IPD+ANAK+JANTUNG+PARU

NO DIAGNOSA Kode INA-Cbgs

1 DIARE / GE (A09.9) K-4-17-I
2 DIARE + DEHIDRASI + ISPA ( VOMITUS ) ( A09.9 + J06.9 ) K-4-17-I
3 ISPA (J06.9) U-4-13-I
4 ISPA + KEJANG DEMAM ( FEBRIS KONVULSI) (J06.9+R56.0) U-4-13-II
5 KEJANG DEMAM (R56.0) G-4-22-I
6 DHF (A91) A-4-13-I
7 TONSILOFARINGITIS (J06.8) U-4-13-I
8 THYPOID (A01.0) A-4-14-I
9 MORBILI (B05.9) A-4-13-I
10 DYSPEPSIA (K30) K-4-18-I
11 GASTRITIS (ENDOSCOPY) (K29.7) K-4-11-I
12 AMOEBIASIS (A06.9) A-4-14-I
13 BP ( BRONKOPNEUMONIA ) (J18.0) J-4-16-I
14 THALASEMIA + TRANFUSI (G56.0) D-4-13-I
15 BRONCHITIS (J40) J-4-21-I
16 Cholelitiasis non tindakan (K80.2) B-4-14-I
17 CAD / Atherosklerosis (I25.1) I-4-16-I
18 CAD dengan Sinus (I25.1 + J32.9) I-4-16-I
19 Dermatitis Alergi (L23.9) L-4-14-I
20 Enchepalitis viral (A86) G-4-19-I
21 splenemogali ( pembesaran limpa ) (R16.1) D-4-14-I
22 BRONCHIOLITIS (J21.9) J-4-18-I
23 HEPATITIS A / Hepatitis B ( Sama ) (B15.9/B16.9) B-4-13-I
24 VERTIGO (H81.3) U-4-11-I
25 RHINITIS/FARINGITIS/LARINGITIS (J31.0/J02.9/J04.0) U-4-13-I
26 VOMITUS (R11) K-4-17-I
27 ASTHMA (J45.9) J-4-18-I
28 SALMONELLOSIS (A02.0) K-4-18-I
29 HEG (O21.0) W-4-16-I
30 ANEMIA + TRANFUSI (D64.9+ 99.04) D-4-13-I
31 TB PARU (A16.7) J-4-15-I
32 PAROTITIS (K11.2) U-4-15-I
33 CHEPALGIA (R51) G-4-23-I
34 TUMOR PARU (D14.3) J-4-14-I
35 ABDOMINAL PAIN + CKD (R10.4+N18.9) N-4-10-I
36 ISPA (J06.9) U-4-13-I
37 VARICELA (B01.9) A-4-13-I
38 STEMI (I21.3) I-4-10-I
39 CHF ( Pembengkakan Jantung ) (I50.0) I-4-12-I
40 Colic Abdomen (R10.4) K-4-17-I
41 HIPERTENSI (I10) I-4-17-I
42 ISK (UL Leu> 10/LPB) (N39.0) N-4-12-I
43 HHD & Bronchitis / hypertensi (I11.9+J40+I10) I-4-17-I
44 Splenomegali + Anemia (R16.1+D64.9) D-4-13-I
ITP (Idiopathic Thrombocytopenic Purpura) HARUS ADA TRANSFUSI
45 D-4-11-I
(D69.3)
46 Ileus Paralitic /OBATRUKTIF tanpa tindakan (K56.0) K-4-15-I
47 CAD Dengan Stemi (I25.1+I21.3) I-4-16-III
48 CAD (I25.1) I-4-16-I
49 DIABETES MELITUS (E14.9) E-4-10-I
50 Selulitis + LBP (L03.9+M54.59) L-4-12-I
51 RUBELLA (B06.9) A-4-13-I
52 AKI (N17.9) N-4-10-I
53 CKD (N18.9) N-4-10-I
CKD+ PASANG CDL (dengan indikasi) - Chronic renal failure
54 unspecifiedN18.9 Primer Prosedur (ICD-9-CM): Cari Prosedur Venous N-1-12-I
catheterization for renal dialysis38.95 Hemodialysis39.95
55 Malaria (vivax) (B51.9) A-4-14-I
56 epilepsi (G40.9) G-4-22-I
57 SYNDROMA NEFROTIK (N04.9) N-4-11-I
Nefrokalsinosis - Disorders of calcium metabolismE83.5 Primary
58 Prosedur Diagnostic ultrasound of abdomen and E-4-11-I
retroperitoneum88.76
Batu saluran kemih - Calculus of kidneyN20.0 Primer Prosedur (ICD-
59 9-CM): Diagnostic ultrasound of abdomen and N-4-13-I
retroperitoneum88.76
60 hipokalemia (E87.6) E-4-11-I
61 Low Back Pain (M54.59) M-4-17-I
62 Tension Type Headache (G44.2) G-4-23-I
63 status migrain (G43.2) G-4-23-I
64 Pneumonia (J18.9) J-4-16-I
65 NSTEMI I-4-10-I
66 STEMI I-4-10-I
67 UAP I-4-10-I
68 BP + STATUS EPILEPTIKUS J-4-16-II
69 NSTEMI + BP + DM Tipe 2 + Dislipidemia + Hipokelamia + CHF + IHD I-4-10-III
70 Bronkhitis akut + Hipoalbuminemia + Hipokalemia + SNH DD SH J-4-21-III
71 Hipoglikemia + PPOK + Hipokalemia E-4-10-II
72 CKD on HD + Hipertensi + DM N-4-10-I
73 NSTEMI + PPOK + ADHF + CKD + SNH DD SH I-4-10-III
74 BP + Meningitis G-4-19-III
75 DM Tipe 2 + CKD + Nefropati Diabetik + ALO N-1-12-III
76 TB Paru + Alkalosis Respiratorik + AKI J-4-15-III
77 SNH + Hypernatremia G-4-14-II
78 SNH + BP + DM Tipe 2 G-4-14-III
79 KAD + RBBB Incomplete + Asidosis + BP + Hiponatremia E-4-10-III
Mengitisi Bakterial + BP + Tirotoksikosis + Hipokalemia +
80 G-4-18-III
Hiponatremia
 Gagal Fungsi Hati + Encephalopathy Hepaticum + ALO + Alkalosis
81 B-4-13-III
Respiratorik + AKI
82 DM Tipe 2 + ADHF + IHD + Cystitis + Kolik Renal + Alkalosis N-4-16-II
83 BP + Status Epileptikus + Gizi Buruk + Protein Calorie Malnutrition J-4-16-III
SNH + BP + ALO + Ventricular Premature Complex + Hipoglikemia +
84 G-4-14-III
CKD
85 TB Paru + DM Tipe 2 + Hypokalemia + Hypoalbumin + J-4-15-II
SNH + BP + HHD + HYPOKALEMIA
86 Dyslipidemia G-4-14-III
Hipokalemia
 TARIF NON VENTI VENTI <96 JAM
1 2 3 1 2
2,197,100 1,924,500 1,652,000 21,499,900 18,832,600
2,197,100 1,924,500 1,652,000 21,499,900 18,832,600
2,660,900 2,330,800 2,000,700 21,499,900 18,832,600
3,136,900 2,747,700 2,358,600 21,499,900 18,832,600
3,679,500 3,223,100 2,766,600 21,499,900 18,832,600
2,605,600 2,282,400 1,959,100 21,499,900 18,832,600
2,660,900 2,330,800 2,000,700 21,499,900 18,832,600
3,048,900 2,670,600 2,292,400 21,499,900 18,832,600
2,605,600 2,282,400 1,959,100 21,499,900 18,832,600
1,810,500 1,585,900 1,361,300 21,499,900 18,832,600
3,117,000 2,730,300 2,343,600 21,499,900 18,832,600
3,048,900 2,670,600 2,292,400 21,499,900 18,832,600
4,855,700 4,253,300 3,650,900 21,499,900 18,832,600
3,231,500 2,830,600 2,429,700 21,499,900 18,832,600
3,877,200 3,396,200 2,915,200 21,499,900 18,832,600
4,543,600 3,979,900 3,416,300 21,499,900 18,832,600
2,503,500 2,192,900 1,882,300 21,499,900 18,832,600
2,503,500 2,192,900 1,882,300 21,499,900 18,832,600
3,595,500 3,149,500 2,703,400 21,499,900 18,832,600
4,392,200 3,847,300 3,302,400 21,499,900 18,832,600
3,465,900 3,036,000 2,606,000 21,499,900 18,832,600
2,991,300 2,620,200 2,249,100 21,499,900 18,832,600
4,548,500 3,984,200 3,419,900 21,499,900 18,832,600
1,911,000 1,674,000 1,436,900 21,499,900 18,832,600
2,660,900 2,330,800 2,000,700 21,499,900 18,832,600
2,197,100 1,924,500 1,652,000 21,499,900 18,832,600
2,991,300 2,620,200 2,249,100 21,499,900 18,832,600
1,810,500 1,585,900 1,361,300 21,499,900 18,832,600
2,915,100 2,553,500 2,191,800 21,499,900 18,832,600
3,231,500 2,830,600 2,429,700 21,499,900 18,832,600
5,827,700 5,104,700 4,381,700 21,499,900 18,832,600
4,018,000 3,519,500 3,021,000 21,499,900 18,832,600
2,867,400 2,511,600 2,155,900 21,499,900 18,832,600
4,776,000 4,183,500 3,591,000 21,499,900 18,832,600
4,047,200 3,545,100 3,043,000 21,499,900 18,832,600
2,660,900 2,330,800 2,000,700 21,499,900 18,832,600
2,605,600 2,282,400 1,959,100 21,499,900 18,832,600
4,667,000 4,088,100 3,509,100 21,499,900 18,832,600
3,813,200 3,340,100 2,867,100 21,499,900 18,832,600
2,197,100 1,924,500 1,652,000 21,499,900 18,832,600
2,818,300 2,468,600 2,119,000 21,499,900 18,832,600
3,297,100 2,888,100 2,479,100 21,499,900 18,832,600
2,818,300 2,468,600 2,119,000 21,499,900 18,832,600
3,231,500 2,830,600 2,429,700 21,499,900 18,832,600
4,994,400 4,374,800 3,755,200 21,499,900 18,832,600
3,236,400 2,834,900 2,433,400 21,499,900 18,832,600
4,385,300 3,841,300 3,297,300 21,499,900 18,832,600
2,503,500 2,192,900 1,882,300 21,499,900 18,832,600
4,852,700 4,250,700 3,648,700 21,499,900 18,832,600
2,207,200 1,933,400 1,659,600 21,499,900 18,832,600
2,605,600 2,282,400 1,959,100 21,499,900 18,832,600
4,047,200 3,545,100 3,043,000 21,499,900 18,832,600
4,047,200 3,545,100 3,043,000 21,499,900 18,832,600

