BPJS e-SIMULASI KODING&TARIF BEDAH UMUM RS TYPE D (inaCBG) [PDF]

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E- SIMULASI LIST OPERASI SPESIALIS BEDAH RS TYPE D ( inaCBG ) Sub Bedah Oncologi DIAGNOSA BREAST Accessory breast ( mammae abberans ) Benign neoplasm of breast Malignant neoplasm, lower-outer quadrant of breast Malignant neoplasm, lower-outer quadrant of breast Inflammatory disorders of breast Hypertrophy of breast Secondary malignant neoplasm, axillary and upper limb lymph nodes



ICD 10



TINDAKAN



ICD 9



KELAS 3



Q83.1 D24 C50.5 C50.5 N61 N62 C77.3



Excision of ectopic breast tissue Local excision of lesion of breast Unilateral radical mastectomy (MRM) Open biopsy of breast Excisional debridement of wound, infection, or burn Local excision of lesion of breast Radical excision of axillary lymph nodes



85.24 85.21 85.45 85.12 86.22 85.21 40.51



4,361,100 4,361,100 4,361,100 4,361,100 1,964,400 4,361,100 3,445,900



LYMPH Acute lymphadenitis of SUM head and neck Acute lymphadenitis of upper limb ( axilla ) Tuberculous peripheral lymphadenopathy Tuberculous peripheral lymphadenopathy



L04.0  L04.2 A18.2 C83.3



Excision of deep cervical lymph node Excision of axillary lymph node Biopsy of lymphatic structure Biopsy of lymphatic structure



40.21 40.23 40.11 40.11



3,445,900 3,445,900 3,445,900 3,445,900



Soft Tissue Tumor Benign neoplasm, skin of upper limb, including shoulder Benign neoplasm, connective and other soft tissue of head, face and neck Synovial cyst of popliteal space [Baker], lower leg Synovial cyst of popliteal space [Baker], hand



D23.6 D21.0 M71.26 M71.24



Radical excision of skin lesion Radical excision of skin lesion Radical excision of skin lesion Radical excision of skin lesion



86.4 86.4 86.4 86.4



3,445,900 3,445,900 3,445,900 3,445,900



NOTED dari verifikator : SEMUA TUMOR YANG DILAKUKAN EKSISI DG FLAP CUKUP DI KODING TUNGGAL ( radical excision of skin lession )



KELAS 1 6,105,500



5,233,300



6,105,500



5,233,300



6,105,500



5,233,300 2,357,300



6,105,500 2,750,200



5,233,300



6,105,500



4,135,000



4,824,200



4,135,000 4,135,000



4,824,200 4,824,200



4,135,000



4,824,200



4,135,000



4,824,200



4,141,000 4,141,000



4,831,200 4,831,200



4,141,000



4,831,200



4,141,000



4,831,200



86.4



Malignant neoplasm, connective and soft tissue of head, face and neck Malignant neoplasm, skin of eyelid, including canthus Malignant neoplasm, skin of eyelid, including canthus Malignant neoplasm, anterior two-thirds of tongue, part unspecified



C49.0  C44.1 C44.1 C02.3



Radical excision of skin lesion Radical excision of skin lesion Other reconstruction of eyelid with flaps or graft Partial glossectomy



86.4 86.4 08.61 25.2



Benign neoplasm of major salivary glands ( parotid, submandibula ) Benign neoplasm, other major salivary glands ( tumor submandibula ) Submandibular abcess Abscess of salivary gland



D11.0 D11.7 K12.2 K11.3



Other excision of salivary gland lesion Complete sialoadenectomy Drainage of face and floor of mouth Incision of salivary gland or duct



26.29 26.32 27.0 26.0



Benign neoplasm of thyroid gland Nontoxic single thyroid nodule Thyroid Gland Neoplasma Thyroid Gland Neoplasma Thyroglossal cyst ( Congenital malformations of other endocrine glands



D34 E04.1 D44.0 D44.0 Q89.2



Unilateral thyroid lobectomy Unilateral thyroid lobectomy Unilateral thyroid lobectomy Total Thyroidectomy Excision of thyroglossal duct or tract



