PERATURAN MENKES NO: 5 TAHUN 2014

TENTANG

PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN TINGKAT PRIMER

NO NAMA PENYAKIT ICPC II ICD X

A. KELOMPOK UMUM
1 Tuberculosis (TB) Paru A70 Tuberculosis A15 Respiratory
tuberculosis,bacteriologically and
histologically confirmed
2 Morbili A71 Measles B05.9 Measles without complication
(Measles NOS)
3 Varisela A72 Chickenpox B01.9 Varicella without complication
(Varicella NOS)
4 Malaria A73 Malaria B54 Unspecified malaria
5 Demam Dengue dan DBD A77 Viral disease other/NOS A90 Dengue fever dan A91 Dengue
haemorrhagic fever
6 Leptospirosis A78 Infection disease other/NOS A27.9
7 Infeksi pada umbilikus A78 Infection disease other -
8 Kandidiasis mulut A78 Infection disease other B 37.9 Candidiasis unspecified
9 Lepra A78 Infection disease other/NOS A30 Leprosy (Hansen disease)
10 Keracunan makanan A86 Toxic effect non medical T.62.2 Other ingested (parts of plant(s))
substance
11 Alergi makanan A92 Allergic/allergic reaction NOS -
12 Exanthematous drug S07 Rash generalized L27.0 Generalized skin eruption due to
eruption drug medicaments
13 Fixed drug eruption ( FDE) A85 Adverse effect medical agent L27.0 Generalized skin eruption due to
drug medicaments
14 Reaksi anafilaktik A92 Allergic/allergic reaction NOS -
15 Syok K99 Cardiovasculer disease other R57.9 Shock,unspecified
B. DARAH,PEMBENTUKAN DARAH,SISTEM IMUN
16 Anemia B82 Anaemia other/unspecified D64.9 Anaemia unspesified
17 HIV/AIDS tanpa komplikasi B90 HIV-infection/AIDS Z21 Asymptomatic human
immunodeficiency virus (HIV) infection
status
18 Limfadenitis L04.9 B70 Lymphadenitis acute
C.DIGESTIVE
19 Refluks gastroesofageal D84 Oesphagus K21.9 Gastro-oesophageal reflux disease
without oesophagitis
20 Gastritis D07 Dyspepsia/indigestion K29.7 Gastritis, unspecified
21 Intoleransi makanan D29 Digestive -
syndrom/complaint other
22 Malabsorbsi makanan D29 Digestive -
syndrom/complaint other
23 Demam tifoid D70 Gastrointestinal infection A01.0 Typhoid fever
24 Gastrointestinal (termsk D73 Gastroenteritis presumed A09 Diarrhoea and gastroenteritis of
disentri infection presumed infection origin
kolera dan giardiasis)
25 Disentri basiler dan disentri D70 Gastrointestinal infection -
amuba
26 Apendisitis akut S87 Appendicitis K.35.9 Acute appendicitis
27 Perdarahan sal makan bgn D14 Haematemesis /vomiting -
atas blood
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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN TINGKAT PRIMER
D15 Melaena
28 Perdarahan sal makan bgn D70 Gastrointestinal infection -
bawah
29 Hemoroid grade 1-2 D95 Anal fissure/perianal abscess -
30 Hepatitis A D72 Viral Hepatitis -
31 Hepatitis B D72 Viral Hepatitis -
32 Parotitis D83 Mouth/tounge/lip disease K11.2 Sialoadenitis
33 Askariasis D96 Worms/other parasites B77.9 Ascariaris unspecified
34 Cutaneus larva migrans D96 Worms/other parasites B76.9 Hookworm disease unspecified
35 Penyakit cacing tambang D96 Worms/other parasites B76.0 Ankylostomiasis
B76.1 Necatoriasis
36 Skistosomiasis D96 Worms/other parasites B65.9 Skistosomiasis unspecified
B65.2 Schistomiasis due to S. japonicum
37 Strongiloidiasis D96 Worms/other parasites B78.9 Strongyloidiasis
38 Taeniasis D96 Worms/other parasites B68.9 Taeniasis
39 Peritonitis D99 Disease digestive K65.9 Peritonitis, unspecified
system,other
40 Kolesistitis D98 Cholecystitis/ cholelithiasis K81.9 Cholecystitis, unspecified
D.MATA
41 Mata kering/ dry eye F99 Eye/adnexa disease other H04.1 Other disorders of lacrimal gland
42 Buta senja F99 Eye/adnexa disease other H53.5 Colour vision,deficiencies
43 Hordeulum F72 Blepharitis/stye/chalazion H00.0 Hordeolum and other deep
inflammation of eyelid
44 Konjungtivitis
Konjungtivitis infeksi F70 Conjunctivitis infectious H10.9 Conjunctivitis, unspecified
Konjungtivitis alergi F71 Conjunctivitis allergic H10.1 Acute atopic conjuctivitis
45 Blefaritis F72 Blepharitis/stye/chalazion H01.0 Blepharitis
46 Perdarahan subkonjungtiva F75 Contusion/haemorrhage eye H57.8 Other specified disorder of eye and
adnexa
47 Benda asing di konjungtiva F76 Foreign body in eye T15.9 Foreign body on external eye, part
unspecified
48 Astigmatism F91 Refractive error H52.2 Astigmatism
49 Hipermetropia F91 Refractive error H52.0 Hypermetropia
50 Miopia ringan F91 Refractive error H52.1 Myopia
51 Presbiopia F91 Refractive error H52.4 Presbyopia
52 Katarak pada pasien dewasa F92 Cataract H26.9 Cataract, unspecified
53 Glaukoma akut F93 Glaucoma H40.2 Primary angle-closure glaucoma
E.TELINGA
54 Otitis eksterna H70 Otitis eksterna H60.9 Otitis externa, unspecified
55 Otitis media akut H71 Acute otitis media/myringitis H66.0 Acute suppurative otitis media
56 Serumen prop H81 Excessive ear wax H61.2 Impacted cerumen

