PENGENALAN

ICPM, ICHI & ICD-9-CM Volume 3

 DESCRIPTION

Pembahasan materi meliput pengenalan istilah

sebutan berbagai prosedur/tindakan medis operasi
terapi dan diagnostik, cara menentukan kode yang
akurat, tepat dan berhasilguna menunjang sistem
informasi tindakan operasi/medis, diagnostik maupun
terapuetik.
 TUJUAN INSTRUKSIONAL UMUM

Mampu menentukan kode tindakan operasi/

terapi, diagnostik ataupun terapuetik dengan
presisi, akurat dan tepat, berhasil mengumpulkan,
menyimpannya dan mengambil kembali bagi
kepentingan penyelesaian pelaporan rutin
tindakan
pelayanan ataupun yang suatu waktu diperlukan
oleh manajemen medis ataupun manajemen
kesehatan.
 TUJUAN INSTRUKSIONAL KHUSUS

Menjelaskan:
- ICPM
- Bab 5 (kode bedah) ICPM yang
di-Indonesiakan
- ICHI
- ICD-9-CM volume 3
 ICOPIM
• International Classification of Procedures in
Medicine

Buku klasifikasi prosedur tindakan medis

yang, memuat pengelompokan berbagai
prosedur tindakan dari berbagai cabang ilmu
medis, disusun oleh WHO sebagai suplement
dan bukan bagian integral dari ICD-9.
(10 April 1971, Chicago, AHA, USA)
ICOPIM (Lanjutan-1)

• Lingkup & Form

(a) memungkinan ekspansi bagi yang meng-inginkan
yang lebih rinci, namun juga harus dapat digunakan
sebagai form yang terpampatkan.

(b) harus aplikabel bagi pasien rawat inap maupun

rawat jalan

(c) harus memuat juga semua tipe prosedur yang harus

terrekam bagi kepentingan statistik, adminstrasi, tujuan
klinis maupun riset, meliput tindakan ekplorasi,
radiologik, operasi dan tindakan lain-lain diagnostik,
profilaksis ataupun bentuk terapuetik.
ICOPIM (Lanjutan-2)

Klasifikasi terbagi dalam 9 Bab:

1. Prosedur tindakan medis diagnostik
2. Prosedur laboratoris
3. Radiologii dan aplikasi lain dari kedokteran
fisik
4. Prosedur tindakan preventif
5 Operasi pembedahan
6 & 7 Obat, agen medikamens dan biologis
8 Prosedur terapuetik lain
9/ Prosedur penunjang.
STRUKTUR:

• Struktur mirip dengan ICD: tersusun dari satu

daftar tabulasi dan satu daftar indeks alfabetik.
• Penomoran kategori dimulai dari 1-100 s/d
9-823, dengan digit pertama menunjukkan
nomor Bab klasifikasi, dengan penomoran
dengan 3 digit, dan rincian dan ketepatan pada
digit ke-4.
Digit ke-5 optional sebagai nomor kode subdivisi
bagi kategori-kategori tertentu.
SUMBER:

• Bab 1
Sumber istilah: - AMA, Canada: Schedul of unit value,
- Ontario MA: List of fee dan
- Nomenclatur des acies professionels (France)

• Bab 2
Berdasarkan prosedur laboratoris French project
yang ditata untuk memberi kemungkinan penambahan di
kemudian hari.

• Bab 3
Berdasarkan klasifikasi Swedish, French, Switzerland
yang kemudian dimodifikasi.
Sumber (Lanjutan-1)

• Bab 4
Berdasarkan pelaporan pusat kesehatan dari beberapa
negara.