06.2 06.2 06.2 06.4 06.7



Unilateral thyroid lobectomy



06.2



Benign neoplasm of thyroid gland + Thyrotoxicosis with toxic multinodular goitre D34



KELAS 2 5,233,300



3,450,800



4,141,000



4,831,200



3,450,800



4,141,000



4,831,200



1,899,300 3,435,800



2,279,100 4,123,000



2,659,000 4,810,200



4,160,300 4,160,300 3,435,800 1,787,100



4,992,300



5,824,400



4,992,300



5,824,400



5,015,500 5,015,500 5,015,500 5,015,500 5,015,500



6,018,600



7,021,600



6,018,600 6,018,600



7,021,600 7,021,600



6,750,700



4,123,000 2,144,500



4,810,200 2,501,900



6,018,600



7,021,600



6,018,600



7,021,600



8,100,800



9,450,900



E05.2



Sub Bedah DIGESTIF Acute appendicitis with localized peritonitis Acute appendicitis with localized peritonitis Acute appendicitis with Generalized Peritonitis PERITONITIS Peritonitis + Septicaemia Peritonitis + Perforasi Gaster Ulcer Perforation of intestine (nontraumatic) Intestinal adhesions [bands] with obstruction



K35.3 K35.3 K35,2 K65,8 K65,8 + A41,9 K65,8 + K25,5 K63.1 K56.5



Appendectomy open Laparascopic appendectomy Laparotomy explorasi Laparotomy explorasi Laparotomy explorasi Laparotomy explorasi + Suture gastric ulcer Exteriorization of small intestine Other lysis of peritoneal adhesions



47.09 47.01 54.11 54.11 54.11 54,11 + 44,41 46.01 54.59



2,507,700 2,507,700 5,199,600 5,199,600 9,715,000 16,070,700 7,880,000 5,456,800



Malignant neoplasm, descending colon  Malignant neoplasm of rectum Malignant neoplasm of rectum Malignant neoplasm of rectum+ Ileus, unspecified



C18.6 C20 C20 C20 + K56.7



Open and other Right hemicolectomy Biopsy of anus Temporary colostomy Temporary colostomy



45.75 49.23 46.11 46.11



7,880,000 3,973,100 7,880,000 11,006,500



9,455,900



Malignant neoplasm, caecum



C18.0



Open and other Right hemicolectomy



45.73



7,880,000



Malignant neoplasm caecum + Congestive heart failure



C18.0 I50.0 C18.0 I11.0



45.73



11,006,500



Malignant neoplasm, caecum + Hypertensive heart disease with (congestive) heart failure



Open and other Right hemicolectomy



3,009,200 3,009,200



6,239,600 6,239,600 11,658,000 19,284,800 9,455,900



6,548,200



4,767,700



3,510,800 3,510,800 7,279,500 7,279,500 13,601,000 22,499,000 11,031,900



7,639,600 11,031,900



5,562,300



9,455,900



11,031,900



13,207,800



15,409,100



9,455,900



11,031,900



13,207,300



45.73



Closure of stoma of large intestine Closure of stoma of small intestine



46.52 46.51 54.61



T81.3



Reclosure of postoperative disruption of abdominal wall



I84.1



Excision of hemorrhoids



3,973,100



4,767,700



5,562,300



I84.1 K61.0 K61.2 K60.3 K60.1 K62.2 k62.4 I84.6



Ligation of hemorrhoids ( Pila, Hal-rar) Incision of perianal abscess Incision of perianal abscess Anal fistulectomy Left lateral anal sphincterotomy Reduction of anal prolapse Implantation or revision of artificial anal sphincter Other procedures on hemorrhoids



3,973,100 3,973,100 3,973,100 3,973,100 3,973,100 3,973,100 3,973,100 3,973,100



4,767,700



49.01 49.01 49.12 49.51 49.94 49.75 49.49



5,562,300 5,562,300 5,562,300 5,562,300 5,562,300 5,562,300 5,562,300 5,562,300



Calculus of bile duct with cholecystitis Calculus of bile duct with cholecystitis other CHOLELITHIASIS Obstruction of bile duct



K80.4 K80.4 K80.8 K83.1



Cholecystectomy Open Laparoscopic cholecystectomy Cholecystectomy Open Anastomosis of gallbladder to intestine



