,400 6,698,800 8,038,600 9,378,400
Tanpa Infark (Berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI ARTERI CAROTID ( ) 2
Diagnosis Tindakan
 Occlusion and stenosis of carotid artery (I65.2)  Angioplasty (39.50)
 Endarterectomy, upper limb vessels (ICD IX 38.13)
 Endarterectomy, lower limb vessels (ICD IX 38.18)
 Endarterectomy, unspecified site (ICD IX 38.10)

20.883.000
I-1-20-I Prosedur sistem peredaran 20.675.700 24.810.900 28.946.000 14.916.500 17.899.700
27.424.600
I-1-20-III Prosedur sistem peredaran 27.152.300 32.582.800 38.013.300 19.589.000 23.506.800
Comorbid
wound (T81.3)
STENOSIS/OKLUSI AORTA TORAKALIS ( ) 1
Diagnosis Tindakan
 Atherosclerosis of Aorta (ICD X: I70.0)  Angiography / phlebography of other specific sites
using contrast material (88.67)

I-4-15-I 4,722,500 5,667,000 6,611,500 4,351,800 5,222,100 6,092,500
(sedang)
I-4-15-III 10,686,300 12,823,500 14,960,800 7,104,400 8,525,200 9,946,100
Comorbid
wound (T81.3)
STENOSIS/OKLUSI AORTA TORAKALIS ( ) 2
Diagnosis Tindakan
 Atherosclerosis of Aorta (ICD X: I70.0)  Angioplasty (39.50)
 Endarterectomy of other thoracic vessels (38.15)

Prosedur pembuluh darah
I-1-12-I 16,202,500 19,443,000 22,683,600 11,689,300 14,027,100 16,365,000
torasik kompleks (ringan)
I-1-12-II 26,462,000 31,754,400 37,046,800 18,518,200 22,221,900 25,925,500
torasik kompleks (sedang)
I-1-12-III 34,814,800 41,777,700 48,740,700 24,363,500 29,236,200 34,108,900
torasik kompleks (berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI AORTA ABDOMINALIS ( ) 1
Diagnosis Tindakan
 Atherosclerosis of Aorta (ICD X: I70.0)  Angiography (88.67)

I-4-15-I 4,722,500 5,667,000 6,611,500 4,351,800 5,222,100 6,092,500
(sedang)
I-4-15-III 10,686,300 12,823,500 14,960,800 7,104,400 8,525,200 9,946,100
Comorbid
wound (T81.3)
STENOSIS/OKLUSI AORTA ABDOMINALIS ( ) 2
Diagnosis Tindakan
 Atherosclerosis of Aorta (ICD X: I70.0)  Angioplasty (39.50)
 Endarterectomy of other Abdominal vessels (38.16)

I-1-13-I abdominal komplek (ringan) 15,716,200 18,859,500 22,002,700 11,338,400 13,606,100 15,873,800
I-1-13-II abdominal komplek 20,929,400 25,115,300 29,301,100 15,099,400 18,119,300 21,139,200
(sedang)
I-1-13-III 25,811,700 30,974,100 36,136,400 18,621,800 22,346,100 26,070,500
abdominal komplek (berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI ARTERI RENAL ( ) 1
Diagnosis Tindakan
 Atherosclerosis of Renal Artery (ICD X: I70.1)  Angiography (88.67)

Penyakit ginjal dan saluran
N-4-16-I 5,127,500 6,153,000 7,178,500 3,588,200 4,305,900 5,023,500
urin lain-lain (ringan)
N-4-16-II 7,318,600 8,762,300 10,246,000 5,121,600 6,145,900 7,170,200
urin lain-lain (sedang)
N-4-16-III 9,741,600 11,689,900 13,638,200 7,028,000 8,433,600 9,839,200
urin lain-lain (berat)
Comorbid
wound (T81.3)
STENOSIS/OKLUSI ARTERI RENAL ( ) 2
Diagnosis Tindakan
 Atherosclerosis of Renal Artery (ICD X: I70.1)  Angioplasty or atherectomy of other non-coronary
vessel (39.50)

