PEMERINTAH KOTA BANDUNG

DINAS KESEHATAN
UPT PUSKESMAS SUKAJADI
Jalan Sukagalih No.26, Bandung 40162 Telp (022) 6441018

KEPUTUSAN
KEPALA UPT. PUSKESMAS SUKAJADI
NOMOR :……/SK/……/ 2017

TENTANG
STANDARDISASI KODE KLASIFIKASI DIAGNOSIS DAN TERMINOLOGI
PUSKESMAS SUKAJADI

Menimbang : a. Bahwa dalam penyelenggaraaan pelayanan klinis

yang berkualitas di Puskesmas, diperlukan
penulisan rekam medis yang sesuai standar.
b. Bahwa dalam rangka penulisan rekam medis yang
sesuai standar, perlu ditetapkan standarisasi kode
diagnosis dan terminologi.
c. Bahwa berdasarkan pertimbangan pada huruf a
dan b, perlu menetapkan Keputusan Kepala UPT
Puskesmas Sukajadi tentang Standarisasi Kode
Klasifikasi Diagnosis dan Terminologi.
Mengingat : a. UU Nomor 29 Tahun 2004, tentang Praktik
Kedokteran
b. UU Nomor 36 Tahun 2009, tentang Kesehatan
c. UU Nomor 44 Tahun 2009, tentang Rumah Sakit
d. Keputusan Menteri Kesehatan RI No.
128/Men.Kes/SK/II/ 2004 tentang Kebijakan
Dasar Puskesmas
e. Peraturan Menteri Kesehatan
No.1691/MENKES/PER/VIII/2011 Tentang
Keselamatan Pasien Rumah Sakit
f. Peraturan Menteri Kesehatan
No.269/MENKES/PER/III/2008 tentang Rekam
Medis
 MEMUTUSKAN

KEPUTUSAN KEPALA UPT PUSKESMAS SUKAJADI

Menetapkan : TENTANG STANDARISASI KODE KLASIFIKASI

DIAGNOSIS DAN TERMINOLOGI.

Kesatu : Menentukan standarisasi kode klasifikasi diagnosis
dan terminologi sebagaimana terlampir dalam
keputusan ini.

Kedua : Kode klasifikasi sebagaimana dimaksud dalam

diktum Pertama menggunakan standard ICD X.
Ketiga : Keputusan ini berlaku sejak tanggal ditetapkan dan
apabila dikemudian hari terdapat kekeliruan dalam
penetapannya, maka akan diadakan pembetulan
sebagai mana mestinya.

KEPALA
UPT PUSKESMAS SUKAJADI

dr. Hj. Erti Rostiaty MH.Kes

NIP. 19671209 199103 2 005
 Daftar : Surat Keputusan
Lampiran Kepala UPT
: Puskesmas
Sukajadi
Nomor :
Tanggal :