6,104,600 5,347,300 4,589,900 21,499,900 18,832,600

3,048,900 2,670,600 2,292,400 21,499,900 18,832,600

3,679,500 3,223,100 2,766,600 21,499,900 18,832,600
3,021,100 2,646,300 2,271,500 21,499,900 18,832,600

4,184,500 3,665,300 3,146,200 21,499,900 18,832,600

4,763,900 4,172,900 3,581,900 21,499,900 18,832,600

4,184,500 3,665,300 3,146,200 21,499,900 18,832,600

3,990,100 3,495,100 3,000,100 21,499,900 18,832,600
2,867,400 2,511,600 2,155,900 21,499,900 18,832,600
2,867,400 2,511,600 2,155,900 21,499,900 18,832,600
4,855,700 4,253,300 3,650,900 21,499,900 18,832,600
4,667,000 4,088,100 3,509,100 21,499,900 18,832,600
4,667,000 4,088,100 3,509,100 21,499,900 18,832,600
4,832,300 4,232,800 3,633,300 16,165,300 16,165,301
6,823,500 5,976,900 5,130,400 24,959,700 21,863,200
10,915,700 9,561,500 8,207,300 31,248,500 27,371,800
8,715,700 7,634,400 6,553,200 31,248,500 27,371,800
6,780,900 5,939,700 5,098,400 24,959,700 21,863,200
4,047,200 3,545,100 3,043,000 21,499,900 18,832,600
10,915,700 9,561,500 8,207,300 31,248,500 27,371,800
9,605,000 8,413,400 7,221,800 31,248,500 27,371,800
20,936,000 18,338,700 15,741,400 20,936,000 18,338,700
9,367,200 8,205,100 7,043,000 31,248,500 27,371,800
7,369,100 6,454,900 5,540,700 24,959,700 21,863,200
8,715,700 7,634,400 6,553,200 31,248,500 27,371,800
8,415,600 7,371,500 6,327,500 31,248,500 27,371,800
8,512,100 7,456,100 6,400,100 31,248,500 27,371,800
7,299,500 6,393,900 5,488,300 31,248,500 27,371,800
5,707,600 4,999,500 4,291,400 24,959,700 21,863,200
8,627,200 7,557,000 6,486,700 31,248,500 27,371,800
9,581,100 8,392,500 7,203,800 31,248,500 27,371,800
6,890,600 5,906,200 4,921,900 17,562,600 15,053,700