20.883.00
I-1-20-I Prosedur sistem peredaran 20.675.700 24.810.900 28.946.000 14.916.500 17.899.700 0
27.424.60
I-1-20-III Prosedur sistem peredaran 27.152.300 32.582.800 38.013.300 19.589.000 23.506.800 0
Comorbid
wound (T81.3)
ARTERIAL THROMBOSIS
Diagnosis : Embolism and thrombosis of other arteries (I82.8)
Tindakan :
• Endovaskular trombektomi (39.79)
• Tromboembolektomi (Other surgical occlusion of vessels, unspecified site) (38.80)
• Other (peripheral) vascular shunt or bypass (39.29)
20.883.00
27.424.60
Comorbid
wound (T81.3)
DIABETIC WITH VASCULAR COMPLICATION ( ) 1
Diagnosis :
 Non-insulin-dependent diabetes mellitus: With peripheral circulatory complications (E11.5); DM dengan CKD E10-13.2
• Non-insulin-dependent diabetes mellitus: With peripheral circulatory complications (ulcer, gangrene) (E14.5)
• Ulkus decubitus karena DM (L89)
Tindakan :
 Excisional debridement of wound, infection, or burn (86.22)
 Application of other wound dressing (93.57)

I-4-15-I 4,722,500 5,667,000 6,611,500 4,351,800 5,222,100 6,092,500
I-4-15-II perifer dan lain-lain (sedang) 8,905,200 10,686,300 12,467,300 5,920,300 7,104,400 8,288,400
I-4-15-III 10,686,300 12,823,500 14,960,800 7,104,400 8,525,200 9,946,100
Comorbid
wound (T81.3)
Diagnosis : DM dengan Gangren E10-13.5
Tindakan : Amputation of toe (ICD IX 84.11) (Mutilasi)
Kode Deskripsi TIPE A TIPE B

INA-CBG Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
M-1-30-I Prosedur kaki 11.762.000 14.114.300 16.466.700 11.879.90
(ringan) 8.485.600 10.182.800 0
M-1-30-II Prosedur kaki 19.059.200 22.871.000 26.682.800
(sedang) 13.750.200 16.500.200 19.250.300
27.526.10
M-1-30-III Prosedur kaki (berat) 27.252.900 32.703.500 38.154.100 19.661.500 23.593.800 0
Comorbid
wound (T81.3)
Diagnosis : DM dengan Gangren (E10-13.5)
Tindakan :
 Lower limb amputation, not otherwise specified (84.10)
 Other amputation below knee (84.15)
 Amputation above knee (84.17)
 Amputation through foot (84.12)
 Amputation of ankle through malleoli of tibia and fibula (84.14)

M-1-02-I Amputasi (ringan) 12.796.500 15.355.800 17.915.100 9,232,000 11,078,400 12,924,800
M-1-02-II Amputasi (sedang) 20.992.200 25.190.600 29.389.000 15,144,700 18,173,700 21,202,600
M-1-02-III Amputasi (berat) 35.665.200 42.798.200 49.931.200 24,958,600 29,950,300 34,942,100
Comorbid
wound (T81.3)
KOMPRESI VENA CAVA ( ) 1
Diagnosis : Compression of vein (ICD X I87.1)

Tindakan : Veno-venous bypass (ICD IX 39.29)

I-1-12-I 16,202,500 19,443,000 22,683,600 11,689,300 14,027,100 16,365,000
torasik kompleks (ringan)
I-1-12-II 26,462,000 31,754,400 37,046,800 18,518,200 22,221,900 25,925,500
torasik kompleks (sedang)
I-1-12-III 34,814,800 41,777,700 48,740,700 24,363,500 29,236,200 34,108,900
torasik kompleks (berat)
Comorbid
wound (T81.3)
KOMPRESI VENA CAVA ( ) 2
Diagnosis : Compression of vein (I87.1)

Tindakan : Veno cava stent (38.7)

20.883.00
27.424.60
Comorbid
wound (T81.3)
DEEP VEIN THROMBOSIS (DVT)
Diagnosis : Embolism and thrombosis of other specified veins (I82.8)
Tindakan
 Venography (ICD IX: 88.67) -- tambahan  Other (peripheral) vascular shunt or bypass (ICD IX :
 Injection of anticoagulant ICD IX : 99.19) -- 39.29)
tambahan  Pasang Vena Cava Filter (ICD IX: 86.07)
 Other endovascular procedures on other vessels  Tromboembolektomi (Other surgical occlusion of
(ICD IX : 39.79) vessels, unspecified site) (38.80)

lain-lain (ringan)
lain-lain (sedang)
lain-lain (berat)
Comorbid
wound (T81.3)
VARICOSE VEIN ( ) 1
Pilihan diagnosis Pilihan Tindakan

 Varicose veins of lower extremities (ICD X : I83)  Endovenous radiofrequency / laser ablation (ICD IX
 Venous insufficiency (ICD X I87.2) 38.50)
 Varicose veins of lower extremities without ulcer  Injection of sclerosing agent into vein (ICD IX 39.92)
or inflammation (ICD X I83.9)