Standarisasi Kode Diagnosis Yang Sering Digunakan

Di Puskesmas Sukajadi

Kode Nama Diagnosis

Diagnosis
195 Hipotensi
A00 Kolera
A01 Demam tifoid
A06 Disentri amuba
A09 Diare
A15 TB Paru BTA+
A16 TB Paru lainnya
A18 TB Ekstra paru
A19 TB Miliar
A30 Kusta
A36 Difteri
A51 Sifilis
A63 Condyloma accuminata candidiasis
A91 DBD
A92 Cikungunya
B00 Herpes simplex/Herpes zooster
B01 Varicella
B05 Campak
B15 Hepatitis A akut
B16 Hepatits B akut
B20 HIV
B26 Parotitis
B35 Tineacapitis
B36.8 Jamur
B37 Digigit serangga
B50 Malaria
B74 Filariasis
B77 Askaris
B86 Scabies
C00 Tumor ganas bibir, mulut
C15 Tumor ganas saluran cerna
C30 Tumor ganas sel pernafasan
C44 Tumorkulit
C50 Camamae
C53.9 Caservix
D17 Lipoma
D24 Fibroadenoma mamae
D25 Myoma
D46 Catiroid
D48 Tumor jinak yang tidak diketahui
D50 Anemia def Fe
D53 Anemia def Gizi
D53.8 Anemia
D56 Thalasemia
E05 Hipertiroid
E14 DM
E40 Kuasiokor
E78 Displidemia
F00 Dementia
F20 Skizoperenia
F23 Gangguan psikotik akut
F32 Episode depresi
F66.2 Sexual relationship disorder
F66.9 Psychosexual development disorder
F81.9 Gangguan perkembangan
G43 Migren
G44.2 TTH
G47 Insomnia
G50 Trigeminal neuralgia
G51 Bell palsy
G56 CTS
G98 Syaraf yang tidak diklasifikasi
H00 Hordeolum
H10 Konjungtivitis
H11 Pterigium
H16 Keratitis
H25 Katarak
H35.9 Ablastioretina
H40 Glaucoma
H44 Foreign body mata
H52 Gangguan refraksi dan akomodasi
H54 Butarabun
H60 OE
H61 Serumen
H65 OMA
H66 OMS
H71 Cholesteatorn
H75 Mastoiditis
H91 Presbiacusis
H93 Gangguan telinga lain
H93.1 Tinitus
I10 Hipertensi
I20 Angina pectoris
I22 MCI
I25 CAD
I49 Aritmia
I50 CHF
I64 Stroke
I84 Hemorroid
J03/J35 Tonsilitis akut/kronik
J06 Ispa yang tidak spesifik
J09 Flu burung
J12 Pneumonia
J18 Bronkopneumonia
J30 Alergi rhinitis akibat kerja
J32/J01 Sinusitis cronis/Sinusitis
J33 Polip nasal
J37/J04 Laringitis
J44 PPOK
J45 Asma
J91 Pleural effusion Caparu
K00.1 Supernumerary teeth
K00.2 Abnormalities of size and form of teeth
K00.3 Mottled teeth
K00.4 Disturbances in tooth formation
K00.5 Hereditary disturbances in tooth structure, not elsewhere
classified
K00.6 Disturbances in tooth eruption
K00.7 Teething syndrome
K00.8 Other disorders of tooth development
K00.9 Disorder of tooth development, unspecified
K01.0 Embedded teeth
K01.1 Impacted teeth
K02 Carries
K02.0 Caries limited to enamel
K02.1 Caries of dentine
K02.2 Caries of cementum
K02.3 Arrested dental caries
K02.4 Odontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified
K03.0 Excessive attrition of teeth
K03.1 Abrasion of teeth
K03.2 Erosion of teeth
K03.3 Pathological resorption of teeth
K03.4 Hypercementosis
K03.5 Ankylosis of teeth
K03.6 Deposits [accretions] on teeth
K03.7 Posteruptive colour changes of dental hard tissues
K03.8 Other specified diseases of hard tissues of teeth
K03.9 Disease of hard tissues of teeth, unspecified
K04.0 Pulpitis
K04.1 Necrosis of pulp
K04.2 Pulp degeneration
K04.3 Abnormal hard tissue formation in pulp
K04.4 Acute apical periodontitis of pulpal origin
K04.5 Chronic apical periodontitis
K04.6 Periapical abscess with sinus
K04.7 Periapical abscess without sinus
K04.8 Radicular cyst
K04.9 Other and unspecified diseases of pulp and periapical tissues
K05.0 Acute gingivitis
K05.1 Chronic gingivitis
K05.2 Acute periodontitis
K05.3 Chronic periodontitis
K05.4 Periodontosis
K05.5 Other periodontal diseases
K05.6 Periodontal disease, unspecified
K06.0 Gingival recession
K06.1 Gingival enlargement