9,007,600 7,720,800 6,434,000 26,895,300 23,053,100

<96 JAM VENTI >96
3 1 2 3
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000

16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,300 31,846,800 27,895,900 23,945,000
16,165,302 16,165,303 16,165,304 16,165,305
18,766,700 43,456,000 38,064,800 32,673,700
23,495,100 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
18,766,700 43,456,000 38,064,800 32,673,700
16,165,300 31,846,800 27,895,900 23,945,000
23,495,100 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
15,741,400 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
18,766,700 43,456,000 38,064,800 32,673,700
23,495,100 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
18,766,700 43,456,000 38,064,800 32,673,700
23,495,100 71,760,500 62,857,900 53,955,300
23,495,100 71,760,500 62,857,900 53,955,300
12,544,700 43,012,300 36,867,700 30,723,100

19,210,900 71,028,100 60,881,200 50,734,400

 BEDAH DAN THT
NO DIAGNOSA
1 FAM (D24)
2 APP (K37)
3 HERNIA INGUINAL (K40.9)
4 HERNIA UMBILICAL (K42.9)
5 ULKUS DIABETIKUM (E14.5)
6 HEMORHOID / POST OP POLIP ANUS (I84.9)
7 HEMORHOID NON TINDAKAN OPERASI (I84.9)
8 FISTULA ANI (K60.3)
9 LYMPADENOPATHY (R59.1)
10 TUMOR MAMMAE (D24)
11 TUMOR AXILARY (D36.7)
12 MASTITIS (N61)
13 FURUNCLE / STT REGIONAL KLAFIKULA / STT COLLI
PEDIS (D21.2)
14 GANGLION OS RADIUS

15 AKUT ABDOMEN /ILEUS

18 FIMOSIS (N47)
20 TONSILITIS KRONIS (J35.0)
21 SINUSITIS (J32.9)

25 TUMOR TYROID (D34)

26 STT ABDOMEN (D21.4)

29 STT THORAX (D21.3)
30 Selulitis Oksitipal (L03.8)
31 Bacelioma Nassal
32 Struma nodosa tiroid
33 Struma difus tiroid
34 Hydrocele unspecified N43.3

35
peritonitisK65.0 Prosedur (ICD-9-CM): Cari
Prosedur Other lysis of peritoneal adhesions54.59

37 Other cholelithiasis K80.8 Primer Prosedur (ICD-9-

CM): Cholecystectomy51.22
38 Preauricular sinus and cystQ18.1 Primer Prosedur
(ICD-9-CM): 1821 Excision of preauricular
sinus18.21
39 Hypertrophy of nasal turbinatesJ34.3 Primer
Prosedur (ICD-9-CM): 216 Other
turbinectomy21.69

40 ILEUS OBSTRUKTIF (K56.6)

 41 tumor auricula (D23.2)
42 polip nasal (J33.9)

UROLOGY
1 hydrochele communicons ( urology )
2 Eksisi Varicocele ( urology )

3 tumor Prostate
4 BPH (Benign Prostat Hiperplasia)

ORTHOPEDI
1 Malunion Fraktur radius dan ulna ( Opern fraktur )

2 Fracture foot (open)

3 fracture forearm (open)

4 fracture forearm (CLOSE)

5 CARPAL TUNNEL SYNDROME

8 UNION FRACTURE FOREARM (CLOSE)

9 FRACTURE LOWER LEG (CLOSE)

10 UNION FRACTURE FOREARM (CLOSE)

11 OSTEOMYELITIS

12 OA GENUE/FRAKTUR PATELLA

13 Fracture of neck of femur, closedS72.00

DX : EKSISI SOFT TISSU TUMOR DENGAN PA HUMERUS OR STT THORAX (POKOK

KELAS I
Rp 5,386,100
DX : EKSISI SOFT TISSU TUMOR TANPA PA HUMERUS OR STT THORAX (POKOKN
KELAS I
Rp 4,505,200
 TINDAKAN
EXCISION (85.21)
APPENDECTOMY (47.09)
HERNIOTOMY (53.00)
HERNIOTOMY UMBILICAL (53.00)
DEBRIDEMENT + NECROTOMY (86.22)
HEMOROIDDECTOMY / EKSISI SKIN DENGAN REG PIRENEUM (49.46)

fistulektomi (49.12)

OPEN BIOPSY /EKSISI (85.21)

EXCISION (86.3)
EXCISION
EXCISION 86.3
EXCISION
LAPARATOMY (OMIT CODE TIDAK BOLEH DICODING UNTUK KLAIM,
HANYA UNTUK KEPERLUAN DENDA PELAYANAN)
SIRKUMSISI
TONSILECTOMY (28.3)
SINUSECTOMY (22.60)

EXCISION TYROIDECTOMY (06.39)

EXCISION (86.3)
EXCISION (86.3)
EXCISION (86.3)
EXCISION
TYROIDECTOMY (06.39)
TYROIDECTOMY (06.39)
eksisi hydrocele Excision of hydrocele (of tunica vaginalis)61.2

ADHESIOLISIS PERITONEUM (SYARAT TIDAK BOLEH PADA KASUS AKUT

KOLESISTEKTOMI

EKSISI SINUS PREAURIKULA (18.21)

TURBINEKTOMI (21.69)

Other and unspecified partial excision of large intestine45.79 Intestinal

anastomosis, not otherwise specified45.90
 eksisi auricle (18.29)
polipektomi (21.31)

TINDAKAN
eksisi hydrocele Excision of hydrocele (of tunica vaginalis)61.2
eksisi (Scrotal varicesI86.1 Primer Prosedur (ICD-9-CM): Excision of
varicocele and hydrocele of spermatic cord63.1)
Prostatectomy
transurethral resection of the prostate (Hyperplasia of prostateN40
Primer Prosedur (ICD-9-CM): Cari Prosedur Other transurethral
prostatectomy60.29)