I-1-17-I Ligasi dan Stripping Pembuluh Darah 18.343.000 22.011.600 25.680.200
13,630,500 16,356,600 19,082,700
Vena (Ringan)
I-1-17-II Ligasi dan Stripping Pembuluh Darah 22.967.200 27.560.600 32.154.100
17,066,700 20,480,000 23,893,400
Vena (Sedang)
I-1-17-III Ligasi dan Stripping Pembuluh Darah 28.410.100 34.092.100 39.774.100
21,111,200 25,333,500 29,555,700
Vena (Berat)
Comorbid
wound (T81.3)
VARICOSE VEIN ( ) 2

 Varicose veins of lower extremities (ICD X : I83)  Elastic bandage (ICD IX 93.59)
 Venous insufficiency (ICD X I87.2)
 Varicose veins of lower extremities without ulcer
or inflammation (ICD X I83.9)

I-4-15-I Penyakit Pembuluh Darah Perifer dan 4.722.500 5.667.000 6.611.500
4,351,800 5,222,100 6,092,500
Lain – Lain (Ringan)
I-4-15-II Penyakit Pembuluh Darah Perifer dan 8.905.200 10.686.300 12.467.300
5,920,300 7,104,400 8,288,400
Lain – Lain (Sedang)
I-4-15-III Penyakit Pembuluh Darah Perifer dan 10.686.300 12.823.500 14.960.800
7,104,400 8,525,200 9,946,100
Lain – Lain (Berat)
Comorbid
• Severity III : Pneumonia (J18.9)/Efusi Pleura (J90)/ Sepsis (A41.8), Coagulopathy (D68.9)
PHLEBITIS AND THROMBOPHLEBITIS ( ) 1
Diagnosis Tindakan
 Phlebitis and thrombophlebitis (I80)  Elastic bandage (ICD IX 93.59)
 Other venous embolism and thrombosis (I82)  Application of other wound dressing (93.57),
 Embolism and thrombosis of other specified veins (I82.9)  Application of pressure dressing (93.56)

I-4-15-I perifer dan lain-lain (ringan) 4,722,500 5,667,000 6,611,500 4,351,800 5,222,100 6,092,500
I-4-15-II perifer dan lain-lain (sedang) 8,905,200 10,686,300 12,467,300 5,920,300 7,104,400 8,288,400
I-4-15-III perifer dan lain-lain (berat) 10,686,300 12,823,500 14,960,800 7,104,400 8,525,200 9,946,100
Comorbid
wound (T81.3)
PHLEBITIS AND THROMBOPHLEBITIS ( ) 2
Diagnosis Tindakan
 Phlebitis and thrombophlebitis (I80)  Other (peripheral) vascular shunt or bypass (39.29)
 Other venous embolism and thrombosis (I82)
 Embolism and thrombosis of other specified veins (I82.9)

lain-lain (ringan)
lain-lain (sedang)
lain-lain (berat)
Comorbid
wound (T81.3)
THROMBOANGITIS OBLITERANS ( ) 1
Diagnosis : Thromboangiitis obliterans [Buerger] (ICD X I73.1)

Tindakan : Lumbal simpatektomi (ICD IX 05.23)

G-1-20-I Prosedur Saraf Kranial dan Perifer 11.594.600 13.913.500 16.232.400
8,809,200 10,571,100 12,332,900
(Ringan)
G-1-20-II Prosedur Saraf Kranial dan Perifer 17.544.400 21.053.300 24.562.200
14,340,800 17,209,000 20,077,200
(Sedang)
G-1-20-III Prosedur Saraf Kranial dan Perifer 29.916.400 35.899.700 41.883.000
22,008,300 26,410,000 30,811,600
(Berat)
Comorbid
wound (T81.3)
Diagnosis : Thromboangiitis obliterans [Buerger] (ICD X I73.1) dengan atau tanpa gangrene kode sama
Tindakan : Amputation and disarticulation of finger (hand) (ICD IX 84.01)

M-1-80-I Prosedur anggota 11.670.100 14.004.200 16.338.200 11.787.10
tubuh atas (ringan) 8.419.400 10.103.300 0
M-1-80-II Prosedur anggota 13.859.400 16.631.300 19.403.100
tubuh atas (sedang) 9.998.800 11.998.600 13.998.300
31.507.20
M-1-80-III Prosedur anggota 31.194.500 37.433.400 43.672.300 22.505.200 27.006.200 0
tubuh atas (berat)
Comorbid
wound (T81.3)
Diagnosis : Thromboangiitis obliterans [Buerger] (ICD X I73.1) dengan atau tanpa gangrene kode sama
Tindakan : Amputation of toe (ICD IX 84.11)