• Bab 5
Berdasarkan klasifikasi revisi ke 8 Klasifikasi Tidakan
(Adapted) (US Public Health sErvice Publication No;
1693) berserta yang diambil dari Dutch code (Algemene
Ziekenfondsen, 1968), dan klasifikasi Office of
Population Censuses and Surveys (England and Wales,
1974) dan dari dokumen=dokumen administratif
kesehatan masyarakat berbagai regio.
Pengurutan kategori atas dasar topografi, bukan
spesilisasi bedahnya.
Sumber (Lanjutan-2)

• Bab 6 & 7
Dikembangkan selaras dengan ICD-9 960-979
yang mengklasifikasi efek keracunan. Nomor
kode diambil dari ICD-9 dengan menghilangkan
digit pertamanya. 960.0 untuk penisilin menjadi
6-00 pada klasifikasi obat dan subdivisi 6-000-6-
009 untuk identifikasi berbagai penisilin.
• Bab 8
Termasuk di sini prosedur medis terapuetiks
NEC. Aksis klasifikasi mengacu ke intervensi
bukan sistem anatomik.
Sumber (Lanjutan-3)

• Bab 9
Terdiri dari semua prosedur yang tidak termasuk
ke bab-bab lain. Terdiri dari koleksi aktifitas
penunjang yang mungkin saja nampak tidak
berkaitan dengan tujuan dari pegguna
klasifikasi. Klasifikasi disediakan dengan
adanya kemungkinan tindakan-2 terkait
mempunyai pengaruh terhadap aktivitas klinis
yang profesional.
 MODE of UTILIZATION

• Urutan tindakan pengkodean sama dengan ICD

• PPerhatikan tabular list dan inedks alfabetnya agar
dapat menemukan kode yang tepat
• Di dalam daftar tabulasi kode terurut secara numerik,
kadang ada yang melompt urutannya untuk
kemungkinan penmabhan pada masa mendatang.
• Sistem penomorannya satu angka diikuti – dan 3 angka
berikutnya.
• Untuk keperluan tertentu Bab-bab tertentu bisa berdiri
sendiri: Radioterapi, laboratoris, prenventive yang tidak
emmpengaruhi pelayanan terapi, Bab 6 dan Farmasi,
Mode of Utilization (Lanjutan-1)

• Mengingat pasien kemungkinan menerima berbagai

jenis prosedur tindakan, aturan umum koding multiple
adalah esensial, dalam satu bab atau beberapa bab.
Secara ideal semua tindakan harus dikode, Hal ini yang
diperlukan bidang administratif (tagihan dsb) serta untuk
keperluan statistik  berapa jenis yang diplerkukan
diserahkan kepada masing institusi.
• Penggunaan nomor kode berdigit 4 akan lebih rinci.
• Desain formulir sistem pengumpulan data sangat
bergantung kepada nomor kode dan aspek lain
pemrosesan data. Form untuk antry data sangat
bergantung pada kebutuhan institusi, oleh karenanya
dipersilahkan mengembangkan sesuai kebutuhan.
Mode of Utilization (Lanjutan-2)

• Mengkode berdasarkan ICPM lebih sederhana dibanding

dengan ICD, mengingat di ICPM tidak ada aturan
khusus seperti pada ICD, ada rules morbidity dan
mortality.

• Komentar dan Usulan:

Bisa dikirim ke:
 baca di Buku Volume 1 halaman: ix.
 Bab 1: Prosedur Diagnostik Medis

- Medical Services
Tersedia subdivisi digit ke 4, 0. 1. 2, 3, 4, dan 9
- Initial Medical Attention
Termasuk rekaman terkait: riwayat sakit, pem. fisik,
program diagnostik yang akan dijalankan, dan R/
pada permulaan episode pelayanan yang berjalan.
- Subsequent Medical Attention
- Consultation
- Newborn Sevices
- Examination of Special System
- Examination of Other Special System
Bab 1: (Lanjutan)

- Biopsy
- Surgical Biopsy
- Endoscopy
- Physiological Function Tests
- Exploratory Diagnostic Procrdures
- Other Procedures for Diagnosis
 2. Laboratory Procedures

• Clinical Chemistry of Blood

• Clinical Function Tests
• Microbiology
• Mycology and Parasitology
• Hematology
• General Pathology
 4. Preventive Procedures

• Certain Health Examinations

• Screening Examination
• Prevention and Control of Infectious Diseases
• Control of Local Conditions
• Maternal and Child Health Care
 5. Surgical Procedures
(Bab ini telah diterjemahkan ke dalam Bahasa Indonesia)

Excludes: biopsies (1-4 & 1-5), performed as

independent procedures.

