Tarif Paket RS Negeri tipe A

Diagnosis Tindakan (code ICD 9) Paket Jasa

(code ICD 10)
Hirschprung disese 1. 45.71 16.531.000
Q43.1 Open and other multiple segmental
resection of large intestine
(colostomy)

2. 48.49 16.531.000
Other pulltrough resection of rectum

3. 45.70 16.531.000
Open and other partial excision of large
intestine
( potong stump rectum)

Hirschprung disese Semua coding tindakan hirchprung + 33.714.200

Q43.1 + Anemia D64.9 transfusi PRC 99.04
+ Sepsis A41.9

Malformasi anorectal 1. 45.71 16.531.000

Q43.9 Open and other multiple segmental
resection of large intestine
(Colostomy)

2. 45.79
Other and unspecified partial excision 16.531.000
of large intestine
(PSARP)

3. Resesksi anastomose 45.94

Large to large intestinal intestinal 16.531.000
anastomosis
(tutup colostomy)

Malformasi anorectal Q43.9 + Semua coding tindakan MAR + transfusi 33.714.200

Anemia D64.9 PRC 99.04
+ Sepsis A41.9

Malformasi anorectal Q43.9 + PSARP/ ASARP 45.79 + other repair of 16.531.000

fistula rectourethral Q64.7 urethra 58.49

Hernia K40.40 Herniotomy 53.00 7.683.600

Unilateral repair of inguinal hernia not
otherwise specified

Laparoscopic hernia repair 53.63 4.664.700

Tarif Paket RS Negeri tipe A

Hernia K40.40 + Anemia Herniotomy 53.00 + transfusi PRC 15.720.200

D64.9 99.04 Prosedur
+ Sepsis A41.9 hernia berat

Hernia dengan gangrene Herniotomy 53.00 + transfusi PRC 33.714.200

K40.40 + Anemia D64.9 99.04 + reseksi anastomose small Prosedur
+ Sepsis A41.9 intestine 45.91 intestinal
berat

Hydrocoele N43.3 Hydrocelectomy 63.1 12.094.900

Excision of varicocele and hydrocele of
spermatic cord

Invaginasi K56.1 1. Milking procedure 46.81 11.117.400

Intraabdominal manipulation of small
intestine

2. Reseksi anastomose 45.94 16.531.000

Large to large intestinal intestinal
anastomosis

Invaginasi K56.1 + Reseksi anastomose 45.94 + 33.714.200

Anemia D64.9 transfuse PRC 99.04
+ Sepsis A41.9

Tumor intra abdomen Removal tumor 54.4 10.908.200

D48.7 Excision or destruction of peritoneal
tissue

Atresia esophagus dengan 1. Gastrostomy 43.1 16.531.000

fistel
Q39.1
2. Intrathoracic anastomose of 16.531.000
esophagus 42.51

3. Thoracotomy exploration 34.02 20.468.000

Prosedur
system
pernapasan
ringan

4. Repair fistula trakeoesofagus 42.84 16.531.000

Atresia esophagus Q39.1 + Coding 42.51 + 34.02 + 42.84 + transfuse 20.090.300

anemia D64.9 PRC 99.04
Tarif Paket RS Negeri tipe A

Atresia esophagus Q39.1 + Coding 34.02 + 42.51 + 42.84 + 33.714.200

Anemia D64.9 transfuse PRC 99.04
+ Sepsis A41.9

Atresia esophagus Q39.1 + Thoracotomy exploration 34.02 + 63.745.400

Anemia D64.9 transfuse PRC 99.04
+ Sepsis A41.9

Atresia duodenum Partial gastrectomy with anastomosis to 16.531.000

Q41.0 jejunum 43.7

Apendisitis akut unspecified Appendectomy laparoscopic 5.260.800

K35.9 47.01

Other appendectomy 47.09 5.260.800

Apendisitis akut unspecified Other appendectomy 47.09 + transfuse 5.260.800

K35.9 + Anemia D64.9 PRC 99.04

Apendisitis akut unspecified Other appendectomy 47.09 + transfuse 9.248.700

K35.9 + Anemia D64.9 + sepsis PRC 99.04
A41.9

Apendisitis akut dengan Other laparotomy 54.19 10.908.200

peritonitis difus K35.2

Apendisitis akut dengan Other laparotomy 54.19 + transfuse PRC 12.026.700

peritonitis difus K35.2 + 99.04
anemia D64.9

Apendisitis akut dengan Other laparotomy 54.19 + transfuse PRC 20.380.800

peritonitis difus K35.2 + 99.04
anemia D64.9 + sepsis A41.9
Peritonitis Akut Other laparotomy 54.19 10.908.200
K65.0
Peritoneal adhesi K66.0 Other laparotomy 54.19 20.380.800
+ peritonitis akut K65.0

Peritoneal adhesi K66.0 Laparoscopic adhesiolysis 54.51 10.440.660