M-1-30-I Prosedur kaki 11.762.000 14.114.300 16.466.700 8.485.600 10.182.800 11.879.900
(ringan)
13.750.200 16.500.200 19.250.300
(sedang)
M-1-30-III Prosedur kaki (berat) 27.252.900 32.703.500 38.154.100 19.661.500 23.593.800 27.526.100
Comorbid
wound (T81.3)
RAYNAUD’S SYNDROME (tanpa gangrene)
Diagnosis : Raynaud’s Syndrome (I73.00)
Tindakan : Torakal simpatektomi (ICD IX 05.29)

G-1-20-I Prosedur Saraf Kranial dan Perifer 11.594.600 13.913.500 16.232.400
8,809,200 10,571,100 12,332,900
(Ringan)
G-1-20-II Prosedur Saraf Kranial dan Perifer 17.544.400 21.053.300 24.562.200
14,340,800 17,209,000 20,077,200
(Sedang)
G-1-20-III Prosedur Saraf Kranial dan Perifer 29.916.400 35.899.700 41.883.000
22,008,300 26,410,000 30,811,600
(Berat)
Comorbid
wound (T81.3)
RAYNAUD’S SYNDROME (dengan gangrene) (1)
Diagnosis : Raynaud’s Syndrome dengan gangrene (I73.01)
Tindakan : Amputation and disarticulation of finger (hand) (ICD IX 84.01)
Kode INA- Deskrip TIPE A TIPE B

CBG si Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
M-1-80-I Prosedur anggota 11.670.100 14.004.200 16.338.200
tubuh atas (ringan) 8.419.400 10.103.300 11.787.100
M-1-80-II Prosedur anggota 13.859.400 16.631.300 19.403.100
tubuh atas (sedang) 9.998.800 11.998.600 13.998.300
M-1-80-III Prosedur anggota 31.194.500 37.433.400 43.672.300 22.505.200 27.006.200 31.507.200
tubuh atas (berat)
Comorbid
wound (T81.3)
RAYNAUD’S SYNDROME (dengan gangrene) (2)
Diagnosis : Raynaud’s Syndrome dengan gangrene (I73.01)
Tindakan : Amputation of toe (ICD IX 84.11)
Kode INA- Deskrips TIPE A TIPE B

CBG i Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1
M-1-30-I Prosedur kaki 11.762.000 14.114.300 16.466.700
(ringan) 8.485.600 10.182.800 11.879.900
(sedang) 13.750.200 16.500.200 19.250.300
M-1-30-III Prosedur kaki (berat) 27.252.900 32.703.500 38.154.100 19.661.500 23.593.800 27.526.100
Comorbid
wound (T81.3)
PLACENTA ACCRETA
(DENGAN KLAMP TEMPORER AORTA)
Diagnosis: Placenta accreta, unspecified trimester (O43.219)
Tindakan
• Other surgical occlusion of vessels, aorta, abdominal (38.84)
• Other intra-abdominal vascular shunt or bypass (39.26)
• Other operations on vessels (39.99)

lain-lain (ringan)
lain-lain (sedang)
lain-lain (berat)
Comorbid
wound (T81.3)
PLASENTA AKRETA
(DEDANGAN EKSPLORASI VASKULAR SAJA)
Diagnosis : Morbidly Adherent Placenta (O43.2)
Tindakan :
- Eksplorasi vaskular/ Other Operations on Vessels (39.99)

271 I-1-20-I PROSEDUR SISTIM PEREDARAN 20,675,700 24,810,900 28,946,000 15,363,900 18,436,700 21,509,500
DARAH LAIN-LAIN (RINGAN)
271 I-1-20-II PROSEDUR SISTIM PEREDARAN 25,829,700 30,995,600 36,161,600 19,193,800 23,032,500 26,871,300
DARAH LAIN-LAIN (SEDANG)
271 I-1-20-III PROSEDUR SISTIM PEREDARAN 27,152,300 32,582,800 38,013,300 20,176,600 24,212,000 28,247,300
DARAH LAIN-LAIN (BERAT)
Comorbid
• Severity II: DM (E11.8)/ Anemia (D64.9)/ TB Paru (A16)/ Gagal jantung (I50.9)/ CKD st.V (N18)/Hipoalbumin (R 77.0)
• Severity III : Pneumonia (J18.9)/Efusi Pleura (J90)/ Sepsis (A41.8), Coagulopathy (D68.9)/ Disruption of
operation wound (T81.3)
LIMFOEDEMA
Diagnosis : Lymphoedema, not elsewhere classified (ICD X I89.0)
Tindakan : Excision Of Lymphatic Structure (ICD IX 40.2)