• Operations on the Nervous System

• Operations on the Eyes
• Operations on Nose, Mouth and Pharynx
• Operations on the Cardiovascular System
• Operations on the Digestive System
• Operations on the Urinary Tract
• Operation on the Male Genital Organs
• Operation on Female Genital Organs
• Obstetric Operations
• Operations on The Musculoskeletal System
• Operations on The Breast
• Disruption of Tissue
• Optional Surgery
• Ill-defined Operations
 8. Other Therapeutic Procedures

• Removal of Unwanted Material

• Correction of Misplacement
• Immobilization and Support
• Skeletal and Other Traction
• Other therapy by Physical Agents\
• Respiratory Procedures
• Procedures Affecting Circulatory System
• Pre- and Postoperative Procedures
• Monitoring of Patient
 9. Ancillary Procedures

• Other Therapy
• Other Care
• Anatomy-Physiological Assistance
• Physiotherapeutic and Related Techniques
• Other Rehabilitation
• Psychotherapy
• Long term and Follow-up Procedures
 Volume 2
3. Radiology and Certain Other Application of
Physics In Medicine
• Tersedia subdivisi digit-5 dan digit-6 yang optional bagi
beberapa grup kategori.
• Penomoran dengan 3-digit masih signifikan.
• Digit-5 dan digit-6 karena optional maka tidak muncul
pada indeks alfabetik.

Bab 3 ini ada 3 grup

(a) 3-00 s/d 3-09 untuk merekam aktivitas umum beserta
upaya fisik dalam kedokteran, dan mewakili aksis lain
klasifikasi yang termasuk di grup lain.
 Volume 2
3. Radiology and Certain Other Application of Physics In Medicine
(Lanjutan)

(b) Kategori 3-10 s/d 3-02 dan 3-63 s/d 3-99 untuk
mengkode prosedur khusus yang terklasifikasi
hanya di dapal bab ini.

(c) Kategori 3-63 dan 3-64 grup prosedur diagnostik

tertentu yang juga terklasifikasi di Bab 1.
Oleh karenanya kategori ini digunakan hanya bila
Bab 1 tidak dimanfaatkan.
Kode 3-63 dan 3-64 tidak muncul di dalam indeks
alfabetik Bab 3; apabila diperlukan, cari di daftar
tabulasi.
 3-00 – 3-99

• General Aspects
• Radiography (tersedia subdivisi digit ke 5 dan ke 6)
• Contrast Radiography
• Other Contrast Radiography (tersedia subdivisi digit
ke 5)
• Other X-ray Diagnostic Procedures (tersedia subdivisi
digit ke 5)
• Diagnostic Nuclear Medicine (tersedia subdivisi digit
ke 5.
• Other Diagnostic Procedures from Physics
3-00 – 3-99 (Lanjutan)

• External Radiotherapy (tersedia subdivisi digit ke 5 dan

ke 6)
• Other Therapeutic Nuclear Medicine (tersedia 4 grup
subdivisi digit ke 5 yang optional)
• Other Therapeutic Procedures from Physics.
 6 & 7 Drugs, Medicaments, and
Biological Agents

Notes:
Aksi obat bisa berubah sesuai rute pemberiannya,
Local anesthetics dibagi utama sesuai model pengunaannya
(permukaan, infiltrasim memblokir saraf, dan spinal), ada
anestesi lokal yang pengguna-annya bisa lebih dari satu cara.
3 anestetik yang diguga terbanyak digunakan terdaftar pada
masing-masing model penggunaannya.
Anestetik lain dialkoasik sesuai cara penggunaan yang diduga
paling umum.
6 & 7 Drugs … (Lanjutan-1)

• Dalam praktik, indeks kode bisa mesleading apabila

nomor kode diambil kembali pada hari kemudian,
sebagai contoh: kode menunjukkan anestesi spinal,
padhal anestetiknya dilaksanakan secara topikal.
Untuk inilah koder hendaknya harus memperhatikan
aspek mana yang paling penting alasannya – sifat
kekhususannya, model pemberiannya. Apabila kedua
aspek tersebut diperlukan, buatlah kode ganda untuk
menyimpan dan menghasilkan infomasi lebih rinci dan
tepat.
Kode ganda obat juga menduduki rincian perekaman
kombinasi.
6 & 7 Drugs … (Lanjutan-2)

