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  • Koding BPJS CMF RS Pemerintah Regional

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    The document lists diagnosis codes, secondary diagnosis codes, and procedures for 11 cases according to the Indonesian National Casemix system. It provides classification, coding, and reimbursement rates for cranial and facial reconstruction procedures in government class A regional hospitals based on the 2016 Health Minister Regulation No. 64. The cases involve fractures, neoplasms, and other conditions of the skull and face requiring reconstruction of bones and soft tissues. Reimbursement rates differ based on the complexity of the procedure and patient's classification into class 1-3.

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    KODING_BPJS_CMF_RS_PEMERINTAH_REGIONAL

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    The document lists diagnosis codes, secondary diagnosis codes, and procedures for 11 cases according to the Indonesian National Casemix system. It provides classification, coding, and reimbursement rates for cranial and facial reconstruction procedures in government class A regional hospitals based on the 2016 Health Minister Regulation No. 64. The cases involve fractures, neoplasms, and other conditions of the skull and face requiring reconstruction of bones and soft tissues. Reimbursement rates differ based on the complexity of the procedure and patient's classification into class 1-3.

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    27 views24 pages

    Koding BPJS CMF RS Pemerintah Regional

    Uploaded by

    Nenden Siti
    The document lists diagnosis codes, secondary diagnosis codes, and procedures for 11 cases according to the Indonesian National Casemix system. It provides classification, coding, and reimbursement rates for cranial and facial reconstruction procedures in government class A regional hospitals based on the 2016 Health Minister Regulation No. 64. The cases involve fractures, neoplasms, and other conditions of the skull and face requiring reconstruction of bones and soft tissues. Reimbursement rates differ based on the complexity of the procedure and patient's classification into class 1-3.

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    © All Rights Reserved
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    of 24

    LIST KODING DAN TARIF INA CBG'S PERMENKES NO.

    64 TAHUN 2016
    RS PEMERINTAH KELAS A REGIONAL 1

    No Diagnosis Utama Diagnosis Sekunder Prosedur

    1 S02.81 Fractures of other skull and S02.41 Fracture of malar & maxillary bones, 76.46 Other reconstruction of other facial
    facial bones, open open bone

    S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    2 S02.7 Fractures of other skull and S02.4 Fracture of malar & maxillary bones, open 76.46 Other reconstruction of other facial
    facial bones, open bone

    3 C04.8 Malignant neoplasm K07.3 Anomalies of mouth position 76.46 Other reconstruction of other facial
    overlapping floor of mouth site bone

    D64.9 Anemia, unspecified 76.43 Other reconstruction of mandible


    A41.9 Septicaemia, unspecified 27.49 Other excision of mouth
    I98.8 Other specified respiratory disorders 27.56 Other skin graft to lip and mouth
    I87.8 Other disorder of electrolyte and fluid
    balance, not elsewhere classified

    4 S02.4 Fractures of malar and S02.3 Fracture of orbital floor 76.79 Other open reduction of facial
    maxillary bones fracture

    S06.4 Epidural Hemorrhagic 76.46 Other reconstruction of other facial


    bone
    5 M72.2 Plantar fascial fibromatosis S02.6 Fracture of mandible 76.43 Other reconstruction of mandible
    66.89 Other repair and reconstruction of
    skin and subcutan of tissue
    76.76 Open reduction of mandibular
    fracture
    39.98 Control of hemorrhage, not
    otherwise specified
    96.54 Dental scalling, polishing and
    debridement
    6 K07.4 Malocclusion S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    7 K07.1 Anomalies of jawcranial bone K07.4 Malocclusion 76.64 Other orthognathic surgery on
    relationship mandible

    8 E43 Unspecified severe protein D63.0 Anemia in neoplastic disease 76.44 Total osteotomy of maxilla
    energy malnutrition

    C30.0 Malignant neoplasm of nasal cavity 27.64 Insertion of platal implant


    D10.3 Benign neoplasm of other and 21.02 Control of epistaxis by posterior and
    unspecified parts of mouth anterior packing
    D31.9 Benign neoplasm of eye, unspecified 31.1 Temporary tracheostomy
    R04.0 Epistaxis 99.21 Injection of antibiotic