Prosedur pada darah dan organ
D-1-20-I pembentuk darah lain-lain 7,164,500 8,597,400 10,030,300 5,013,800 6,016,500 7,019,300
(ringan)
D-1-20-II pembentuk darah lain-lain 19,744,300 23,693,200 27,642,100 13,817,200 16,580,600 19,344,000
(sedang)
D-1-20-III pembentuk darah lain-lain 31,320,300 37,584,400 43,848,400 21,918,100 26,301,700 30,685,300
(berat)
Comorbid
 Severity I : DM (E11.8)/ Hipertensi (I.10)/Anemia (D64.9)
 Severity II : DM+Hipertensi/TB Paru (A16.0)
 Severity III : Pneumonia (J18.9)/Efusi Pleura (J90)/Sepsis (a41.8)/Disruption of operation wound (T81.3)
FASCITIS NECROTICAN
Diagnosis : Necrotizing fasciitis (M72.66); Gas Gangren tanpa DM (A48.0)
Tindakan :
• Fasciotomy (83.14)
• Lower limb amputation, not otherwise specified (84.10)
• Other amputation below knee (84.15)
• Other immobilization, pressure, and attention to wound (93.59)
M-I-50-I Prosedur jaringan lunak (ringan) 7,174,800 8,609,800 10,044,800 5,176,300 6,211,500 7,246,800
M-I-50-II Prosedur jaringan lunak (sedang) 11,906,600 14,287,900 16,669,200 8,590,000 10,307,900 12,025,900
M-I-50-III Prosedur jaringan lunak (berat) 19,555,800 23,466,900 27,378,100 14,108,500 16,930,100 19,751,800
Comorbid
wound (T81.3)
AKSES VASKULAR HAEMODIALISA
Diagnosis : CKD stg V on HD Regular (N18.5)
Tindakan
• Pemasangan CDL non-tunneling (ICD IX : 38.95)
• Pasang CDL tunneling (ICD IX: 38.95)
• Arteriovenostomy for renal dialysis (ICD IX: 39.27)
• Revisi AV Shunt/ CDL (ICD IX: 39.42)

N-1-12-I Membuat baru, merevisi, dan 6.021.800 7.226.200 8.430.600 4,214,100 5,056,900 5,899,700
memindahkan alat dialysis (ringan)
N-1-12-II Membuat baru, merevisi, dan 11.988.800 14.386.600 16.784.400 8,649,300 10,379,200 12,109,000
memindahkan alat dialysis (sedang)
N-1-12-III Membuat baru, merevisi, dan 26.016.200 31.219.400 36.422.700 18,769,300 22,523,200 26,277,000
memindahkan alat dialysis (berat)
Comorbid
• Severity II: DM (E11.8)/ Anemia pada CKD (D63.8) : Hb < 8 (Wajib Tranfusi)/TB Paru (A16)/ Gagal jantung (I50.9)
wound (T81.3)
MALFUNGSI AV SHUNT
Diagnosis : Other mechanical complication of surgicaly created arteriovenous shunt (T82.5)
Tindakan
• Pemasangan CDL non-tunneling (ICD IX : 38.95)
• Pasang CDL tunneling (ICD IX: 38.95)
• Arteriovenostomy for renal dialysis (ICD IX: 39.27)
• Revisi AV Shunt/ CDL (ICD IX: 39.42)

N-1-12-I Membuat baru, merevisi, dan 6.021.800 7.226.200 8.430.600 4,214,100 5,056,900 5,899,700
memindahkan alat dialysis (ringan)
N-1-12-II Membuat baru, merevisi, dan 11.988.800 14.386.600 16.784.400 8,649,300 10,379,200 12,109,000
memindahkan alat dialysis (sedang)
N-1-12-III Membuat baru, merevisi, dan 26.016.200 31.219.400 36.422.700 18,769,300 22,523,200 26,277,000
memindahkan alat dialysis (berat)
Comorbid
wound (T81.3)
INFECTED AKSES VASKULAR
ICDX:
Infections following infusion transfusion and therapeutic inject T80.2
ICD IX :
Removal of other therapeutic device from head and neck 97.39