F.HIDUNG
57 Benda asing di hidung R87 Foreign body T17.1 Foreign body in nostril
nose/larynx/bronchus

G.KARDIOVASKULAR
58 Angina pektoris K74 Ischaemic heart disease with angina I20.9 Angina pectoris, unspecified

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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN TINGKAT PRIMER
59 Infark Miokard K75 Acute myocardial infarction I21.9 Acute myocardial infactin,
unspecified
60 Takikardia K79 Paroxysmal tachicardy R00.0 Tachicardy unspecified
I47.1 Supraventicular tachicardy
I47.2 Ventricular tachicardy
61 Gagal jantung akut dan K77 Heart failure I50.9
kronik
62 Cardiorespiratory arrest K80 Cardiac arrythmia NOS -
63 Hipertensi esensial K86 Hypertension uncomplicated I10 Essential (primary)
hypertension
64 Infark serebral/ Stroke K90 Stroke/ cerebrovascular accident I63.9 Cerebral infarction,
unspecified
H.MUSKULOSKELETAL
65 Fraktur terbuka L76 Fracture other T14 Fracture of unspecified body
66 Fraktur tertutup L76 Fracture other T14 Fracture of unspecified body
67 Polimialgia reumatik L99 Musculosceletal disease other M53.3 Polymyalgia rheumatica
68 Artritis reumatoid L99 Musculosceletal disease other M53.3 Polymyalgia rheumatica
69 Artritis,osteoartritis L91 Osteoarthrosis other M19.9 Osteoarthrosis other
70 Lipoma S78 Lipoma D17.9 Benign lipomatous neoplasm
I.NEUROLOGI
71 Kejang demam N07 Convulsion/ seizure R56.0 Febrile convulsions
72 Vertigo N17 Vertigo/ dizziness R42 Dizziness and giddiness
73 Delirium P71 Organic psychosis other F05.9 Delirium, unspecified
74 Tetanus N72 Tetanus A35 Other tetanus
75 Rabies A77 Viral disease other/ NOS A82.9 Rabies, unspecified
76 Epilepsi N88 Epilepsy G40.9 Epilepsy, unspecified
77 Status epileptikus N88 Epilepsy G41.9 Status epilepticus,
unspecified
78 Migren N89 Migraine N43.9 Migraine,unspecified
79 Bells’ palsy N91 Facial paralysisi/ Bells’ palsy G51.0 Bells’ Palsy
80 Tension headache N95 tension headache G44.2 Tension-type headache
J.PSIKOLOGIS
81 Insomnia P06 Sleep disturbance G47.0 Disorder of initiating and
maintaining sleep (insomnias)
82 Demensia P70 Dementia F03 Unspecified dementia
83 Gangguan campuran P74 Anxiety disorder (anxiety state) F41.2 Mixed anxiety and
anxietas dan depresi depression disorder
84 Gangguan psikotik P98 Psychosis NOS/ other F20# Chronic psychotic disorder
K.RESPIRASI
85 Epistaksis R06 Nose bleed/ epistaxis R04.0 Epistaxis
86 Furunkel pada hidung R73 Boil/abscess nose J34.0 Abscess,furuncle and
carbuncle of nose
87 Faringitis R74 Upper respiratory infection acute J02.9 Acute pharyngitis,
unspecified
88 Rhinitis akut R74 Upper respiratory infection acute J00 Acute nasopharingitis
(common Cold)