51.22 51.23 51.22 51.32



4,556,200 4,986,500 4,556,200 4,666,100



K40.9



Repair of inguinal hernia with graft or prosthesis, not otherwise specified



53.05



Unilateral or unspecified inguinal hernia, without obstruction or gangrene



K40.3



Repair of inguinal hernia with graft or prosthesis, not otherwise specified



53.05



Unilateral or unspecified inguinal hernia, with obstruction, without gangrene



K40.4



Repair of inguinal hernia with graft or prosthesis, not otherwise specified



53.05



Unilateral or unspecified inguinal hernia, with gangrene Unilateral or unspecified femoral hernia, with obstruction, without gangrene Unilateral or unspecified femoral hernia, without obstruction or gangrene Unilateral or unspecified femoral hernia, with gangrene



K41.3 K41.9  K41.4



Unilateral or unspecified femoral hernia, with gangrene + Perforation of intestine (nontraumatic)



K41.4 + K63.1



Unilateral repair of femoral hernia with graft or prosthesis Unilateral repair of femoral hernia with graft or prosthesis Unilateral repair of femoral hernia with graft or prosthesis Other small-to-small intestinal anastomosis Unilateral repair of femoral hernia with graft or prosthesis Other small-to-small intestinal anastomosis



53.21 53.21 53.21 45.91 53.21 45.91



K41.3



Unilateral repair of femoral hernia with graft or prosthesis Other repair of omentum



53.21 54.74



5,199,600



K41.3 + K56.5



Unilateral repair of femoral hernia with graft or prosthesis Other lysis of peritoneal adhesions



53.21 54.59



Internal haemorrhoids with other complications ( bleeding,prolaps,strangulatad,ulcer) Internal haemorrhoids with other complications ( bleeding,prolaps,strangulatad,ulcer) Perianal Abscess Anorectal abscess Anal Fistula Chronic anal fissure Anal prolapse Stenosis of anus and rectum Residual haemorrhoidal skin tags



Unilateral or unspecified femoral hernia, with obstruction, without gangrene



Unilateral or unspecified femoral hernia, with obstruction, without gangrene + Intestinal adhesions [bands] with obstruction



16,070,700



5,299,400 5,299,400 5,199,600



19,284,800



15,549,300



Open and other Right hemicolectomy



Z93.3 Z93.2



Colostomy status Ileostomy status Disruption of operation wound, not elsewhere classified , Dehiscence, ruptur , burst abdomen



6,359,200 6,359,200



6,239,600



22,499,000



7,419,100 7,419,100



7,279,500



49.46 49.45 4,767,700 4,767,700 4,767,700 4,767,700 4,767,700 4,767,700 4,767,700 5,467,400



6,378,700



5,467,400



6,981,100



6,080,700 6,378,700 5,599,300 6,532,500



4,069,600



4,883,500



5,697,400



4,069,600



4,883,500



5,697,400



4,069,600



4,883,500



5,697,400



4,069,600 4,069,600 7,880,000



4,883,500



5,697,400



4,883,500



5,697,400



16,000,000



9,445,900



11,031,900



19,284,800 22,499,000



9,486,500



6,239,600



11,383,800



7,279,500



13,281,100



Umbilical hernia without obstruction or gangrene



K42.9



Other open umbilical herniorrhaphy



53.49



2,223,500



2,668,200



3,112,900



Unspecified abdominal hernia with obstruction without gangrene



K46.0



Incisional hernia repair



53.51



2,223,500



2,668,200



3,112,900



ASCITES



R18



Percutaneous abdominal drainage Paracentesis ( pungsi ascites)



54.91



2,805,400



3,336,500



3,927,600



Sub UROLOGI Calculus in bladder Calculus of ureter Calculus of kidney Hyperplasia of prostate Hyperplasia of prostate + Cystitis



N21.0 N20.1 N20.0 N40 N40 + N30.8



Other cystotomy Ureterotomy Pyelotomy Suprapubic prostatectomy Suprapubic prostatectomy