KODE
DESKRIPSI
INACBGS
A-4-11-I INFEKSI SESUDAH OPERASI &

4,263,700 5,116,500 5,969,200 3,197,800 3,837,300 4,476,900
TRAUMA (RINGAN)
A-4-11-II INFEKSI SESUDAH OPERASI &

TRAUMA (SEDANG) 6,068,500 7,282,200 8,495,900 4,551,400 5,461,700 6,371,900
A-4-11- INFEKSI SESUDAH OPERASI &

III TRAUMA (BERAT) 8,399,400 10,079,200 11,759,100 6,299,500 7,559,400 8,819,300
Comorbid
wound (T81.3)
AKSES VASKULAR KEMOTERAPI
Diagnosis : Chemotherapy session for neoplasm (Z51.1)
Tindakan
• Pemasangan kemoport (86.07)

L-1-40-I Prosedur pada kulit, jaringan bawah 6.906.900 8.288.300 9.669.700
4,833,500 5,800,200 6,766,900
kulit (ringan)
L-1-40-II Prosedur pada kulit, jaringan bawah 13.853.700 16.624.500 19.395.200
9,694,900 11,633,900 13,572,800
kulit (sedang)
L-1-40-III Prosedur pada kulit, jaringan bawah 23.318.900 27.982.700 32.646.500
16,318,700 19,582,400 22,846,100
kulit (berat)
Comorbid
wound (T81.3)
AKSES VASKULAR VENA SENTRAL
Diagnosis : Hipokalemia (E87.6) dll
Tindakan
• Central venous catheter placement with guidance (38.97)

E-4-11-I Hipovolemia & Gangguan 4.099.400 4.919.300 5.739.200 2.868.800 3.442.500 4.016.300
Elektrolit (ringan)
E-4-11-II Hipovolemia & Gangguan 6.249.900 7.449.900 8.749.900 4.373.700 5.248.400 6.123.200
Elektrolit (sedang)
E-4-11-III Hipovolemia & Gangguan 8.469.100 10.162.900 11.856.700 6.110.000 7.332.000 8.554.000
Elektrolit (berat)
Comorbid
wound (T81.3)
HEMANGIOMA
Diagnosis : Haemangioma and lymphangioma, any site (D18)
Tindakan : Other excision of vessels, unspecified site (38.60)

20.883.00
27.424.60
Comorbid
wound (T81.3)
ARTERI-VENOUS MALFORMASI (AVM)
Diagnosis : Arteriovenous malformation (peripheral) (Q27.3)
Tindakan
• Angiografi (ICD IX: 88.67) -- tambahan
• Embolisasi (ICD IX: 38.80)
• Other excision of vessels, unspecified site ( ICD IX : 38.60)
• Other endovascular procedures on other vessels (ICD IX : 39.79)

lain-lain (ringan)
lain-lain (sedang)
lain-lain (berat)
Comorbid
wound (T81.3)
KRIPPEL TRENAUNAY SYNDROME
Diagnosis : Krippel Trenaunay Syndrome (Q87.2)
Tindakan :
RUPTURE OF ARTERY
 Rupture of artery (I77.2)  Suture of artery (39.31)
 Injury of brachial artery (S45.1)  Endovascular procedure (39.79)
 Injury of popliteal artery (S85.0)  Angioplasty of other non-coronary vessel(s) (39.50)
 Injury of blood vessels at hip and thigh level (S75.-)  Other revision of vascular procedure (39.49)
 Injury of (anterior)(posterior) tibial artery (S85.1)  Repair of blood vessel with tissue patch graft (39.56)
 Injury of ulnar artery at forearm level (S55.0)  Control of hemorrhage following vascular surgery (39.41)
 Injury of unspecified blood vessel at neck level (S15.9)  Incision of vessel, lower limb arteries (38.08)
 Injury of unspecified blood vessel at shoulder and upper
arm level (S45.9)

lain-lain (ringan)
lain-lain (sedang)
lain-lain (berat)
Comorbid
• Severity I : Hipertensi (I10)
• Severity II : DM (E11.8)/ Anemia (D64.9)/ TB Paru (A16)/ Gagal jantung (I50.9)/ CKD st.V (N18)
• Severity III: Pneumonia (J18.9)/Efusi Pleura (J90)/ Sepsis (A41.8), Coagulopathy (D68.9)/ Disruption of operation wound (T81.3)
RUPTURE OF VEIN
 Injury of axillary or brachial vein (ICD X S45.2)  Suture of vein (39.32)
 Injury of inferior vena cava (S35.1)