TINDAKAN
Osteotomy Orif Bone Graft (Fracture of lower end of both ulna and
radius, closedS52.60 Primer Prosedur (ICD-9-CM): 7803 Other division of
radius and ulna77.33 Bone graft of radius and ulna78.03)
ORIF (Fracture of foot, unspecified , openS92.91 Primer Prosedur Open
reduction of fracture with internal fixation, tarsals and
metatarsals79.37)
ORIF (Fracture of forearm, part unspecified , openS52.91 Primer Prosedur
(ICD-9-CM): Open reduction of fracture with internal fixation, radius and
ulna79.32)
ORIF (Fracture of forearm, part unspecified , closedS52.90 Primer
Prosedur (ICD-9-CM): Open reduction of fracture with internal fixation,
radius and ulna79.32)
Decompression (Carpal tunnel syndromeG56.0 Primer Prosedur (ICD-9-
CM): Release of carpal tunnel04.43)
REMOVAL IMPLANT (Fracture of forearm, part unspecified , openS52.91
Primer Prosedur (ICD-9-CM): 7863 Removal of implanted device from
radius and ulna78.63)
ORIF (Fracture of lower leg, part unspecified, closedS82.90 Primer
Prosedur (ICD-9-CM): Open reduction of fracture with internal fixation,
tibia and fibula79.36)
sequestrectomy (Fracture of forearm, part unspecified , closedS52.90
Primer Prosedur (ICD-9-CM): Sequestrectomy of radius and ulna77.03)

AMPUTASI

TKR (TOTAL KNEE REPLACEMENT)

THR (TOTAL HIP REPLACEMENT)

MOR DENGAN PA HUMERUS OR STT THORAX (POKOKNYA TINDAKAN EXCISION STT) SEMU
KELAS II
Rp 4,717,900
MOR TANPA PA HUMERUS OR STT THORAX (POKOKNYA TINDAKAN EXCISION STT) SEMUA
KELAS II
Rp 3,946,300
 NAMA PROSEDUR KODE INACBG

PROSEDUR PADA PAYUDARA (RINGAN) L-1-50-I

PROSEDUR APPENDIK (RINGAN) K-1-13-I
PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN) K-1-14-I
PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN) K-1-14-I
PENYAKIT PEMBULUH DARAH DAN LAIN-LAIN (RINGAN) I-4-15-I
PROSEDUR ANAL (RINGAN) K-1-50-I
GANGGUAN SISTEM PENCERNAAN LAIN-LAIN (RINGAN) K-4-18-I
PROSEDUR ANAL (RINGAN) K-1-50-I
GANGGUAN PADA DARAH & ORGAN PEMBENTUK DARAH LAIN-LAIN (RINGAN) D-4-14-I
PROSEDUR PADA PAYUDARA (RINGAN) L-1-50-I
PROSEDUR PADA KULIT, JARINGAN) BAWAH KULIT (RINGAN) L-1-40-I
PROSEDUR PADA PAYUDARA (RINGAN) L-1-50-I
L-1-40-I
PROSEDUR PADA KULIT, JARINGAN) BAWAH KULIT (RINGAN)
PROSEDUR PADA KULIT, JARINGAN) BAWAH KULIT (RINGAN) L-1-40-I
PROSEDUR SISTEM PENCERNAAN LAIN-LAIN (RINGAN) K-1-40-I

SIRKUMSISI DENGAN KONDISI TERTENTU (RINGAN) V-1-15-I

PROSEDUR TONSIL & ADENOID (RINGAN) U-1-15-I
U-1-12-I
PROSEDUR MASTOID DAN SINUS (RINGAN)
E-1-20-I
PROSEDUR PADA TIROID, PARATIROID DAN SALURAN TIROGLOSAL (RINGAN)
PROSEDUR PADA KULIT, JARINGAN) BAWAH KULIT (RINGAN) L-1-40-I
PROSEDUR PADA KULIT, JARINGAN) BAWAH KULIT (RINGAN) L-1-40-I
PROSEDUR PADA KULIT, JARINGAN) BAWAH KULIT (RINGAN) L-1-40-I

PROSEDUR PADA TIROID, PARATIROID DAN SALURAN TIROGLOSAL (RINGAN) E-1-20-I

PROSEDUR PADA TIROID, PARATIROID DAN SALURAN TIROGLOSAL (RINGAN) E-1-20-I

PROSEDUR PADA SKROTUM DAN PROSTAT NON KOMPLEK (RINGAN) V-1-12-I

ADHESIOLISIS PERITONEAL (RINGAN) K-1-11-I

CHOLESISTEKTOMI TANPA LAPAROSKOPIK (RINGAN)

B-1-12-I

U-1-20-I
PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN TELINGA LAIN-LAIN (RINGAN)

U-1-20-I
PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN TELINGA LAIN-LAIN (RINGAN)
PROSEDUR INTESTINAL KOMPLEKS (RINGAN) K-1-20-I
 GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN (RINGAN) L-4-14-I
PENYAKIT TELINGA, HIDUNG, MULUT DAN TENGGOROKAN LAIN-LAIN (RINGAN) U-4-15-I

PROSEDUR PADA SKROTUM DAN PROSTAT KOMPLEK-MODERAT (RINGAN) V-1-12-I

PROSEDUR PADA SKROTUM DAN PROSTAT KOMPLEK-MODERAT (RINGAN)
V-1-12-I

PENGANGKATAN PROSTAT MELALUI URETRA (RINGAN) V-1-12-I

PENGANGKATAN PROSTAT MELALUI URETRA (RINGAN) V-1-12-I

PROSEDUR ANGGOTA TUBUH ATAS (RINGAN)

M-1-80-I

PROSEDUR KAKI (RINGAN)

M-1-30-I

PROSEDUR ANGGOTA TUBUH ATAS (RINGAN)

M-1-80-I

PROSEDUR ANGGOTA TUBUH ATAS (RINGAN)

M-1-80-I

PROSEDUR CARPAL TUNNEL RELEASE (RINGAN)

G-1-13-I
EKSISI LOKAL DAN PENGANGKATAN ALAT FIKSASI INTERNAL (RINGAN)
M-1-40-I

PROSEDUR LUTUT DAN TUNGKAI BAWAH SELAIN KAKI (RINGAN)

M-1-70-I

PROSEDUR ANGGOTA TUBUH ATAS (RINGAN)