K06.2 Gingival and edentulous alveolar ridge lesions associated with
trauma
K06.8 Other specified disorders of gingiva and edentulous alveolar
ridge
K06.9 Disorder of gingiva and edentulous alveolar ridge, unspecified
K07.0 Major anomalies of jaw size
K07.1 Anomalies of jaw-cranial base relationship
K07.2 Anomalies of dental arch relationship
K07.3 Anomalies of tooth position
K07.4 Malocclusion, unspecified
K07.5 Dentofacial functional abnormalities
K07.6 Temporomandibular joint disorders
K07.8 Other dentofacial anomalies
K07.9 Dentofacial anomaly, unspecified
K08.0 Exfoliation of teeth due to systemic causes
K08.1 Loss of teeth due to accident, extraction or local periodontal
disease
K08.2 Atrophy of edentulous alveolar ridge
K08.3 Retained dental root
K08.8 Other specified disorders of teeth and supporting structures
K08.9 Disorder of teeth and supporting structures, unspecified
K09.0 Developmental odontogenic cysts
K09.1 Developmental (nonodontogenic) cysts of oral region
K09.2 Other cysts of jaw
K09.8 Other cysts of oral region, not elsewhere classified
K09.9 Cyst of oral region, unspecified
K10.0 Developmental disorders of jaws
K10.1 Giant cell granuloma, central
K10.2 Inflammatory conditions of jaws
K10.3 Alveolitis of jaws
K10.8 Other specified diseases of jaws
K10.9 Disease of jaws, unspecified
K11.0 Atrophy of salivary gland
K11.1 Hypertrophy of salivary gland
K11.2 Sialoadenitis
K11.3 Abscess of salivary gland
K11.4 Fistula of salivary gland
K11.5 Sialolithiasis
K11.6 Mucocele of salivary gland
K11.7 Disturbances of salivary secretion
K11.8 Other diseases of salivary glands
K11.9 Disease of salivary gland, unspecified
K12 Stomatitis
K12.0 Recurrent oral aphthae
K12.1 Other forms of stomatitis
K12.2 Cellulitis and abscess of mouth
K13.0 Diseases of lips
K13.1 Cheek and lip biting
K13.2 Leukoplakia and other disturbances of oral epithelium,
including tongue
K13.3 Hairy leukoplakia
K13.4 Granuloma and granuloma-like lesions of oral mucosa
K13.5 Oral submucous fibrosis
K13.6 Irritative hyperplasia of oral mucosa
K13.7 Other and unspecified lesions of oral mucosa
K14.0 Glossitis
K14.1 Geographic tongue
K14.2 Median rhomboid glossitis
K14.3 Hypertrophy of tongue papillae
K14.4 Atrophy of tongue papillae
Plicated tongue
K14.6 Glossodynia
K14.8 Other diseases of tongue
K14.9 Disease of tongue, unspecified
K29 Gastritis
K30 Dispepsia
K35 Appendicitis
K40 HIL
K59 Konstipasi
K74 Sirosishepatis
K80 Cholelitiasis
K80 Cholelitiasis
K85 Pankreatitis
L02 Abses, Karbunkel, Furunkel, Paronicia
L21 Dermatitis seborolka
L23 Dermatitis kontak
L30 Dermatitis lain tidak spesifik
L40 Psoriasis
L50 Urticaria
L63.8 Alopecia
L80 Vitiligo
L91 Keloid scar
L98 Gangguan kulit lain
M10 Gout
M13 Hyperuric /OA
M41 Skiliosis
M54.1 Spondilosis servical
M54.5 LBP
M60 Benda asing
M67.4 Ganglion
M79.0 Reumatic
M79.1 Myalgia
M79.2 Neuralgia/neuritis tidak spesifik
M96.6 Ambil pen
N18 Gagalginjal
N20 Batuginjal
N23 Colic renal
N28 SN
N30 Sistitis
N40 BPH
N61 Mastitis
N77 Keputihan
N92 Menorraghia/Metromenoragi
O03 Abortus
O82.9 Sectio
Q50 Kistaovari
Q50.1 Caovari
Q90 Down syndrome
R04 Epistaxis
R06 Dyspneu
R07.4 Chest pain
R10 Nyeri pinggul dan perut
R42 Vertigo
S05.0 Injury corneal
S05.5 Mata penetrating wound
S06 EDH
S42 Fraktur tidak gerak
S70 Osteomyelitis
S72 Fraktur femur
T14 VL/VE
T16 Corpus allenium
T20 Luka bakar
Z30.5 Off IUD
Z34 Hamil

Kepala
UPT Puskesmas Sukajadi

dr. Hj. Erti Rostiaty MH.Kes

NIP. 19671209 199103 2 005