I-1-17-I Ligasi dan Stripping Pembuluh Darah 18.343.000 22.011.600 25.680.200
13,630,500 16,356,600 19,082,700
Vena (Ringan)
I-1-17-II Ligasi dan Stripping Pembuluh Darah 22.967.200 27.560.600 32.154.100
17,066,700 20,480,000 23,893,400
Vena (Sedang)
I-1-17-III Ligasi dan Stripping Pembuluh Darah 28.410.100 34.092.100 39.774.100
21,111,200 25,333,500 29,555,700
Vena (Berat)
Comorbid
wound (T81.3)
DEAD LIMB
Diagnosis : Ischaemic infarction of muscle (M 62.2)
Tindakan :
•
Injection of Antibiotic (99.21)
TIPE A TIPE B
Kode INA-
Deskripsi
CBG
Gangguan sistem
muskuloskeletal & jaringan
M-4-21-I penyambung lain-lain 3.686.500 4.423.800 5.161.100 2.866.500 3.439.800 4.013.100
(ringan)
Gangguan sistem
M-4-21-II penyambung lain-lain (sedang) 4.610.800 5.532.900 6.455.100 3.585.200 4.302.200 5.019.200
Gangguan sistem
M-4-21-III penyambung lain-lain 10.337.300 12.404.700 14.471.200 8.037.900 9.645.400 11.253.000
(berat)
Comorbid
wound (T81.3)
Diagnosis Vaskular Lainnya
Peripheral Vascular disease, unspesific I73.9
Ischaemic infarction of muscle M62.2
Traumatic ischaemia of muscle T79.6
Cutaneous abscess, furuncle and carbuncle of limb L02.4
Ulcer of lower limb, not elsewhere classified L97
Necrosis of artery I77.5
Other chronic osteomyelitis M86.6
Disruption of operation wound, not elsewhere classified T81.3
Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts T82.7
Congenital malformation syndromes predominantly involving limbs Q87.2
Deep phlebothrombosis in the puerperium O87.1
L92.-
Granulomatous disorders of skin and subcutaneous tissue
T87.5
Necrosis of amputation stump
Osteonecrosis M87.-
KETENTUAN KODING VASKULAR
 Anemia pada CKD (D63.8) : Hb < 8 (Wajib Tranfusi)
 Koding DM dengan CKD E10-13.2
 Koding DM dengan Gangren E10-13.5
 Ulkus decubitus karena DM (L89)
 Gas Gangren tanpa DM (A48.0)

 CPR (99.60)
 Hipertensi
 Pada koding elektrolit imbalans seperti hiponatremi, hipernatremi dan hipo/hiper kalemi mohon disertakan terapi
dan lab pendukung
 Pneumonia Covid -19 (B34.2)
PNEUMONIA COVID 19
Diagnosis : Tindakan :
- Other Viral Pneumonia (J12.8) - Extracorporeal Membrane Oxygenation (ECMO) (39.65)
- Respiratory Failure, not elsewhere classified (J96) - Other Diagnostic Ultrasound (88.79)
- Non-Insulin-Dependent Diabetes Melitus (E11)
- Obesity (E66)

251 I-1-11-I DEFIBRILATOR JANTUNG DAN 5,628,900 6,754,600 7,880,400 4,182,800 5,019,300 5,855,900
PEMASANGAN SISTEM BANTUAN
JANTUNG (RINGAN)
251 I-1-11- DEFIBRILATOR JANTUNG DAN 6,258,700 7,510,500 8,762,200 4,650,800 5,581,000 6,511,100
II PEMASANGAN SISTEM BANTUAN
JANTUNG (SEDANG)
251 I-1-11- DEFIBRILATOR JANTUNG DAN 8,328,500 9,994,100 11,659,800 6,188,800 7,426,600 8,664,300
III PEMASANGAN SISTEM BANTUAN
JANTUNG (BERAT)
Comorbid
• Severity III : Pneumonia (J18.9)/Efusi Pleura (J90)/ Sepsis (A41.8), Coagulopathy (D68.9)/ Disruption of operation wound (T81.3)
PERHITUNGAN TARIF BIAYA RAWAT INAP BERDASARKAN KETENTUAN KEMENKES UNTUK COVID-19
(SESUAI DENGAN PERATURAN KEMENKES TERTANGGAL 05 APRIL 2021)
Norma pembayaran sebagai berikut:

