No.

ICD X Diagnosis Tarif Ina CBG'S

1 p22.9 Respiratory distress of newborn, unspecified  
2 p.22.1 Transient tachypnea of newborn.
3 p21.9  Birth asphyxia, unspecified
4 P22.8 Congenital pneumonia due to other organisms
5  J93.9  Pneumothorax, unspecified  
6 P24.8  Other neonatal aspiration syndromes  
7 P59.9 Neonatal jaundice, unspecified  
8 P70.4 Other neonatal hypoglycaemia  
9 P12.0 Cephalhaematoma due to birth injury 
10 P39.9  Infection specific to the perinatal period, unspecified  
11 P36.8 Other bacterial sepsis of newborn  
12 P07.3 Other preterm infants  
13 p08.2 Post-term infant, not heavy for gestational age
14 P92.9 Feeding problem of newborn, unspecified  
15  P12.8 Other birth injuries to scalp  
16 P24.0 Neonatal aspiration of meconium  
17 Q90.9 Down's syndrome, unspecified  
18 Z38.0 Singleton, born in hospital  
19  Z38.4 Twin, born outside hospital 
20 P03.4  Fetus and newborn affected by caesarean delivery  
21 P28.5 Respiratory failure of newborn  
22 P07.1 Other low birth weight 
syarat klaim ketereangan
RD
TTN
asfiksia neonatorum
pneomonia neonatal

NH

neonatal infeksi
SNAD
bayi kurang bulan
bayi lebih bulan

hematome forcep / vacum

MAS

ncb smk
bayi kembar
bayi lahir sc
No. ICD X
1 A91
2 A09
3 J18.0
4 E46
5 E40
6 E41
7 E42
8 E44.1
9 Z03
10 A15.7
11 R56.0
12 G03.9
13  G04.9
14 A01.0
15 J02.9
16 E87.6
17 E87.1
18  N39.0
19 R50.9
20 J06.9
21 B34.9
22  A49.9
23 B34.2
24 B15.9
25 J45.9
26 N47
27 R10.0
28 A41.9
Diagnosis
Dengue haemorrhagic fever 
Diarrhoea and gastroenteritis of presumed infectious origin
Bronchopneumonia
Unspecified protein-energy malnutrition 
 Kwashiorkor 
 Nutritional marasmus
Marasmic kwashiorkor
Mild protein-energy malnutrition 
Observation for suspected tuberculosis
Primary respiratory tuberculosis, confirmed bacteriologically and histologically  
Febrile convulsions  
 Meningitis, unspecified  
Encephalitis, myelitis and encephalomyelitis, unspecified  
Typhoid fever  
Acute pharyngitis, unspecified  
Hypokalaemia  
 Hypo-osmolality and hyponatraemia  
 Urinary tract infection, site not specified  
Fever, unspecified  
 Acute upper respiratory infection, unspecified  
 Viral infection, unspecified  
 Bacterial infection, unspecified  
Coronavirus infection, unspecified  
Hepatitis A without hepatic coma  
Asthma, unspecified  
Redundant prepuce, phimosis and paraphimosis  
Acute abdomen  
Septicaemia, unspecified  
Tarif Ina CBG'S syarat klaim ketereangan
DHF
GEA
bp
susp gizi buruk / gizi kurang

gizi kurang
susp tb paru
Tb paru
kdk / kds
susp meningitis
susp encphalitis

tfa

isk
hiperpirexia
ispa

covid
No. ICD X Diagnosis
1 A91 Dengue haemorrhagic fever 
2 A09 Diarrhoea and gastroenteritis of presumed infectious origin
3 J18.0 Bronchopneumonia
4 J45.9 Asthma, unspecified  
5 J18.9 Pneumonia, unspecified  
6 Z03  Observation for suspected tuberculosis  
7 A15.7 Primary respiratory tuberculosis, confirmed bacteriologically and histologically  
8 D64.9 Anaemia, unspecified  
9 A19.2 Acute miliary tuberculosis, unspecified
10
11
12
13
14 A01.0 Typhoid fever  
15
16 E87.6 Hypokalaemia  
17 E87.1  Hypo-osmolality and hyponatraemia  
18  N39.0  Urinary tract infection, site not specified  
19
20
21 B34.9  Viral infection, unspecified  
22  A49.9  Bacterial infection, unspecified  
23 B34.2 Coronavirus infection, unspecified  
24 B15.9 Hepatitis A without hepatic coma  
25 B16.1 Acute hepatitis B with delta-agent (coinfection) without hepatic coma  
26
27 R10.0 Acute abdomen  
28 A41.9 Septicaemia, unspecified  
Tarif Ina CBG'S syarat klaim ketereangan
DHF
GEA
bp

susp tb paru
Tb paru

tb miliar

isk

covid
hepatitis a
hepatitis b