    9 D16.5 Benign neoplasm of lower 76.31 Partial mandibulectomy


    jaw bone
    76.43 Other reconstruction of mandible
    39.98 Control of hemorrhage, not
    otherwise specified
    10 S02.61 Fracture of mandibular S52.6 Fracture of lower or distal ends 76.43 Other reconstruction of mandible
    open

    S42.0 Fracture of clavicle


    S62.2 Fracture of first metacarpal bone
    G91.9 Hydrocephalus, unspecified 76.46 Other reconstruction of other facial
    bone
    11 Q67.0 Facial Asymmetry
    R62.9 Lack of expected normal physiologic 93.57 Application of other wound dressing
    development unspecified
    G83.9 Paralytic syndrome, unspecified
    e43 Unspecified servere protein-energy
    malnutrition
    Q75.8 Other specified congenital
    malformations of skull face bones
    ERMENKES NO.64 TAHUN 2016
    S A REGIONAL 1

    Deskripsi Kode INA CBG's Tarif Kelas A CASE


    Kelas 3 Kelas 2 Kelas 1
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG 113,466,900 136,160,300 158,853,700
    WAJAH BERAT
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 52,606,300 63,127,600 73,648,800
    WAJAH SEDANG
    CMF

    M-1-10-III PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 113,466,900 136,160,300 158,853,700
    WAJAH BERAT

    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 52,606,300 63,127,600 73,648,800
    WAJAH SEDANG
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 52,606,300 63,127,600 73,648,800
    WAJAH SEDANG

    CMF
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 52,606,300 63,127,600 73,648,800 CMF
    WAJAH SEDANG

    M-1-10-I PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 22,002,200 26,402,600 30,803,100 CMF
    WAJAH RINGAN

    I-1-20-II Prosedur Sistem


    Peredaran Darah Lain-Lain 25,829,700 30,995,600 36,161,600
    Sedang

    CMF

    I-1-20-I Prosedur Sistem


    Peredaran Darah Lain-Lain 20,675,700 24,810,900 28,946,000
    Ringan
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 52,606,300 63,127,600 73,648,800
    WAJAH SEDANG
    CMF & HAND
    CMF & HAND

    M-1-10-III PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 158,853,700.00
    WAJAH BERAT
    LIST KODING DAN TARIF INA CBG'S PERMENKES NO.64 TAHUN 2016
    RS PEMERINTAH KELAS B REGIONAL 1

    No Diagnosis Utama Diagnosis Sekunder Prosedur


    1 S02.81 Fractures of other skull and S02.41 Fracture of malar & maxillary bones, 76.46 Other reconstruction of other facial
    facial bones, open open bone

    S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    2 S02.7 Fractures of other skull and S02.4 Fracture of malar & maxillary bones, open 76.46 Other reconstruction of other facial
    facial bones, open bone

    3 C04.8 Malignant neoplasm K07.3 Anomalies of mouth position 76.46 Other reconstruction of other facial
    overlapping floor of mouth site bone

    D64.9 Anemia, unspecified 76.43 Other reconstruction of mandible


    A41.9 Septicaemia, unspecified 27.49 Other excision of mouth
    I98.8 Other specified respiratory disorders 27.56 Other skin graft to lip and mouth
    I87.8 Other disorder of electrolyte and fluid
    balance, not elsewhere classified

    4 S02.4 Fractures of malar and S02.3 Fracture of orbital floor 76.79 Other open reduction of facial
    maxillary bones fracture

    S06.4 Epidural Hemorrhagic 76.46 Other reconstruction of other facial


    bone
    5 M72.2 Plantar fascial fibromatosis S02.6 Fracture of mandible 76.43 Other reconstruction of mandible
    66.89 Other repair and reconstruction of
    skin and subcutan of tissue
    76.76 Open reduction of mandibular
    fracture
    39.98 Control of hemorrhage, not
    otherwise specified
    96.54 Dental scalling, polishing and
    debridement
    6 K07.4 Malocclusion S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    7 K07.1 Anomalies of jawcranial bone K07.4 Malocclusion 76.64 Other orthognathic surgery on
    relationship mandible