• Antibiotics
• Other Anti-Infective Drugs
• Hormones & Synthetic Substitutes
• Systematic Agents
• Drugs Primarily Affecting Blood Constituents
• Analgetics, Antiseptics, and Antirheumatics
• Sedatives & Hypnotics
• Central Nervous System Depressants
• Psychotic Drugs
• Central Nervous System Stimulants
6 & 7 Drugs … (Lanjutan-3)

• Drugs Primarily Affective The Autonomic Nervous

System
• Drugs Primarily Affecting the Gastrointestinal System
• Water, Mineral, and Uric Acid Metabolism Drugs
• Drugs Acting Primarily on The Smooth and Skeletal
Muscle and Respiratory System
• Drugs Acting Locally
• Other Drugs and Medicaments
• Bacterial Vaccines
 National Centre for Classification
in Health - Australia
INTERNATIONAL CLASSIFICATION of
HEALTH INTERVENTIONS
ICHI
 ICHI

• Struktur Isi:
Introduksi
Konvensi yang diberlakukan dalam Daftar Tabulasi
Konvensi yang diberlakukan dalam Daftar Indeks
Alfabetik Prosedur/Tindakan.

Daftar Kode

Daftar Tabulasi Prosedur/Tindakan

Indeks Alfabetik Prosedur/Tindakan.

ICHI (Lanjutan)

• Daftar Tabulasi Prosedur /Tindakan:

I. Procedures on Nervous System
II. Procedures on Endocrine System
III. Procedures on Eye and Adnexa
IV. Procedures on Ear and Mastoid Process
V. Procedures on Nose, Mouth and Pharynx
VI. Dental Services
VII. Procedures on Respiratory System
VIII. Procedures on Cardiovascular System
IX. Procedures on Blood and Bllood-Forming Organs
X. Procedures on Digestive System
Lanjutan

XI. Procedures on Urinary System

XII. Procedures on Male Genital Organs
XIII. Gynaecological Procedures
XIV. Obstetric Procedures
XV. Procedures on Musculoskeletal System
XVI. Dermatological and Plastic Procedures
XVII. Procedures on Breast
XVIII. Radiation Oncology Procedures
XIX. Non-invasive, Cognitive and Other Interventions,
NEC.
XX. Imaging Services
 INTRODUKSI

• Beta-ICHI dikreasi oleh National Centre for Classification

in Health, Australia, sebagai anggota ICD-FIC, WHO.
Klasifikasi didisain untuk digunakan bersama dengan
ICD-10 bagi yang memerlukan klasifikasi tindakan dan
intervensi yang ringkas dan sederhana.
Klasifikasi terdiri dari berbagai intervensi bedah dan non-
bedah.
ICHI menampung kurang lebih 1.400 kode tindakan
spesifik berserta terms tindakan yang inclusion.
Struktur dan konvensi untuk indeks sama dengan
klasifikasi procedure WHO.
Introduksi (Lanjutan)

• ICHI in its alpha-version was known as the Australian

Classification of Health Interventions Adapted for
International Use, or ACHI-1.
The edition of ICHI is derived from the Fourth Edition of
the Australian Classification of Health Interventions
(ACHI) which forms volumes three and four of the Fourth
Edition of the ICD, 10th, Australian Modification
-ICD-10-AM (2004).

• Baca selanjutnya pada buku ICHI, 2004.

 ICD-9-CM
Volume 3

Petikan dari
ICD-9-CM, HCIA
Baltimore, Maryland, 1992
 ICD-9-CM Volume 3
• PROCEDURES TABULAR LIST and
ALPHABETIC INDEX
Introduction
Conventions used in the Procedure Classification
Preface to the Annotated ICD-9-CM
Sybolsw and Annotations in Volume 3
Tabular List
1. Operations on the Nervous System (01.-05.9)
2. Operations on the Endocrine System (06.-07.99)
3. Operations on the Eye (08.-016.99)
4. Operations on the Ear (18.-20.99)
5. Operations on the Nose, Mouth, and Pharynx
(21.-29.99)
 ICD-9-CM Tabular List (Cont.-)