M-1-80-I

Amputation of toe
M-1-30-I

Fracture of patella, closedS82.00/ Arthrosis, unspecified, other sitesM19.98 Primer

M-1-04-I
Prosedur (ICD-9-CM): Total knee replacement81.54

Fracture of neck of femur, closedS72.00 Primer Prosedur (ICD-9-CM): Total hip

M-1-04-I
replacement81.51

OKNYA TINDAKAN EXCISION STT) SEMUA SAMA

KELAS III
Rp 4,049,700
KNYA TINDAKAN EXCISION STT) SEMUA SAMA
KELAS III
Rp 3,387,400
 NON VENTI VENTI <96 VENTI >96
1 2 3 1 2 3 1
7,071,500 6,194,200 5,316,900 21,499,900 18,832,600 16,165,300 31,846,800
4,879,000 4,273,700 3,668,500 21,499,900 18,832,600 16,165,300 31,846,800
6,598,700 5,780,000 4,961,400 21,499,900 18,832,600 16,165,300 31,846,800
6,598,700 5,780,000 4,961,400 21,499,900 18,832,600 16,165,300 31,846,800
6,209,300 5,439,000 4,668,700 21,499,900 18,832,600 16,165,300 31,846,800
7,729,900 6,770,900 5,812,000 21,499,900 18,832,600 16,165,300 31,846,800
1,810,500 1,585,900 1,361,300 21,499,900 18,832,600 16,165,300 31,846,800
7,729,900 6,770,900 5,812,000 21,499,900 18,832,600 16,165,300 31,846,800
3,465,900 3,036,000 2,606,000 21,499,900 18,832,600 16,165,300 31,846,800
7,071,500 6,194,200 5,316,900 21,499,900 18,832,600 16,165,300 31,846,800
5,386,100 4,717,900 4,049,700 21,499,900 18,832,600 16,165,300 31,846,800
7,071,500 6,194,200 5,316,900 21,499,900 18,832,600 16,165,300 31,846,800

5,386,100 4,717,900 4,049,700 21,499,900 18,832,600 16,165,300 31,846,800

5,386,100 4,717,900 4,049,700 21,499,900 18,832,600 16,165,300 31,846,800
8,431,200 7,385,200 6,339,200 21,499,900 18,832,600 16,165,300 31,846,800

2,516,100 2,203,900 1,891,800 21,499,900 18,832,600 16,165,300 31,846,800

5,171,400 4,529,900 3,888,300 21,499,900 18,832,600 16,165,300 31,846,800

7,417,100 6,497,000 5,576,800 21,499,900 18,832,600 16,165,300 31,846,800

9,300,300 8,146,500 6,992,700 21,499,900 18,832,600 16,165,300 31,846,800

5,386,100 4,717,900 4,049,700 21,499,900 18,832,600 16,165,300 31,846,800
5,386,100 4,717,900 4,049,700 21,499,900 18,832,600 16,165,300 31,846,800
5,386,100 4,717,900 4,049,700 21,499,900 18,832,600 16,165,300 31,846,800
21,499,900 18,832,600 16,165,300 31,846,800
9,300,300 8,146,500 6,992,700 21,499,900 18,832,600 16,165,300 31,846,800
9,300,300 8,146,500 6,992,700 21,499,900 18,832,600 16,165,300 31,846,800

9,348,400 8,188,600 7,028,900 21,499,900 18,832,600 16,165,300 31,846,800

9,648,900 8,451,900 7,254,800 21,499,900 18,832,600 16,165,300 31,846,800

8,003,200 7,010,300 6,017,400 21,499,900 18,832,600 16,165,300 31,846,800

8,190,400 7,174,300 6,158,200 21,499,900 18,832,600 16,165,300 31,846,800

8,190,400 7,174,300 6,158,200 21,499,900 18,832,600 16,165,300 31,846,800

12,775,900 11,190,900 9,605,900 21,499,900 18,832,600 16,165,300 31,846,800

 3,595,500 3,149,500 2,703,400 21,499,900 18,832,600 16,165,300 31,846,800
4,018,000 3,519,500 4,018,000 21,499,900 18,832,600 16,165,300 31,846,800

NON VENTI VENTI <96 VENTI >96

1 2 3 1 2 3 1
9,348,400 8,188,600 7,028,900 21,499,900 18,832,600 16,165,300 31,846,800
9,348,400 8,188,600 7,028,900
21,499,900 18,832,600 16,165,300 31,846,800
9,562,200 8,375,900 7,189,700 21,499,900 18,832,600 16,165,300 31,846,800

9,562,200 8,375,900 7,189,700 21,499,900 18,832,600 16,165,300 31,846,800

NON VENTI VENTI <96 VENTI >96

1 2 3 1 2 3 1
9,409,000 8,241,800 7,074,500 21,499,900 18,832,600 16,165,300 31,846,800

9,172,800 8,034,800 6,896,800 21,499,900 18,832,600 16,165,300 31,846,800

9,409,000 8,241,800 7,074,500 21,499,900 18,832,600 16,165,300 31,846,800

9,409,000 8,241,800 7,074,500 21,499,900 18,832,600 16,165,300 31,846,800

3,239,600 2,837,700 2,435,800 21,499,900 18,832,600 16,165,300 31,846,800

5,445,200 4,769,700 4,094,100 21,499,900 18,832,600 16,165,300 31,846,800

16,010,400 14,024,100 12,037,900 21,499,900 18,832,600 16,165,300 31,846,800

9,409,000 8,241,800 7,074,500 21,499,900 18,832,600 16,165,300 31,846,800

9,172,800 8,034,800 6,896,800 21,499,900 18,832,600 16,165,300 31,846,800

16,265,100 14,247,300 12,229,400

16,265,100 14,247,300 12,229,400

VENTI >96
2 3
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000

27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000

27,895,900 23,945,000
27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000
27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000
27,895,900 23,945,000
 27,895,900 23,945,000
27,895,900 23,945,000