    8 E43 Unspecified severe protein D63.0 Anemia in neoplastic disease 76.44 Total osteotomy of maxilla
    energy malnutrition

    C30.0 Malignant neoplasm of nasal cavity 27.64 Insertion of platal implant


    D10.3 Benign neoplasm of other and 21.02 Control of epistaxis by posterior and
    unspecified parts of mouth anterior packing
    D31.9 Benign neoplasm of eye, unspecified 31.1 Temporary tracheostomy
    R04.0 Epistaxis 99.21 Injection of antibiotic
    9 D16.5 Benign neoplasm of lower 76.31 Partial mandibulectomy
    jaw bone
    76.43 Other reconstruction of mandible
    39.98 Control of hemorrhage, not
    otherwise specified
    10 S02.61 Fracture of mandibular S52.6 Fracture of lower or distal ends 76.43 Other reconstruction of mandible
    open

    S42.0 Fracture of clavicle


    S62.2 Fracture of first metacarpal bone
    G91.9 Hydrocephalus, unspecified 76.46 Other reconstruction of other facial
    bone
    11 Q67.0 Facial Asymmetry
    R62.9 Lack of expected normal physiologic 93.57 Application of other wound dressing
    development unspecified
    G83.9 Paralytic syndrome, unspecified
    e43 Unspecified servere protein-energy
    malnutrition
    Q75.8 Other specified congenital
    malformations of skull face bones
    ERMENKES NO.64 TAHUN 2016
    S B REGIONAL 1

    Tarif RS Kelas B
    Deskripsi Kode INA CBG's CASE
    Kelas 3 Kelas 2 Kelas 1
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG 95,050,800 114,061,000 133,071,100
    WAJAH BERAT
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 44,068,100 52,881,700 61,695,300
    WAJAH SEDANG
    CMF

    M-1-10-III PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 95,050,800 114,061,000 133,071,100
    WAJAH BERAT

    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 44,068,100 52,881,700 61,695,300
    WAJAH SEDANG
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 44,068,100 52,881,700 61,695,300
    WAJAH SEDANG

    CMF
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 44,068,100 52,881,700 61,695,300 CMF
    WAJAH SEDANG

    M-1-10-I PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 18,431,100 22,117,300 25,803,500 CMF
    WAJAH RINGAN

    I-1-20-II Prosedur Sistem


    Peredaran Darah Lain-Lain 18,634,700 22,361,700 26,088,600
    Sedang

    CMF

    I-1-20-I Prosedur Sistem


    Peredaran Darah Lain-Lain 14,916,500 17,899,700 20,883,000
    Ringan
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 44,068,100 52,881,700 61,695,300
    WAJAH SEDANG
    CMF & HAND
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG
    WAJAH BERAT
    LIST KODING DAN TARIF INA CBG'S PERMENKES NO.64 TAHUN 2016
    RS PEMERINTAH KELAS C REGIONAL 1

    No Diagnosis Utama Diagnosis Sekunder Prosedur


    1 S02.81 Fractures of other skull and S02.41 Fracture of malar & maxillary bones, 76.46 Other reconstruction of other facial
    facial bones, open open bone

    S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    2 S02.7 Fractures of other skull and S02.4 Fracture of malar & maxillary bones, open 76.46 Other reconstruction of other facial
    facial bones, open bone

    3 C04.8 Malignant neoplasm K07.3 Anomalies of mouth position 76.46 Other reconstruction of other facial
    overlapping floor of mouth site bone

    D64.9 Anemia, unspecified 76.43 Other reconstruction of mandible


    A41.9 Septicaemia, unspecified 27.49 Other excision of mouth
    I98.8 Other specified respiratory disorders 27.56 Other skin graft to lip and mouth
    I87.8 Other disorder of electrolyte and fluid
    balance, not elsewhere classified

    4 S02.4 Fractures of malar and S02.3 Fracture of orbital floor 76.79 Other open reduction of facial
    maxillary bones fracture