a. Merawat ≤ 6 jam, dibayar sesuai tarif INA-CBG rawat jalan.
b. Merawat > 6 jam-2 hari, dibayar 70 % dari tarif klaim.
c. Merawat > 2-5 hari, dibayar 80 % dari tarif klaim.
d. Merawat > 5 hari, dibayar 100% dari tarif klaim.
e. Bila pasien suspek/probable/konfirmasi COVID-19 datang ke rumah sakit dengan kondisi berat/kritis, kemudian pasien
tersebut meninggal, maka dibayar 100% dari tarif klaim. Dibuktikan dengan resume medis dan telah dilakukan tindakan
resusitasi dan dilakukan pelayanan pemulasaraan jenazah sesuai protokol pemulasaraan jenazah kasus konfirmasi
COVID-19
Penggantian Biaya yang diberikan untuk pemulasaran jenazah

NO. Kriteria Besaran
1. Pemulasaraan Jenazah 550,000
2. Kantong Jenazah 100,000
3. Peti Jenazah 1,750,000
4. Plastik Erat 260,000
5. Desinfektan Jenazah 100,000
6. Transport mobil jenazah 500,000
7. Desinfektan mobil jenazah 100,000
Perhitungan Tarif Klaim Pasien Rawat Inap
TARIF KLAIM PASIEN: (a+ ((n.b)-a)-c

Keterangan:
Tarif klaim pasien adalah tarif INA-CBG ditambah jumlah LOS pasien dikalikan cost per hari
a = Tarif INA-CBG n = Jumlah LOS
b = Tarif per hari (cost per day)
c = APD dan obat-obatan dari bantuan
Besaran Tarif per hari (cost per day)

Gabung KODING 10072021

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Gabung KODING 10072021

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KODING

ICD X - ICD IX-CM

Repair of atrial septal defect with tissue graft (35.61)

Kode INA - TIPE A TIPE B

• Repair of ventricular septal defect with prosthesis. open technique 35.53

Kode INA TIPE A TIPE B

Kode INA - TIPE A TIPE B

Kode INA TIPE A TIPE B

Kode TIPE A TIPE B

Kode INA - TIPE A TIPE B

Kode TIPE A TIPE B

Kode INA TIPE A TIPE B

Kode TIPE A TIPE B

Kode INA TIPE A TIPE B

Kode INA TIPE A TIPE B

Kode INA - TIPE A TIPE B

 Nonexcisional debridement of wound, infection, or burn ICD IX 86.28

Kode INA- RS Tipe A RS Tipe B

Komplikasi dari Penatalaksanaan

Kode INAC RS Tipe A RS Tipe B

Cardiopulmonary resuscitation, not otherwise specified (99.60)

KETENTUAN KODING UMUM

I-1- Pembedahan Bypass Pembuluh Koroner

I-1- Pembedahan Bypass Pembuluh Koroner

I-1- Pembedahan Bypass Pembuluh Koroner

I-1- Prosedur Bypass Koroner Tanpa

I-1- Prosedur Bypass Koroner Tanpa

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Katup Jantung

I-1- Prosedur Katup Jantung

I-1- Prosedur Katup Jantung

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Katup Jantung Tanpa

Kode RS Tipe A RS Tipe B

Kode RS Tipe A RS Tipe B

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Katup Jantung Tanpa

Kode RS Tipe A RS Tipe B

I–1– 21,337,800 25,605,400 29,872,900

I–1– 21,337,800 25,605,400 29,872,900

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Katup Jantung Tanpa

I-1- Prosedur Pembuluh Darah

Kode RS Tipe A RS Tipe B

S-4- Komplikasi dari Penatalaksanaan Pasien

CBGs Kelas 3 Kelas 2 Kelas 1 Kelas 3 Kelas 2 Kelas 1

J‐1‐ Ventilasi Mekanikal Long Term 87,278,900 28,008,100 33,609,700 39,211,300

Kode INAC RS Tipe A RS Tipe B

 Extracorporeal circulation auxiliary to open heart surgery ICD IX 39.6

 AV blok(I44.-) : Harap EKG dan pembacaan disertakan

KETENTUAN KODING UMUM

KODE RS. TIPE A RS. TIPE B

PLEURAL EFUSI DAN

KODE RS. TIPE A RS. TIPE B

PLEURAL EFUSI DAN

KODE RS. TIPE A RS. TIPE B

PLEURAL EFUSI DAN

RS. TIPE A RS. TIPE B

PLEURAL EFUSI DAN

PLEURAL EFUSI DAN

PLEURAL EFUSI DAN

KODE RS. TIPE A RS. TIPE B