6. Operations on the Respiratory System (30.-34.99)

7. Operations on the Cardiovascular System
(35.-  39.99)
8. Operations on the Hemic and Lymphatic System
(40.-  41.99)
9. Operations on the Digestive System (42.- 54.99)
10. Operations on the Urinary System (55.-59.99)
11. Operations on the Male Genital Organs (60.-64.99)
12. Operations on the Female Genital Org. (65.-71.9)
13. Obstetrical Procedures (72.-  75.99)
14. Operations on the Musculoskeletal Sys.(76.-84.99)
15. Operations on the Integumentary Sys. (85.- 86.99)
16. Miscellaneous Diagnostic & Therapeutic Procedures
(87.- 99.99)
Alphabetic Index
 7. OPERATIONS ON THE
CARDIOVASCULAR SYSTEM (35.-  39.-)
(hal69-92)

35 Op. on Valves & Septa of Heart

Includes: sternotomy (median)(transverse)
thoracotomy
} as operative approach
Code also cardiopulmonary bypass
[extracorporal
circulation] [heart-lung machine] (39.61)

35.0 Closed heart valvotomy

Excludes: percutaneous (balloon) valvuloplasty (35.96)
 35 Operation on Valves and Septa of Heart
35.0 Closed heart valvotomy
Excudes: percutaneous (balloon) (valvuloplasty)(35.96)

35.00 Closed heart valvotomy, unspecified valve

35.01 Closed heart valvotomy aortic valve
35.02 Closed heart valvotomy, mitral valve
35.03 Closed heart valvotomy, pulmonary valve
35.04 Closed heart valvotomy, tricuspid valve

35.1 Open Heart Valvuloplasty without Replacement

Includes: open heart valvotomy
Excludes: percutaneous (balloon) valvuloplasty (35.96)
(cont.- ) 
35.1 Open Heart Valvuloplasty without Replacement
Includes: open heart valvotomy

Excludes: percutaneous (balloon) valvuloplasty (35.96)

that associated with repair of:
endocardial cushen defect (35.54, 35.63, 35.73)
valvular defect ass. with atrial & ventricular
septal defect (35.54, 35.63, 35.73)
Code also cardiopulmonary bypass [extracorporal circulation]
[heart –lung machinal] (39.61)
35.10 Open heart valvuloplasty without replacement,
unspecified valve
35.11 Open heart valvuloplasty of aortic valve without replacement
35.12 Open heart valvuloplasty of mitral valve without replacement
35.13 Open heart valvuloplasty of pulm. valve without replacement
35.14 Open heart valvuloplasty of tricus. valve without replacement
35.2 Replacement of Valve
 SYMBOLS and ANNOTATIONS in VOLUME 3

The use of DRGs to determine prospective payment and

Medicare Code Edits (MCEs) to show inconsistencies in
patient information make certain aspects coding
particularly important.
To make sure you assign the right DRG for each patient,
you must code the PRINCIPAL DIAGNOSIS fully and
correctly; you must also include all SECONDARY
DIAGNOSES and all PROCEDURES.
The DRG grouper assumes all patient information is
correct.
The MCEs alert you to errors, inconsistencies, and
nonspecific information, for resolution before you
group the record.
 Symbols and Annotations in Volume 3 (CONT.-1)

To keep these factors in front of you and simplify the

coding process, ICD-9-CM have color-coded the
diagnosis and procedure tabular lists. In volume 3.
the annotations are as follows:

_____ A non specific code which should not be used

when more precise information is obtainable
A code considered by MCE to be sex-specific
O To be used only for male patients
o To be used only for female patients
A code for a procedure not normally covered by
Medicare
 Symbols and Annotations in Volume 3 (Cont.- 2)

-------- A code which is NOT considered by the grouper to

be an operating room procedure. When a code is
boxed and shaded, the box is in black ink to
differentiate it more easily from the green shading.