89 Rhinitis alergik R97 Allergic rhinitis J30.0 Vasomotor rhinitis
90 Rhinitis vasomotor - -
91 Tonsilitis R76 Tonsilitis acute ? Acute tonsilitis, unspecified
92 Laringitis R77 Laryngitis/ tracheitis acute J04.0 Acute laryngitis
93 Bronkitis akut R78 Acute bronchitis/ bronchiolitis J20.9 Acute bronchitis, unspecified
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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN TINGKAT PRIMER
94 Influenza R80 Influenza J11 Influenza, virus not identified
95 Pneumonia aspirasi R99 Respiratory disease other J69.0 Pneumonitis due to food and
vomit
96 Pneumonia dan R81 Pneumonia J18.9 Pneumonia, unspecified
bronkopneumonia
97 Pertusis R71 Whooping cough A37.8 Whooping cough, bordetella
bronchiseptica
98 Asma bronkial R96 Asthma J45 Asthma
L.KULIT
99 Miliaria S02 S92 Sweat gland disease L74.3 Miliaria, unspecified
100 Veruka vulgaris S03 Warts B07 Viral warts
101 Reaksi gigitan serangga S12 Insect bite/sting T63.4 Venon of other artropods
102 Herpes zoster S70 Herpes zoster B02.9 Zoster without complication
103 Herpes simpleks S71 Herpes simplex B00.9 Herpesviral infection,
unspecified
104 Skabies S72 Scabies/other acariasis B86 Scabies
105 Pedikulosis kapitis S73 Pediculosis/ skin infeslation other B85.0 Pediculosis due to pediculus
humanus capitis
106 Dermatofitosis S74 Dermatophtosis B35 Dermatophytosis
B35.0 Tinea barbae and tinea
capitis
B35.1 Tinea unguium
B35.2 Tinea manuum
B35.3 Tinea pedis
B35.4 Tinea corporis
B35.5 Tinea imbricate
B35.6 Tinea cruris
B35.8 Other dermatophytoses
107 Pitiriasis versikolor/Tinea S76 Skin infection versikolor B36.0 Pityriasis versicolor
versikolor
108 Pioderma S84 Impetigo L01 Impetigo
S76 Skin infection other L02 Cutaneus abcess,furuncle and
carbuncle
L08.0 Pyoderma
109 Dermatitis seboroik S86 Dermatitis seborrhoeic L21 Seborrhoeic dermatitis
110 Dermatitis Atopik S87 Dermatitis/atopic eczema L20 Atopic dermatitis
111 Dermatitis numular S87 Dermatitis/atopic eczema L20.8 Other atopic dermatitis
112 Liken simples kronik S87 Dermatitis/atopic eczema L28.0 Lichensimplex chronicus
(Neurodermatitis
sirkumkripta)
113 Dermatitis kontak alergik S88 Dermatitis contact/allergic L23 Allergic contact dermatitis
(DKA)
114 Dermatitis kontak iritan S88 Dermatitis contact/allergic L24 Irritant contact dermatitis
115 Napkin Eczema (dermatitis S89 Diaper Rash L22 Diaper(napkin) dermatitis
popok)
116 Pitiriasis rosea S90 Pityriasis rosea L42 Pityriasis rosea
117 Moluskum kontangiosum S95 Molluscum contangiosum B08.1 Molluscum contangiosum
118 Urtikaria S98 Urticaria L50 Urticaria
L50.9 Urticaria, unspecified
119 Filariasis S99 Skin infection other B74 Filariasis