57.19 56.2 55.11 60.3 60.3



5,795,200 6,332,400 6,332,400 3,223,200 6,639,800



6,954,200 7,598,900 7,598,900 3,867,300 7,967,700



8,113,300 8,865,300 8,865,300 4,512,500 9,295,700



Congenital Hydrocele Hydrocele, unspecified Scrotal varices Undescended testicle, unilateral Torsion of testis Malignant neoplasm, descended testis Malformation of urachus



P83.5  N43.3 I86.1 Q53.1 N44 C62.1 Q64.4



Excision of hydrocele (of tunica vaginalis) Excision of varicocele and hydrocele of spermatic cord Excision of varicocele and hydrocele of spermatic cord Orchiopexy Unilateral orchiectomy Unilateral orchiectomy Excision of urachus



61.2 63.1 63.1 62.5 62.3 62.3 57.51 86.22



5,765,300 5,765,300 5,765,300 5,765,300 3,007,300 3,007,300 5,795,200



6,918,400 6,918,400 6,918,400 6,918,400 3,608,700 3,608,700 6,954,300



8,071,500 8,071,500 8,071,500 8,071,500 4,210,200 4,210,200 8,113,300



Phimosis



N49.8 N47



Excisional debridement of wound, infection, or burn Circumsision



64.0



2,464,100 949,000



Sub BEDAH VASKULAR Insulin-dependent diabetes mellitus with peripheral circulatory complications Type 2 diabetes mellitus with other specified complications Type 2 diabetes mellitus with circulatory complications



E10.5 E11.6 E11.5



Excisional debridement of wound, infection, or burn Excisional debridement of wound, infection, or burn AMPUTATION OF TOE



86.22 86.22 84.11



4,170,400 4,170,400 6,154,600



6,808,300 5,004,500 7,385,600



CKD V



N 18.5



Inflammatory disorders of other specified male genital organs ( fornier gangren ) 2,957,000 1,139,700



3,449,800 1,329,700



7,943,000 5,838,600 8,616,500



3,475,500



4,054,800



N18,5



39.27 ARTERIOVENOSTOMY FOR RENAL DIALYSIS ( AV-Shunt) PERITONEAL DIALYSIS + INTRA-ABDOMINAL VASCULAR SHUNT 54,98 + 39,26 OR BYPASS



2,896,300



CKD V



7,558,900



9,070,700



10,582,500



Varicose veins of lower extremities with ulcer Varicose veins of lower extremities with ulcer



I83.0 I83.0



Ligation and stripping of varicose veins ,lower limb varicose veins Other excision of vessels, lower limb veins



38.59 38.69



8,822,300 8,822,300



10,586,800 10,586,800



Haemangioma, any site Aneurysm of unspecified site



D18.0 I72.9



Other excision of vessels, unspecified site Other repair of aneurysm



38.60 39.52



9,944,300 9,944,300



11,933,100 13.922.00 11,933,100 13.922.00



Cellulitis of other parts of limb Necrotizing fasciitis, lower leg



L03.1 M72.66



Excisional debridement of wound, infection, or burn Excisional debridement of wound, infection, or burn



86.22 86.22



1,134,400 1,970,100



S61.1



Other repair of hand, fingers, and wrist



81.79 81.79



5,612,900



6,735,500



S63.4  L03.0 S62.61 S62.61 M17.9 S42.2



Other repair of hand, fingers, and wrist Debridement of nail, nail bed, or nail fold Debridement of open fracture of phalanges of hand Amputation and disarticulation of finger Injection of therapeutic substance into joint or ligament ORIF



86.27 79.64 84.01 81.92 79.11



5,612,900 1,134,400 5,612,900 5,612,900 403,700 5,612,900



6,735,500 1,361,300 6,735,500 6,735,500



Sub BEDAH Thorax Pleural effusion in conditions classified elsewhere MULTIPLE FR COSTAE + HEMATOTHORAX



J91 S22,80 + J94,2



Insertion of intercostal catheter for drainage ORIF COSTAE + CHEST TUBE THORACOSTOMY



34.04 79,89 + 34,09



3,440,500 10,121,900



4,141,000



Benign neoplasm, connective and other soft tissue of thorax Benign neoplasm, connective and other soft tissue of thorax



