144 DIAGNOSA LAYANAN LAYANAN PRIMER PRIME R YANG HARUS TUNT TU NTAS AS DITANGANI ( Merupakan diagnosa penyakit yang tidak boleh dirujuk ke FKTL FKTL /RS)
No.
Nama Diagnosa
Nama ICD X
Kod ICD X
C!ini"a! Pa#$%a& '(ada KMK )14*+,1) $a!aman --
1
A-or)&s son)an komli)
%nspecied aborton, complee, !ihou complicaton
O03.9
70 7
2
Alergi makanan
Dermatts due o ingesed food
L27.2
66
3
Anemia $esiensi -esi a$a ke%amilan
Iron deciency anaemia
D 50
69 3
4
Askariasis
Ascariaris unspecied
B77.9
17 6
5
Asma Br Bronkial
Ashma
J 45
431
6
Astg Astgma mats tsm m ring ringan an
Astgmatsme
H52.2
21 2
7
Bell's als!
Bells’ palsy
"51.0
364
#
Ben Ben$a asi asing $i %i %i$&ng $&ng Foreign body in nosril
17.1
4# 1
9
Ben$a asing $i kon*&ngta
Foreign body on e&ernal eye, par unspecied
15.9
20 9
10 Ble(arits
Blepharits
H01.0
20 4
11 Bron Bronki kits ts ak ak&)
Acue bronchits, unspecied
J20.9
42 7
12 B&)a sen*a
Nigh blindness
H53.6
19 6
13 &)ane&s lara migran
Hoo!orm disease, unspecied
B76.9
61 0
A 91
79
A01.0
125
16 Dermatts a)oik Aopic dermatts ke&ali reali)ran)
L20
55 5
17 Dermatts kon)ak iri)an
L24
57 1
L20.#
561
L 21
55 2
14 Dema Demam m $en $eng& g&e+ e+ DH, DH, Dengue haemorrhagic fe"er
15 Demam t(oi$
#yphoid fe"er
Irrian conac dermatts
1# Dermatts n&m&laris $her aopic dermatts 19 Dermatts se-oroik
'eborrhoeic dermatts
20 inea kaits
#inea barbae and tnea capits
B35.0
53 7
21 ine inea a -ar-a ar-ae e
#inea barbae and tnea capits
B35.0
53 7
22 ine inea a /m/m-ri ria a))e
$her dermaophyoses dermaophyoses
B35.#
53 7
23 inea kororis
#inea corporis
B35.4
53 7
24 inea ma man&m
#inea manuum
B35.2
53 7
25 inea &ng&i&m
#inea unguium
B35.1
537
26 inea kr&ris
#inea cruris
B35.6
537
27 inea e$is
#inea pedis
B35.3
537
2# Dia-e)es meli)&s te Diabees insulin dependen 1
#9
A$a $i :8 no.5 )a%&n 2014 %al. 423
29 Dia-e)es meli)&s te Non/insulin/dependen diabees mellius 2
11
635
30 Disen)ri -asiler $an am&-a
Acue amoebic dysenery
A06.0
144
31 Dislii$emia
Hiperlipidemia
7#.5
652
32 is)aksis
(pisa&is
04.0
475
33 ?an)%ema)o&s $r&g er&ton
)eneralied sin erupton due o drugs and medicamen
L27.0
604
34 ,aringits
Acue pharyngits, unspecied
J02.9
411
35 ,ilariasis
Filariasis
B74
42
36 ,&r&nkel a$a %i$&ng Abscess, furuncle and carbuncle of nose
J34.0
4#5
37 "as)rits
)asrits, unspecied
829.7
117
3# "as)roen)erits )ermas&k kolera+ giar$iasis
Diarrhoea and gasroenerits of presumed infecton origin
A09
133
39 "onore
)onococcal infecton, unspecied
A54.9
763
40 Hemoroi$ gra$e 12
Haemorrhoids
/#4
154
41 Heatts A
Acue Hepatts A
B15
157
42 Heres simleks )ana komlikasi
Herpes"iral infecton, unspecied
B009
517
43 Heres >os)er )ana komlikasi
*oser !ihou complicaton
B02.9
514
H52.0
214
/10
2#0
46 Hier&riemia "o&) )ou
:10
649
47 Hioglikemia ringan