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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN TINGKAT PRIMER
120 Luka bakar derajat I dan II
M.METABOLIK ENDOKRIN DAN NUTRISI
121 Obesitas
122 Tirotoksikosis
123 Hiperglikemia
Hiperosmolar Non Ketotik
124 Hipoglikemia
125 Diabetes melitus
126 Malnutrisi energi
protein(MEP)
127 Hiperuricemia-gout
arthritis
128 Dislipidemia
N.SALURAN KEMIH
129 Infeksi saluran kemih
O.KESEHATAN WAITA
130 Hiperemesis gravidarum
131 Kehamilan normal
132 Pre-eklampsia
133 Eklampsi
134 Abortus
135 Anemia defisiensi besi
pada kehamilan
136 Ketuban Pecah Dini (KPD)
137 Persalinan lama
138 Perdarahan post partum
139 Ruptur perineum tingkat 1-
2 laceration during delivery
140 Mastitis
PERATURAN MENKES NO: 5 TAHUN 2014
TENTANG
S24 Burn/scald
T82 Obesity
T83 Overweight
T85 Hipertiroidisme/tirotoksikosis
A91 Abnormal result invetigation NOS
T87 Hypoglicaemia
T87 Diabetes insulin dependent
T90 Diabetes non-insulin dependent
T91 Vitamin/ nutritional deficiency
T99 Endocrine/metabolic/nutritional
disease other
T92 Gout
T93 Lipid disorder
U71 Cystitis/urinary infection other
W05 Pregnancy vomiting/ nausea
W90 Uncomplicated labour/ delivery
livebirth
W81 Toxaemia of pregnancy
W81 Toxaemia of pregnancy
W82 Abortion spontaneous
W82 Abortion spontaneous
B80 Iron deficiency anaemia
W92 Complicated labour/ delivery livebirth
W92 Life birth
W93 still birth
W17 Post partum bleeding
W92 Complicated labour/ delivery livebirth
X21 Breast symptom/complaint female
other
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B74.0 Filariasis due to wuchereria
bancrofti
B74.1 Filariasis due to brugia
malayi
B74.2 Filariasis due to brugia timori
-
E66.9 Obesity unspecified
E05.9 Tirotoksikosis unspecified
R73.9 Hyperglycaemia unspecified
E16.2 Hypoglycaemia unspecified
E10 Insulin-dependent diabetes
mellitus
E11 Non-insulin-dependent
daibetes mellitus
E46 Unspecified protein-energy
malnutrisi
E79.0 Hyperuricemia without sign
of inflammatory arthritis and
tophaceous
disease
M10 Gout
E78.5 Hiperlipidemia
N39.0 Urinary tract infection, site
not specified
O21.0 Mild hyperemis gravidarum
O80.9 Single spontaneous delivery,
unspecified
O14.9 Pre-eclampsia, unspecified
O15.9 Eclampsia, unspecified as to
time period
O03.9 Unspecified abortion,
complete, without complication
O06.4 Unspecified
abortion,incomplete,without
complication
D50 Iron deficiency anaemia
O42.9 Premature rupture of
membrane, unspecified
O63.9 Long labour
O72.1 Other immediate
postpartum haemorrhage
O70.0 Fist degree perineal
N61 Inflammatory disorder of
breast
 PERATURAN MENKES NO: 5 TAHUN 2014

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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN TINGKAT PRIMER
P.PENYAKIT KELAMIN
141 Fluor albus/vaginal X14 vaginal discharge N98.9
discharge non gonore
X71 Gonore pada perempuan
X72 Urogenital candidiasis pada
perempuan
X73 Tikomoniasis urogenital pada
perempuan
X92 Klamidia genital pada perempuan
142 Sifilis Y70 Syphilis male A51 Early syphilis
X70 Syphilis female A51.0 Primary genital syphilis
A52 Late syphilis
A53.9 Syphilis, unspecified
143 Gonore X71 Gonorrhoea female A54.9 Gonococcal infection,
unspecified
Y71 Gonorrhoea male
144 Vaginitis X84 Vaginitis N76.0 Acute vaginitis
145 Vulvitis X84 Vaginitis N76.0 Acute vaginitis