VENTI >96
2 3
27,895,900 23,945,000

27,895,900 23,945,000
27,895,900 23,945,000

27,895,900 23,945,000

VENTI >96
2 3
27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000

27,895,900 23,945,000
 NEUROLOGI DLL KODE INA-CBGs
NO DIAGNOSA
1 RADIKULOPATI CERVICAL (M54.12) G-4-17-I
2 SNH STROKE dd SH + DM G-4-14-I
3 SNH DD/ SH tanpa ct scan (I64) G-4-14-I
4 SNH DGN CT SCAN (I63.9 + 8703) G-4-14-I
5 SH DGN CT SCAN (I61.9 + 8703) G-4-13-I
6 SEQUELE STROKE (DENGAN ATAU TANPA CT SCAN) G-4-26-I
7 Low Back Pain / LBP (M54.59) M-4-17-I
8 Selulitis + LBP (L03.9 + M54.59) L-4-12-I
9 Menometorrhagia (N92.1) W-4-12-I
10 Radikulopati lumbal (M54.16) M-4-17-I
11 Epilepsi (G40.9) G-4-22-I
12 Myasthenia gravis (G70.0) G-4-11-I
13 Disfagia (R13) K-4-18-I
14 Meningitis dengan CT scan G-4-19-I
15 Meningitis tanpa CT scan (G03.9) G-4-19-I
16 Meningoenchepalitis tanpa CT scan (G04.9) G-4-19-I
17 Meningoenchepalitis dengan CT scan (G04.9 + 8703) G-4-19-I
18 Status migrain (G43.2) G-4-23-I
19 Vertigo (H81.3) U-4-11-I
20 Carpopedal spasm (R29.0) E-4-10-I
21 Trigger finger (M65.38) M-4-21-I
22 Carpal tunnel syndrome (G56.0) G-4-17-I

PERINATOLOGI DAN NICU

DIAGNOSA BAYI
KETERANGAN: PERI DAN BBL SEMUA KELAS 3 NICU
SESUAI HAK KELAS
1 BAYI ASPIXIA + LAHIR SC ( BB > 2499 ) (P21.9 + P03.4 + Z38.0) P-8-08-I
2 HYPERBILIRUBIN ( BB >2499 ) (P59.9 + 9982) P-8-13-I
3 HYPERBILIRUBIN ( BB 2000 - 2499 ) (P59.9 + 9982) P-8-13-I
4 HYPERBILIRUBIN ( BB <2000 ) (P59.9 + 9982) P-8-12-I
5 Transien takipneu of newborn (BB>2499 gram) (P22.1 + 8749) P-8-08-I
6 Transien takipneu of newborn (BB 2000-2499 gram) (P22.1 + P-8-13-I
8749)
7 Transien takipneu of newborn (BB<2000 gram) (P22.1 + 8749) P-8-12-I
8 P-8-13-I
BAYI ASPIXIA + LAHIR SC ( BB 2000- 2499 ) (P21.9 + P03.4 + Z38.0)
9 BAYI ASPIXIA + LAHIR SC ( BB < 2000) (P21.9 + P03.4 + Z38.0) P-8-12-I
10 vomiting in newborn (BB>2499 gram) (P92.0) P-8-17-I
11 vomiting in newborn (BB 2000-2499 gram) (P92.0) P-8-13-I
12 vomiting in newborn (BB< 2000 gram) (P92.0) P-8-13-I
13 aspirasi mekoneum (bb > 2499 gram) (P24.0 + 8749) P-8-15-I
14 aspirasi mekoneum (bb 2000- 2499 gram) (P24.0 + 8749) P-8-13-I
15 aspirasi mekoneum (bb <2000gram) (P24.0 + 8749) P-8-12-I
16 pneumonia congenital (BB > 2499 gram) (P23.9 + 8749) P-8-08-I
17 pneumonia congenital (BB >2000- 2499 gram) (P23.9 + 8749) P-8-13-I
18 pneumonia congenital (BB <2000 gram) (P23.9 + 8749) P-8-12-I
 TARIF NON VENTI VENTI <96 JAM
1 2 3 1
4,865,800 4,262,100 3,658,500 21,499,900
4,431,400 3,881,700 3,331,900 21,499,900
4,431,400 3,881,700 3,331,900 21,499,900
5,423,501 4,750,600 4,077,800 21,499,900
4,765,100 4,173,900 3,582,800 21,499,900
4,312,600 3,777,600 3,242,600 21,499,900
3,990,100 3,495,100 3,000,100 21,499,900
2,207,200 1,933,400 1,659,600 21,499,900
3,892,200 3,409,300 2,926,400 21,499,900
3,990,100 3,495,100 3,000,100 21,499,900
3,679,500 3,223,100 2,766,600 21,499,900
4,797,400 4,202,300 3,607,100 21,499,900
1,810,500 1,585,900 1,361,300 21,499,900
4,392,200 3,847,300 3,302,400 21,499,900
4,392,200 3,847,300 3,302,400 21,499,900
4,392,200 3,847,300 3,302,400 21,499,900
4,392,201 3,847,300 3,302,400 21,499,900
2,867,400 2,511,600 2,155,900 21,499,900
1,911,000 1,674,000 1,436,900 21,499,900
4,852,700 4,250,700 3,648,700 21,499,900
4,505,200 3,946,300 3,387,400 21,499,900
4,865,800 4,262,100 3,658,500 21,499,900

TARIF NON VENTI VENTI <96 JAM

1 2 3 1
5,803,100 5,083,100 4,363,200 5,803,100
4,846,200 4,245,000 3,419,900 4,846,200
7,269,900 6,368,000 5,466,100 7,269,900
9,732,000 8,524,600 7,317,300 9,732,000
5,803,100 5,083,100 4,363,200 5,803,100
5,466,100
7,269,900 6,368,000 7,269,900
9,732,000 8,524,600 7,317,300 9,732,000
5,466,100
7,269,900 6,368,000 7,269,900
9,732,000 8,524,600 7,317,300 9,732,000
4,846,200 4,245,000 3,643,800 4,846,200
4,846,200 4,245,000 3,643,800 4,846,200
7,269,900 6,368,000 5,466,100 7,269,900
4,517,600 3,957,200 3,396,700 4,517,600
7,269,900 6,368,000 5,466,100 7,269,900
9,732,000 8,524,600 7,317,300 9,732,000
5,803,100 5,083,100 4,363,200 5,803,100
7,269,900 6,368,000 5,466,100 7,269,900
9,732,000 8,524,600 7,317,300 9,732,000
VENTI <96 JAM VENTI >96
2 3 1 2
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900
18,832,600 16,165,300 31,846,800 27,895,900