• Our annotations and other explanatory materials

reflect the latest DRG information available as of
publication date.
• We have taken every precaution to safeguard the
accuracy of this edition, nonetheless, the provider
of service holds the ultimate responsibility for
accurate coding.
 SYMBOLS & ANNOTATIONS in VOLUME 1

A code which should not usually be used as PRINCIPAL

DIAGNOSIS:

+++ For all codes on page 1-917, indicates nonspecific

code.
=== For codes 7981, 798.2, 789.9, and all codes on page
918-969, indicates UNACCEPTABLE PRINCIPAL
DIAGNOSIS CODE.
Q ____ Questionable admission (entire book)
(italicized manifestation codes and E-codes are other
codes not to be used as PRINCIPAL DIAGNOSIS)
A Code considered by the MCE to be age-specific.
B To be used only for patients less than one year old
 SYMBOLS & ANNOTATIONS in VOLUME 1 (Cont.-1)

A Code considered by the MCE to be age-specific.

B To be used only for patients less than one year old

P To be used only for patients less than eighteen

year old
M To be used only for patients between twelve and
fifty-five years old
A To be used only for patients more than fourteen
years old

A code considered by the MCE to be sex-specific

O To be used only for male patients
o To be used only for female patients
SYMBOLS & ANNOTATIONS in VOLUME 1 (Cont.-2)

----- A code considered by the DRG grouper to be a

complication or comorbidity. When a code is boxed
and shaded, box is in black ink to differentiate it
more easily from the green shading.

____ A code which signals the necessity to be absolutely

certain that all secondary diagnoses and
complications are coded well.

This condition occurs when this code is used

as principal diagnosis for a patient who has no
operating procedure.
 NOTES
• Because of the typography of Volume 1 of ICD-9-CM,
it is not always possible to indicate clearly with color
coding the various types of information to be imparted.
This is especially true in those areas where common
fifth-digits apply to several four digit codes.
In some cases the color coding applies to all relevant
fifth digits (e.g in the classification of tuberculosis, when
one five-digit code is designated as a comorbidity, all
five-digit code in sequence are comorbidities), but in
other cases, some of the fifth-digit codes in the
sequence are classified differently from other fifth-digit
codes in the same sequence (e.g. 250.01 is a
comorbidity, but 250.00 is not). In order to make it easier
to understand, the following table shows those cases
where the various five-digit codes within a sequence are
classified. (Lihat hal.xvii – xix, ICD-9-CM vol. 1)
 CONTOH – ICD-9-CM Volume 1
403 Hypertension renal disease
Includes: arteriolar nephritis
arteriosclerosis of:
kidney
renal arterioles
arteriosclerotic nephritis (chronic)(interstitial)
hypertensive
nephropathy
renal failure’
uremia (chronic)
nephrosclerosis
renal sclerosis with hypertension
any condition classifiable to 585, 586, 0r 587
with any condition classifiable to 401.
Excludes: acute renal failure (584,5 – 584.9)
renal disease stated as not due to hypertension
renovascular hypertension (405.0 – 405.9 with
fifth-digit 1)
 ICD-9-CM
yang diperkenalkan di Indonesia
(Contoh)

CLASSIFICATION
OF
PROCEDURES
1. OPERATIONS ON THE NERVOUS SYSTEM
(01 – 05)
01 Incision and excision of skull, brain and cerebral
meninges
01.0 Cranial puncture
01.01 Cisternal puncture
Cisternal tap
pneumosternogram (87.02)
01.02 Ventriculopuncture through
previuosly implanted catheter
Puncture of ventricul shunt tubing
01-09 Other cranial puncture
Aspiration of:
dst.
Lanjutan-1

01.1 Diagnostic procedures on skull, brain, and

cerebral meninges
01.11 Closed [ecutaneous] [needle] biopsy of
cerebral meninges
Burr hole approach
01.12 Open biopsy of cerebral meninges
01.13 Closed [percutaneous] [needle] [biopsy] of
brain
Burr hole approach
Stereotactic method
01.14 Open biopsy of brain
01.15 Biopsy of skull
.
Lanjutan-2

01.18 Other diagnostic procedures on brain and

cerebral meninges
cerebral
arteriography (88.41)
thermography (88,81)
contrast radiogram of brain (87.01-87.02)
echoenchaphalogram (88.71)
dst
01.19 Other diagnostic procedures on skull
transillumination pf skull (89.16)
x-ray of skull (87.17
01.2 Craniotomy and craniectomy
decompression of skull fracture (02.02)
exploration oforbit (16.01 – 16.09)
that as operative approach – omit code