hypoglycaemia unspecied
16.2
646
4# H/@ A/D )ana komlikasi
Asympomatc Human Immunodeciency 2irus 0HI21 infecton saus
;21
92
49 Hor$eol&m
Hordeolum and oher deep in+ammaton of eyelid
H00.0
19#
50 /n(eksi a$a &m-ilik&s
$mphalits of ne!born !ih or !ihou mild haemorrhage
3#
49
<39.0
666
44 Hierme)roia ringan Hypermeropia 45 Hier)ensi esensial
(ssental 0primary1 hyperension
51 /n(eksi sal&ran kemi% %rinary rac infecton, sie no specied 52 /n=&en>a
In+uena, "irus no idented
J11
40#
53 /nsomnia
Insomnia non organi pada psiiari
,51
396
54 /n)oleransi makanan
-alabsorpton due o inolerance
890.4
120
55 8an$i$iasis m&l&)
.andidiasis unspecied
B37.9
52
56 8e%amilan normal
'ingle sponaneous deli"ery, unspecied
O#0.9
67#
57 8e*ang $emam
Febrile con"ulsions
56.0
37#
5# 8era&nan makanan
$her Ingesed 0pars of plan0s11
62.2
63
59 8on*&ngtits
.on3unct"its, unspecied
H10.9
201
60 Laringits
Acue laryngits
J04.0
416
61 Lera
4eprosy 8Hansen disease9
A30
53
62 Le)osirosis )ana komlikasi
4epospirosis, unspecied
A27.9
39
63 Lim(a$enits
4ymphadenits Acue
B70
104
64 Lioma
Benign lipomaous neoplasm
D17.9
307
65 L&ka -akar $era*a) 1 $an 2
burn and corrosion, body region unspecied
30
613
66 :alaria
%nspecied malaria
B54
35
67 :aln&trisi energi ro)ein
%nspecied proein/energy malnuriton
46
662
6# :astts
In+ammaory disorders of breas
<61
742
69 :a)a kering
$herdisorders of lacrimal gland
H04.1
193
70 :igren
-igraine, unspecied
"43.9
313
71 :iliaria
-iliaria, unspecied
L74.3
507
72 :ioia ringan
-yopia
H52.1
216
73 :ol&sk&m kon)agios&m
-olluscum conagiosum
B0#+1
521
74 :or-ili )ana komlikasi
-easles !ihou complicaton 0-easles N$'1:
B05.9
29
75
ema
Diaper 0napin1 dermatts
L22
575
76 O-esi)as
obesiy unspecied
66.9
62#
77 Otts eks)erna
$tts e&erna, unspecied
H60.9
246
7# Otts me$ia ak&)
Acue serous otts media
H65.0
249
79 arotts
-umps
B26
172
#0 e$ik&losis kaits
6ediculosis due o 6ediculus humanus capits
B#5.0
531
#1 en!aki) aing )am-ang
Anylosomiasis
B76.0
1#0
#2 er$ara%an s&-kon*&ngta
$her specied disorders of eye and adne&a
H57.#
207
#3 er)&sis
5tda diemuan 6anduan 7linis di 7-7 L42
5#2
#4 itriasis rosea #5 itriasis ersikolor
6iyriasis "ersicolor
B36.0
541
#6 ne&monia+ -ronkone&monia
Bronchopneumonia, unspecied
J1#.0
457
#7 res-ioia
6resbyopia
H52.4
21#
## eaksi analaktk
Anaphylactc shoc, unspecied
7#.2
74
#9 eaksi gigi)an serangga
2enom of oher arhropods
63.4
524
90 e=&ks
)asro/oesophageal re+u& disease !ihou
821.9
114
gas)roeso agea
oesop ag s
91 %inits ak&)
Acue nasopharyngits 0common cold1
J00
4#7
92 %inits alergika
Allergic rhinits, unspecied
J30.4
494
93 %inits asomo)or
2asomoor rhinits
J30.0
491
94 &)&r erine&m tngka) 12
Firs degree perineal laceraton during deli"ery
O70.0
733
95 er&men ro