    S06.4 Epidural Hemorrhagic 76.46 Other reconstruction of other facial


    bone
    5 M72.2 Plantar fascial fibromatosis S02.6 Fracture of mandible 76.43 Other reconstruction of mandible
    66.89 Other repair and reconstruction of
    skin and subcutan of tissue
    76.76 Open reduction of mandibular
    fracture
    39.98 Control of hemorrhage, not
    otherwise specified
    96.54 Dental scalling, polishing and
    debridement
    6 K07.4 Malocclusion S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    7 K07.1 Anomalies of jawcranial bone K07.4 Malocclusion 76.64 Other orthognathic surgery on
    relationship mandible

    8 E43 Unspecified severe protein D63.0 Anemia in neoplastic disease 76.44 Total osteotomy of maxilla
    energy malnutrition

    C30.0 Malignant neoplasm of nasal cavity 27.64 Insertion of platal implant


    D10.3 Benign neoplasm of other and 21.02 Control of epistaxis by posterior and
    unspecified parts of mouth anterior packing
    D31.9 Benign neoplasm of eye, unspecified 31.1 Temporary tracheostomy
    R04.0 Epistaxis 99.21 Injection of antibiotic
    9 D16.5 Benign neoplasm of lower 76.31 Partial mandibulectomy
    jaw bone
    76.43 Other reconstruction of mandible
    39.98 Control of hemorrhage, not
    otherwise specified
    10 S02.61 Fracture of mandibular S52.6 Fracture of lower or distal ends 76.43 Other reconstruction of mandible
    open

    S42.0 Fracture of clavicle


    S62.2 Fracture of first metacarpal bone
    G91.9 Hydrocephalus, unspecified 76.46 Other reconstruction of other facial
    bone
    11 Q67.0 Facial Asymmetry
    R62.9 Lack of expected normal physiologic 93.57 Application of other wound dressing
    development unspecified
    G83.9 Paralytic syndrome, unspecified
    e43 Unspecified servere protein-energy
    malnutrition
    Q75.8 Other specified congenital
    malformations of skull face bones
    ERMENKES NO.64 TAHUN 2016
    S C REGIONAL 1

    Tarif RS Kelas C
    Deskripsi Kode INA CBG's CASE
    Kelas 3 Kelas 2 Kelas 1
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG 47,554,200 57,065,100 66,575,900
    WAJAH BERAT
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 22,047,400 26,456,900 30,866,400
    WAJAH SEDANG
    CMF

    M-1-10-III PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 47,554,200 57,065,100 66,575,900
    WAJAH BERAT

    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 22,047,400 26,456,900 30,866,400
    WAJAH SEDANG
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 22,047,400 26,456,900 30,866,400
    WAJAH SEDANG

    CMF
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 22,047,400 26,456,900 30,866,400 CMF
    WAJAH SEDANG

    M-1-10-I PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 10,047,200 12,056,700 14,066,100 CMF
    WAJAH RINGAN

    I-1-20-II Prosedur Sistem


    Peredaran Darah Lain-Lain 13,825,400 16,590,500 19,355,500
    Sedang

    CMF

    I-1-20-I Prosedur Sistem


    Peredaran Darah Lain-Lain 11,066,700 13,280,100 15,493,400
    Ringan
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 22,047,400 26,456,900 30,866,400
    WAJAH SEDANG
    CMF & HAND
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG
    WAJAH BERAT
    LIST KODING DAN TARIF INA CBG'S PERMENKES NO.64 TAHUN 2016
    RS PEMERINTAH KELAS D REGIONAL 1

    No Diagnosis Utama Diagnosis Sekunder Prosedur


    1 S02.81 Fractures of other skull and S02.41 Fracture of malar & maxillary bones, 76.46 Other reconstruction of other facial
    facial bones, open open bone

    S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    2 S02.7 Fractures of other skull and S02.4 Fracture of malar & maxillary bones, open 76.46 Other reconstruction of other facial
    facial bones, open bone

    3 C04.8 Malignant neoplasm K07.3 Anomalies of mouth position 76.46 Other reconstruction of other facial
    overlapping floor of mouth site bone

