Special CMG

dalam INA-
CBG

Oleh :

Maulana Tomy Abiyasa

 Contoh Sub Acute

Seorang pasien BPJS Kelas 3 dengan identitas sbb :

Nama : Sutejo DPJP : dr. Zaenal S
Tgl Lahir : 12 Des 1978
No Peserta : 0000324
No. SEP : D22.2009.00855
Tgl Ranap : 9 Okt 2019 – 4 Des 2019
DU : Paranoid Schizoprenia
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Biaya Dokter : Rp. 2.100.000 , Obat : Rp. 500.000, Kamar Ranap :
3.250.000, Keperawatan : 600.000
– Jika LOS Pasien melebihi 104 Hari, maka masuk kedalam
golongan penyakit kronis, misal dari kasus tadi kita Tarik
mundur lagi tgl masuk 8 Agustus – 4 Desember 2019 maka
hasilnya sbb :
 Special
Procedure
koefisien Kode
List Item Special CMG Tipe Special CMG
utk top up INA-CBG dasar
Tumor pineal – Endoskopy Special Procedure 0,5 E-1-01-I
Hip Replacement / knee replacement Special Procedure 0,5 M-1-04-I
PCI Special Procedure 1 I-1-40-I
Keratoplasty Special Procedure 1 H-1-30-I
Pancreatectomy Special Procedure 1 B-1-10-I
Repair of septal defect of heart with
Special Procedure 1 I-1-06-I
prosthesis
Renal Transplantation Special Procedure 1 N-1-01-I
Stereotactic Surgery & Radiotheraphy Special Procedure 1 C-4-12-I
Torakotomi Special Procedure 1 J-1-30-I
Lobektomi / bilobektomi Special Procedure 1 J-1-10-I
Air plumbage Special Procedure 1 J-4-20-I
Timektomi Special Procedure 1 D-1-20-I
Vitrectomy Special Procedure 1 H-1-30-I
Phacoemulsification Special Procedure 1 H-2-36-0
Microlaringoscopy Special Procedure 2 J-3-15-0
Cholangiograph Special Procedure 2 B-3-11-0
 Contoh Kasus Special
Procedures
Seorang pasien BPJS Kelas 3 dengan identitas sbb :
Nama : Sutejo DPJP : dr. Zaenal S
Tgl Lahir : 12 Des 1978
No Peserta : 0000324
No. SEP : D22.2009.00855
Tgl Ranap : 29 Nov 2019 – 4 Des 2019
DU : Corneal Ulcer
DS : Anemia
Px : Keratoplasty
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Biaya Dokter : Rp. 4.100.000 , Obat : Rp. 1.200.000, Kamar Ranap :
1.300.000, Keperawatan : 900.000
 Special
Prosthesis
koefisien
Kode
List Item Special CMG Tipe Special CMG utk top
INA-CBG dasar
up
Subdural grid electrode Special Prosthesis 0,5 G-1-10-I
Cote graft Special Prosthesis 0,5 I-1-03-I
TMJ Prothesis Special Prosthesis 1 M-1-60-I
Liquid Embolic (for AVM) Special Prosthesis 1 G-1-12-I
Hip Implant/ knee implant Special Prosthesis 1 M-1-04-I
Contoh Kasus Special Prosthesis

Seorang pasien BPJS Kelas 3 dengan identitas sbb :

Nama : Sutejo DPJP : dr. Zaenal S
Tgl Lahir : 12 Des 1978
No Peserta : 0000324
No. SEP : D22.2009.00855
Tgl Ranap : 29 Nov 2019 – 4 Des 2019
DU : Tetralogy of Fallot
Px : Perbaikan Tetralogy of fallot
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Biaya Dokter : Rp. 18.000.000 , Obat : Rp. 5000.000, Kamar Ranap :
4000.000, Keperawatan : 3000.000
 Special
Drugs

Kode
Tipe Special koefisien
List Item Special CMG INA-CBG
CMG utk top up
dasar
Streptokinase Special Drug 0,25 I-4-10-I
Deferiprone Special Drug 0,5 D-4-13-I
Deferoksamin Special Drug 0,5 D-4-13-I
Deferasirox Special Drug 0,5 D-4-13-I
Human Albumin Special Drug 0,5 A-4-10-I
Contoh Kasus Special Drugs

Seorang pasien BPJS Kelas 3 dengan identitas sbb :

Nama : Sutejo DPJP : dr. Zaenal S
Tgl Lahir : 12 Des 1978
No Peserta : 0000324
No. SEP : D22.2009.00855
Tgl Ranap : 29 Nov 2019 – 4 Des 2019
DU : Acute transmural myocardial infarction of anterior
wall--------------------------------------------------------------
Biaya Dokter : Rp. 2.000.000 , Obat : Rp. 1.000.000, Kamar
Ranap : 2.800.000, Keperawatan : 300.000
 Special
Investigasi
Kode
koefisien
List Item Special CMG Tipe Special CMG INA-CBG
utk top up
dasar
Other CT Scan Special Investigation 1,5 Z-3-19-0
Nuclear Medicine Special Investigation 1,5 Z-3-17-0
MRI Special Investigation 1,5 Z-3-16-0
Diagnostic and Imaging Special Investigation 1,5 H-3-13-0
Procedure of Eye
Contoh Kasus Special
Investigation
Seorang pasien BPJS Kelas 3 dengan identitas sbb :
Nama : Sutejo DPJP : dr. Zaenal S
Tgl Lahir : 12 Des 1978
No Peserta : 0000324
No. SEP : D22.2009.00855
Tgl Rajal : 4 Des 2019
DU : Complicated Catharact
PX : Fluorescein angiography or angioscopy of eye
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Biaya Dokter : Rp. 300.000 , Obat : Rp. 2500.000, Keperawatan :
100.000