Impaced cerumen
H61.2
259
96 ka-ies
'cabies
B#6
52#
97 kis)osomiasis
'isosomiasis unspecied
B65.9
1#4
9# )rongiloi$iasis
'rongyloidiasis
B7#.9
190
99 aeniasis
#aeniasis
B6#.9
1#7
100 ension %ea$a%e
#ension;ype headache
"44.2
309
101 e)an&s
$her eanus
A35
327
102 onsilits
Acue onsillits
J03
421
103 &-erk&losis ar& )ana komlikasi
A15
13
104 rtkaria ak&) C kronis
%rtcaria
L50
599
105 @aginits
Acue 2aginits
<76.0
767
106 @arisela )ana komlikasi
2aricella !ihou complicaton 02aricella N$'1
B01.9
32
107 @ertgo Benign Diiness and giddiness aro?!smal ositonal ertgo
42
319
10# @er&ka &lgaris
2iral !ars
B07
511
109 @&lits
Acue 2aginits
<76.0
771
110 "angg&an soma)o(orm
'omaoform disorders
,45
3#7
111 rikiasis
(nropion and richiasis of eyelid
H02
229
112 isklerits
(pisclerits
H15.1
232
113 :a-&k er*alanan
5tda diemuan 6anduan 7linis di 7-7
114 lk&s m&l&) a)osa+ %eres
'omatts and relaed lesions
812
10#
115 ielone(rits )ana komlikasi
Acue ubulo/inersttal nephrits 0applicable o= acue pyelonephrits1
<10
669
116 ,imosis
6himosis
<47
673
117 aramosis
6araphimosis
<47.2
676
11# in$rom $&% $is%arge geni)al gonore $an nongonore
.omplicaton associaed !ih artcial fertliaton, unspecied
<9#.9
751
119 /n(eksi sal&ran kemi% %rinary rac infecton, sie no specied -agian -aa%
<39.0
666
120 @aginosis -ak)erialis
Acue 2aginits
<76.0
767
121 alingits
5tda diemuan 6anduan 7linis di 7-7
.raced nipple associaed !ih he O9212E puerperium> .raced nipple associaed !ih lacaton O9213
74#
122 A-ses (olikel ram-&) 5tda diemuan 6anduan 7linis di 7-7 a)a& kelen*ar se-asea
123 rake$ nile
124 /ner)e$ nile
125 Desiensi i)amin
5tda diemuan 6anduan 7linis di 7-7
126 Desiensi mineral
5tda diemuan 6anduan 7linis di 7-7
127 Anemia $esiensi -esi
Iron Deciency Anemias
12# lk&s a$a )&ngkai
2aricose "eins of lo!er e&remites !ih ulcer> %lcer of lo!er limb, noelse!here classied 129 ilis s)a$i&m 1 $an 2 5tda diemuan 6anduan 7linis di 7-7
O92.02E O92.03
745
2#0
##
/#3.0E L97
61#
130 /metgo
Impetgo
L01
544
131 /metgo &lserat( ektma
Impetgo
L02
545
L0#.0
544
L02
544
L0#.1
5#4
A46
549
132 ,olik&lits s&ersialis 6ioderma 133 ,&r&nkel+ kar-&nkel
.uaneous abscess, furuncle and carbuncle
134 ri)rasma
(ryhrasmay
135 risielas
(rysipelas
136 kro(&lo$erma
#uberculosis of sin and subcuaneous tssue
A1#.4
5#7
137 8an$i$osis m&kok&)an ringan
.andidiasis unspecied
B37.9
52
13# e$ik&losis &-is
6hiriasis
B#5.3
535
139 Akne &lgaris ringan Acne "ulgaris
L70.0
594
140 Hi$ra$enits s&&rat( Hidradenits suppurat"a
L73.2
590
141 Dermatts erioral
6erioral dermatts
L71.0
57#
142 @&ln&s lasera)&m+ &n)&m
$pen !ound of unspecied body region
14.1
303
143 8ekerasan )&m&l
5tda diemuan 6anduan 7linis di 7-7
144 8ekerasan )a*am
5tda diemuan 6anduan 7linis di 7-7