VENTI <96 JAM VENTI >96

2 3 1 2
5,083,100 4,363,200 10,804,300 9,463,900
4,245,000 3,643,800 10,804,300 9,463,900
6,368,000 5,466,100 12,227,000 10,710,100
8,524,600 7,317,300 22,449,000 19,664,000
5,083,100 4,363,200 10,804,300 9,463,900

6,368,000 5,466,100 12,227,000 10,710,100

8,524,600 7,317,300 22,449,000 19,664,000

6,368,000 5,466,100 12,227,000 10,710,100

8,524,600 7,317,300 22,449,000 19,664,000
4,245,000 3,643,800 10,804,300 9,463,900
4,245,000 3,643,800 10,804,300 9,463,900
6,368,000 5,466,100 12,227,000 10,710,100
3,957,200 3,396,700 10,804,300 9,463,900
6,368,000 5,466,100 12,227,000 10,710,100
8,524,600 7,317,300 22,449,000 19,664,000
5,083,100 4,363,200 10,804,300 9,463,900
6,368,000 5,466,100 12,227,000 10,710,100
8,524,600 7,317,300 22,449,000 19,664,000
96
3
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000
23,945,000

3
8,123,500
8,123,500
9,193,200
16,879,000
8,123,500

9,193,200
16,879,000

9,193,200
16,879,000
8,123,500
8,123,500
9,193,200
8,123,500
 9,193,200
16,879,000
8,123,500
9,193,200
16,879,000
 OBGYN
NO DIAGNOSA Kode tindakan kode inacbgs
1 AB IMINEN ( TANPA TINDKAN ) ( o20.0 ) W-4-14-I
KURET non hamil (ex. mioma) dan abortus dkk selain
2 69.09 dan 69.02 W-1-11-I
BO
3 kuret BO (69.01) 69.01 W-1-10-I
4 POLIP CERVIX / EKSTERPASI POLIP ( n84.1 ) 67.39 W-1-30-I
5 POST PARTUM CARDIOMIOPATY ( O90.3 ) W-4-17-I

6 eksisi HEMATOMA LABIA MAYORA DEXTRA ( n90.8 ) 86.3 L-1-40-I

7 EKSTIRPASI/MARSUPIALISASI BARTHOLIN ( n75.0 ) 71.24 W-1-30-I

8 KISTEKTOMI / KISTA OVARIUM ( n83.2 ) 65.29 W-1-20-I

9 HAMIL KONTRAKSI (O60.0) W-4-15-I
OP. SC ( GEMELI ) Bayi lahir hidup ( o30.0 + o82.0 +
10 O-6-10-I
z37.2 icd 9 74.4 )

11 OP. SC + BEKAS SC ( o34.2 + o82.0 + z37.0 ) O-6-10-I

OP. SC + ANEMIA (Hb < 8) + TRANFUSI ( o99.0 + o82.0

12 99.04 O-6-10-I
+ z37.0 )
13 LAHIR SPONTAN GEMELI ( o30.0 + o80.9 + z37.2 ) O-6-13-II
LAHIR SPONTAN / NORMAL / P. Ringan ( o80.9 +
14 O-6-13-I
z37.0)

15 TUMOR PUBIS + EKSISI ( d16.8 ) 86.3 L-1-40-I

16 Menometoragia ( n92.1 ) W-4-12-I

17 INDUKSI + IUFD ( o36.4 + z37.1 ) O-6-13-II

18 salphingektomi ai KET/ Hydrosalping 66.51 W-1-20-I

Complete uterovaginal prolapse ( N81.3 ) Primer

19 Cystocele ( N81.1 ) Other and unspecified vaginal 68.59 + 70.51 W-1-30-I
hysterectomy Repair of cystocele
ruptur uteri+ TOTAL ABDOMINAL HYSTEREKTOMI
20 68.49 W-1-20-I
( o71.3)
Leiomyoma of uterus unspecified ( D25.9 ) Primer
21 Prosedur (ICD-9-CM): 682 Other excision or 68.29 W-1-20-I
destruction of lesion of uterus
 Maternal care for cervical incompetence ( O34.3 )
Primer Prosedur (ICD-9-CM): Cari Prosedur Other
22 67.59 W-1-30-I
repair of internal cervical os (TRANSVAGINAL
CERCLAGE)

23 Partus + curretage ( o45.9 + z37.0 ) 69.02 W-1-11-I

24 Hyperemesis gravidarum (HEG) ( o21.0 ) W-4-16-I
25 PEB + Janin Besar + Op SC O-6-10-I
 TARIF NON VENTI VENTI <96 JAM
1 2 3 1 2 3
2,987,500 2,616,800 2,246,200 21,499,900 18,832,600 16,165,300
3,186,800 2,791,500 2,396,100 21,499,901 18,832,601 16,165,301
3,459,500 3,030,300 2,601,100 21,499,902 18,832,602 16,165,302
5,047,700 4,421,500 3,795,300 21,499,902 18,832,602 16,165,302
2,521,000 2,208,300 1,895,500 21,499,903 18,832,603 16,165,303

5,386,100 4,717,900 4,049,700 21,499,904 18,832,604 16,165,304

5,047,700 4,421,500 3,795,300 21,499,905 18,832,605 16,165,305

8,940,600 7,831,500 6,722,300 21,499,906 18,832,606 16,165,306

2,190,000 1,918,400 1,646,700 21,499,907 18,832,607 16,165,307
7,435,500 6,513,000 5,590,500 21,499,908 18,832,608 16,165,308

7,039,300 6,166,000 5,292,800 21,499,909 18,832,609 16,165,309

7,039,300 6,166,000 5,292,800 21,499,910 18,832,610 16,165,310

3,736,700 3,273,100 2,809,600 21,499,911 18,832,611 16,165,311
2,921,100 2,558,700 2,196,300 21,499,912 18,832,612 16,165,312

5,386,100 4,717,900 4,049,700 21,499,914 18,832,614 16,165,314

3,892,200 3,409,300 2,926,400 21,499,915 18,832,615 16,165,315

3,736,700 3,273,100 2,809,600 21,499,916 18,832,616 16,165,316

8,940,600 7,831,500 6,722,300 21,499,917 18,832,617 16,165,317

5,047,700 4,421,500 3,795,300 21,499,918 18,832,618 16,165,318

8,940,600 7,831,500 6,722,300 21,499,918 18,832,618 16,165,318

8,940,600 7,831,500 6,722,300 21,499,919 18,832,619 16,165,319

 5,047,700 4,421,500 3,795,300 21,499,920 18,832,620 16,165,320

3,186,800 2,791,500 2,396,100 21,499,921 18,832,621 16,165,321

2,915,100 2,553,500 2,191,800 21,499,920 18,832,620 16,165,320
7,039,300 6,166,000 5,292,800 21,499,900 18,832,600 16,165,300
 VENTI >96
1 2 3
31,846,800 27,895,900 23,945,000
31,846,801 27,895,901 23,945,001
31,846,802 27,895,902 23,945,002
31,846,802 27,895,902 23,945,002
31,846,803 27,895,903 23,945,003

