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PERATURAN MENTERI KESEHATAN

NOMOR 4 TAHUN 2017

Barru, 16 Februari 2016

1
KDDIAG NMDIAG KASUS BIAYA
I10 Essential (primary) hypertension 10 7.801.400
H110 Pterygium 6 19.126.800

E119 Non-insulin-depend diabetes mellitus without complication 6 907.200

T140 Superficial injury of unspecified body region 6 907.200


D649 Anaemia, unspecified 6 943.200
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200
Pasal 25

KDDIAG NMDIAG KASUS BIAYA


I10 Essential (primary) hypertension 10 7.801.400
H110 Pterygium 6 19.126.800

E119 Non-insulin-depend diabetes mellitus without complication 6 907.200

T140 Superficial injury of unspecified body region 6 907.200


D649 Anaemia, unspecified 6 943.200
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200
CONTOH 1
KELAS 3 KE KELAS 2
KDDIAG NMDIAG KASUS BIAYA
I10
H110

E119
Pterygium
CBGs KELAS 3
Essential (primary) hypertension

Non-insulin-depend diabetes mellitus without complication


10
6

6
7.801.400
19.126.800

907.200
2,000,000
CBGs KELAS 2 2,500,000
T140 Superficial injury of unspecified body region 6 907.200
D649 Anaemia, unspecified 6 943.200
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900

SELISIH 500,000
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200
KDDIAG NMDIAG KASUS BIAYA
I10 Essential (primary) hypertension 10 7.801.400
H110 Pterygium 6 19.126.800

E119 Non-insulin-depend diabetes mellitus without complication 6 907.200

T140 Superficial injury of unspecified body region 6 907.200


D649 Anaemia, unspecified 6 943.200
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200
KELAS 1 KE VIP
CBGs KELAS 1 KDDIAG
I10
4,000,000 NMDIAG
Essential (primary) hypertension
TARIF RIIL VIP 4,500,000
KASUS
10
BIAYA
7.801.400
H110 Pterygium 6 19.126.800

SELISIH MAX (75%)


E119

T140
D649
3,000,000
Non-insulin-depend diabetes mellitus without complication

Superficial injury of unspecified body region


Anaemia, unspecified
SELISIH
6

6
6
907.200

907.200
943.200
500,000
CBGs + SELISIH 4,500,000
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900

BY RS BY RS
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200

7,000,000 7,000,000
KDDIAG NMDIAG KASUS BIAYA
I10 Essential (primary) hypertension 10 7.801.400
H110 Pterygium 6 19.126.800

E119 Non-insulin-depend diabetes mellitus without complication 6 907.200

T140 Superficial injury of unspecified body region 6 907.200


D649 Anaemia, unspecified 6 943.200
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200
CBGs KELAS 1 4,000,000
CBGs KELAS 2 3,500,000
KDDIAG NMDIAG KASUS BIAYA
I10
H110

E119
Essential (primary) hypertension
Pterygium

Non-insulin-depend diabetes mellitus without complication


10
6

6
500,000
7.801.400
19.126.800

907.200

SELISIH
T140
D649
R402
Superficial injury of unspecified body region
Anaemia, unspecified
Coma, unspecified
6
6
4
3,000,000
907.200
943.200
897.500
R060 Dyspnoea 3 723.900
R074
Z33
O342
Chest pain, unspecified
Pregnant state, incidental
Maternal care due to uterine scar from previous surgery
3
3
3
3,500,000
3.784.600
1.477.200
2.380.200

BY RS 7,000,000
9
KELAS 3 KE VIP
CBGs KELAS 1 4,000,000
CBGs KELAS 3
KDDIAG
I10
NMDIAG
Essential (primary) hypertension
KASUS
10
3,000,000
BIAYA
7.801.400
H110 Pterygium 6 19.126.800

E119

T140
Non-insulin-depend diabetes mellitus without complication

Superficial injury of unspecified body region


6

6
1,000,000
907.200

907.200
D649 Anaemia, unspecified 6 943.200

SELISIH
R402
R060
R074
Coma, unspecified
Dyspnoea
Chest pain, unspecified
4
3
3
3,000,000
897.500
723.900
3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3

4,000,000
2.380.200

BY RS 7,000,000
KDDIAG NMDIAG KASUS BIAYA
I10 Essential (primary) hypertension 10 7.801.400
H110 Pterygium 6 19.126.800

E119 Non-insulin-depend diabetes mellitus without complication 6 907.200

T140 Superficial injury of unspecified body region 6 907.200


D649 Anaemia, unspecified 6 943.200
R402 Coma, unspecified 4 897.500
R060 Dyspnoea 3 723.900
R074 Chest pain, unspecified 3 3.784.600
Z33 Pregnant state, incidental 3 1.477.200
O342 Maternal care due to uterine scar from previous surgery 3 2.380.200
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