    D64.9 Anemia, unspecified 76.43 Other reconstruction of mandible


    A41.9 Septicaemia, unspecified 27.49 Other excision of mouth
    I98.8 Other specified respiratory disorders 27.56 Other skin graft to lip and mouth
    I87.8 Other disorder of electrolyte and fluid
    balance, not elsewhere classified

    4 S02.4 Fractures of malar and S02.3 Fracture of orbital floor 76.79 Other open reduction of facial
    maxillary bones fracture

    S06.4 Epidural Hemorrhagic 76.46 Other reconstruction of other facial


    bone
    5 M72.2 Plantar fascial fibromatosis S02.6 Fracture of mandible 76.43 Other reconstruction of mandible
    66.89 Other repair and reconstruction of
    skin and subcutan of tissue
    76.76 Open reduction of mandibular
    fracture
    39.98 Control of hemorrhage, not
    otherwise specified
    96.54 Dental scalling, polishing and
    debridement
    6 K07.4 Malocclusion S02.61 Fracture of mandible, open 76.43 Other reconstruction of mandible

    7 K07.1 Anomalies of jawcranial bone K07.4 Malocclusion 76.64 Other orthognathic surgery on
    relationship mandible

    8 E43 Unspecified severe protein D63.0 Anemia in neoplastic disease 76.44 Total osteotomy of maxilla
    energy malnutrition

    C30.0 Malignant neoplasm of nasal cavity 27.64 Insertion of platal implant


    D10.3 Benign neoplasm of other and 21.02 Control of epistaxis by posterior and
    unspecified parts of mouth anterior packing
    D31.9 Benign neoplasm of eye, unspecified 31.1 Temporary tracheostomy
    R04.0 Epistaxis 99.21 Injection of antibiotic
    9 D16.5 Benign neoplasm of lower 76.31 Partial mandibulectomy
    jaw bone
    76.43 Other reconstruction of mandible
    39.98 Control of hemorrhage, not
    otherwise specified
    10 S02.61 Fracture of mandibular S52.6 Fracture of lower or distal ends 76.43 Other reconstruction of mandible
    open

    S42.0 Fracture of clavicle


    S62.2 Fracture of first metacarpal bone
    G91.9 Hydrocephalus, unspecified 76.46 Other reconstruction of other facial
    bone
    11 Q67.0 Facial Asymmetry
    R62.9 Lack of expected normal physiologic 93.57 Application of other wound dressing
    development unspecified
    G83.9 Paralytic syndrome, unspecified
    e43 Unspecified servere protein-energy
    malnutrition
    Q75.8 Other specified congenital
    malformations of skull face bones
    ERMENKES NO.64 TAHUN 2016
    S D REGIONAL 1

    Tarif RS Kelas D
    Deskripsi Kode INA CBG's CASE
    Kelas 3 Kelas 2 Kelas 1
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG 41,486,500 49,783,800 58,081,000
    WAJAH BERAT
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 19,234,200 23,081,100 26,927,900
    WAJAH SEDANG
    CMF

    M-1-10-III PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 41,486,500 49,783,800 58,081,000
    WAJAH BERAT

    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 19,234,200 23,081,100 26,927,900
    WAJAH SEDANG
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 19,234,200 23,081,100 26,927,900
    WAJAH SEDANG

    CMF
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 19,234,200 23,081,100 26,927,900 CMF
    WAJAH SEDANG

    M-1-10-I PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 8,765,200 10,518,300 12,271,300 CMF
    WAJAH RINGAN

    I-1-20-II Prosedur Sistem


    Peredaran Darah Lain-Lain 12,061,300 14,473,600 16,885,800
    Sedang

    CMF

    I-1-20-I Prosedur Sistem


    Peredaran Darah Lain-Lain 9,654,700 11,585,600 13,516,500
    Ringan
    CMF

    M-1-10-II PROSEDUR KRANIAL


    DAN REKONSTRUKSI TULANG 19,234,200 23,081,100 26,927,900
    WAJAH SEDANG
    CMF & HAND
    M-1-10-III PROSEDUR KRANIAL
    DAN REKONSTRUKSI TULANG
    WAJAH BERAT

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