D21.3 D21.3



Radical excision of skin lesion Other repair of chest wall



86.4 34.79



3,445,900 4,878,300



4,141,000



K44.0



Repair of diaphragmatic hernia, abdominal approach, not otherwise specified



53.75



Diaphragmatic hernia with obstruction, without gangrene



Sub Bedah PLASTIK Temporomandibular joint disorders Fracture of malar and maxillary bones, closed Fracture of nasal bones, closed Fracture of mandible Union Fr maxilofacial



K07.6 S02.40 S02.20 S02.6 Z 47.0



Closed reduction of temporomandibular dislocation Open reduction of maxillary fracture Closed reduction of nasal fracture Open reduction of mandibular fracture removal of implant ( removal archbar )



76.93 76.74 21.71 76.76 76.97



2,461,000 5,329,500 1,976,100 5,329,500 5,329,500



Syndactyly, unspecified Cleft lip, unilateral Keloid scar Scar conditions and fibrosis of skin



Q70.9 Q36.9 L91.0 L90.5



Correction of syndactyly Repair of cleft lip Other operations on skin and subcutaneous tissue Radical excision of skin lesion



86.85 27.54 86.99 86.4 86.4



5,612,900 2,638,900 1,896,000 3,450,800



Sub ORTHOPAEDI Open wound of finger(s) with damage to nail Traumatic rupture of ligament of finger at metacarpophalangeal and interphalangeal joint(s) Cellulitis of finger and toe Fracture of other finger , open Fracture of other finger , open Gonarthrosis, unspecified Humerus fracture ( close )



Scar conditions and fibrosis of skin + Sequelae of burn, corrosion and frostbite of upper limb



L90.5 + T95.2



Contracture of joint, hand



M24.54 M24.54 Contracture of joint, hand + Sequelae of burn, corrosion and frostbite of upper limb T95.2



Sub Bedah Plastik Decubitus ulcer and pressure area, unspecified Decubitus ulcer and pressure area, unspecified



L89.9 L89.9



4,878,300



Radical excision of skin lesion Relaxation of scar or web contracture of skin



5,726,600 86.84 86.84



3,322,000



86.70 86.22



5,927,600 1,140,700



Relaxation of scar or web contracture of skin



Pedicle or flap graft, not otherwise specified Nonexcisional debridement of wound, infection, or burn



6,663,100



1,361,300 2,364,100



6,735,500



12,146,200



12,351,300 12,351,300



1,588,200 2,758,100



7,858,100 7,858,100 1,588,100 7,858,100 7,858,100 7,858,100



4,831,200



14,170,600



4,831,200



5,853,900



6,829,600



5,853,900



6,829,600



2,953,200 3,445,400 6,395,500 7,461,400 2,371,400 2,766,600 6,395,500 7,461,400 6,395,500 7,461,400 6,735,500 3,166,700 2,275,200 4,141,000 6,872,000 3,986,400 7,995,800



7,113,200 1,368,800



7,858,100 3,694,500 2,654,200 4,831,200 8,017,300 4,650,800 9,328,400



8,298,700 1,596,900



86.69 Granulomatous disorder of the skin and subcutaneous tissue, unspecified



L92,9



Burn of second degree, body region unspecified Burns involving 10-19% of body surface Burns involving 20-29% of body surface Burns multi regions at least one burn of third degree mentioned



T30.2 T31.1 T31.2 T29.3



Burns multi regions at least one burn of third degree mentioned



Epidural haemorrhage



SKIN GRAFT



T29.3



S06.4



5,927,600



Excisional debridement of wound, infection, or burn Excisional debridement of wound, infection, or burn Excisional debridement of wound, infection, or burn Excisional debridement of wound, infection, or burn



86.22 86.22 86.22 86.22



Excisional debridement of wound, infection, or burn Other skin graft to other sites



86.22 86.69



Other craniotomy



01.24



7,113,200



7,298,700



3,444,700



4,133,700



4,822,600



3,444,700



4,133,700



4,822,600



3,444,700 3,444,700



4,133,700 4,133,700



4,822,600 4,822,600



12,563,600



3,224,200



15,076,300



3,889,000



17,589,100



4,510,800