31,846,804 27,895,904 23,945,004

31,846,805 27,895,905 23,945,005

31,846,806 27,895,906 23,945,006

31,846,807 27,895,907 23,945,007
31,846,808 27,895,908 23,945,008

31,846,809 27,895,909 23,945,009

31,846,810 27,895,910 23,945,010

31,846,811 27,895,911 23,945,011
31,846,812 27,895,912 23,945,012

31,846,814 27,895,914 23,945,014

31,846,815 27,895,915 23,945,015

31,846,816 27,895,916 23,945,016

31,846,817 27,895,917 23,945,017

31,846,818 27,895,918 23,945,018

31,846,818 27,895,918 23,945,018

31,846,819 27,895,919 23,945,019

 31,846,820 27,895,920 23,945,020

31,846,821 27,895,921 23,945,021

31,846,820 27,895,920 23,945,020
31,846,800 27,895,900 23,945,000
 EXAMPLE INTENSIVE CARE CASES
NO DIAGNOSA Kode INA-Cbgs
1 BP + STATUS EPILEPTIKUS J-4-16-II

2 NSTEMI + BP + DM Tipe 2 + Dislipidemia + Hipokelamia + CHF + IHD I-4-10-III

3 Bronkhitis akut + Hipoalbuminemia + Hipokalemia + SNH DD SH J-4-21-III

4 Hipoglikemia + PPOK + Hipokalemia E-4-10-II
5 CKD on HD + Hipertensi + DM N-4-10-I
6 NSTEMI + PPOK + ADHF + CKD + SNH DD SH I-4-10-III
7 BP + Meningitis G-4-19-III
8 DM Tipe 2 + CKD + Nefropati Diabetik + ALO N-1-12-III
9 TB Paru + Alkalosis Respiratorik + AKI J-4-15-III
10 SNH + Hypernatremia G-4-14-II
11 SNH + BP + DM Tipe 2 G-4-14-III
12 KAD + RBBB Incomplete + Asidosis + BP + Hiponatremia E-4-10-III
Mengitisi Bakterial + BP + Tirotoksikosis + Hipokalemia +
13 G-4-18-III
Hiponatremia
Liver failure (Gagal Fungsi Hati) + Encephalopathy Hepaticum + ALO +
14 B-4-13-III
Alkalosis Respiratorik + AKI
15 DM Tipe 2 + ADHF + IHD + Cystitis + Kolik Renal + Alkalosis N-4-16-II
16 BP + Status Epileptikus + Gizi Buruk + Protein Calorie Malnutrition J-4-16-III
SNH + BP + ALO + Ventricular Premature Complex + Hipoglikemia +
17 G-4-14-III
CKD
18 TB Paru + DM Tipe 2 + Hypokalemia + Hypoalbumin + J-4-15-II

SNH + BP + HHD + HYPOKALEMIA

19 Dyslipidemia G-4-14-III
Hipokalemia

20 ILEUS OBSTRUKTIF (K56.6) DENGAN RESEKSI ILEUS / ANASTOMOSIS K-1-20-I

 TARIF NON VENTI VENTI <96 JAM VENTI >96
1 2 3 1 2 3 1
6,823,500 5,976,900 5,130,400 24,959,700 21,863,200 18,766,700 43,456,000

10,915,700 9,561,500 8,207,300 31,248,500 27,371,800 23,495,100 71,760,500

8,715,700 7,634,400 6,553,200 31,248,500 27,371,800 23,495,100 71,760,500

6,780,900 5,939,700 5,098,400 24,959,700 21,863,200 18,766,700 43,456,000
4,047,200 3,545,100 3,043,000 21,499,900 18,832,600 16,165,300 31,846,800
10,915,700 9,561,500 8,207,300 31,248,500 27,371,800 23,495,100 71,760,500
9,605,000 8,413,400 7,221,800 31,248,500 27,371,800 23,495,100 71,760,500
20,936,000 18,338,700 15,741,400 20,936,000 18,338,700 15,741,400 71,760,500
9,367,200 8,205,100 7,043,000 31,248,500 27,371,800 23,495,100 71,760,500
7,369,100 6,454,900 5,540,700 24,959,700 21,863,200 18,766,700 43,456,000
8,715,700 7,634,400 6,553,200 31,248,500 27,371,800 23,495,100 71,760,500
8,415,600 7,371,500 6,327,500 31,248,500 27,371,800 23,495,100 71,760,500

8,512,100 7,456,100 6,400,100 31,248,500 27,371,800 23,495,100 71,760,500

7,299,500 6,393,900 5,488,300 31,248,500 27,371,800 23,495,100 71,760,500

5,707,600 4,999,500 4,291,400 24,959,700 21,863,200 18,766,700 43,456,000
8,627,200 7,557,000 6,486,700 31,248,500 27,371,800 23,495,100 71,760,500

9,581,100 8,392,500 7,203,800 31,248,500 27,371,800 23,495,100 71,760,500

6,890,600 5,906,200 4,921,900 17,562,600 15,053,700 12,544,700 43,012,300

9,007,600 7,720,800 6,434,000 26,895,300 23,053,100 19,210,900 71,028,100

12,775,900 11,190,900 9,605,900 21,499,900 18,832,600 16,165,300 31,846,800

VENTI >96
2 3
38,064,800 32,673,700

62,857,900 53,955,300

62,857,900 53,955,300
38,064,800 32,673,700
27,895,900 23,945,000
62,857,900 53,955,300
62,857,900 53,955,300
62,857,900 53,955,300
62,857,900 53,955,300
38,064,800 32,673,700
62,857,900 53,955,300
62,857,900 53,955,300

62,857,900 53,955,300

62,857,900 53,955,300
38,064,800 32,673,700
62,857,900 53,955,300

62,857,900 53,955,300

36,867,700 30,723,100

60,881,200 50,734,400

27,895,900 23,945,000