Daftar Kode Diagnosis dan Tindakan
INA - CBG BPJS
Orthopaedi
Januari 2014 Residen wajib mengisi lembar RM 1, Lembar Verifikasi dan laporan operasi sesuai dengan diagnosis dan tindakan yang tertera secara lengkap, setiap selesai operasi
DAFTAR DIAGNOSIS (ICD 10) DAN TINDAKAN (ICD 9) DIVISI ORTHOPAEDI DAN TRAUMATOLOGI Hand (kelainan dan luka di tangan) Keterangan Remove implant
ICD 10 Diagnosis S52.90
ICD 9 Prosedur 78.69 removal implant device from the bone
Plafon 3.765.791
Luka terbuka di tangan, crush injury
S67.8 Crushing injury of other and unspecified parts of wrist and hand S55.1 injury of radial artery at forearm level M65.8 Synovitis and tenosynovitis
84.03 amputation through hand.
14.952.975
82.04 incision and drainage of palmar at thenar space, 86.66 homograft to skin 82.04 incision and drainage of palmar at thenar space, 86.66 homograft to skin 82.29 Excision of other lesion of soft tissue of hand
8.403.235
79.34 open reduction of fracture with internal fixation
12.485.355
Luka kotor /infeksi di jaringan lunak Infeksi jaringan
L.02.51 Cutaneus abscess of the hand.
ganglion
M67.4 ganglion
Fracture pada pergelangan tangan dan tangan
S62.8 fracture at wrist and hand level
Luka berat pada jari, tangan (perlu amputasi)
S68 traumatic amputasion of wrist and hand level S55.1 injury of radial artery at forearm
8.403.235
12.485.355
, carpals and metacarpals. 84.04 amputation and disarticulation of hand
14.952.971
Deformitas/ kelainan pada jari
level M20.0 Deformity of finger
Jepitan pada syaraf/carpal tunnel syndrome Syndactili
Dislokasi pada jari
84.03 amputation and disarticulation of Hand
9099.408
S64 injury of nerves at wrist and hand level Q70 Syndactili
05.9 other operation on nervous system 86.85 correction of syndactyly
11.164.055
S63.1 dislocation and sprain of joints
79.84 open reduction of
12.485.355
and ligaments at wrist and hand level
dislocation of hand and finger
Tumor ganas pada ekstremitas atas
C40.1 malignant neoplasm of short bones of upper limb S55.1 injury of radial artery at forearm leve
84.03 amputation of through hand
14.952.975
Infeksi pada sendi
M00 Pyogenic infection
8.404.231
Kerusakan sendi krn rematik
M05 .38 rheumatoid arthritis with rheumatoid factor M65.80 other synovitis and tenosynovitis
81.29 arthhrodesis of other specified joints 86.66 homograft to skin 81.29 arthhrodesis of other specified joints 86.66 homograft to skin
Kerusakan sendi bukan karena rematik
M06 other rheumatoid arthritis
8.403.235
Deformitas/ kelainan pada jari
M20.0 Deformity of finger
81.29 arthhrodesis of other specified joints 86.72 pedicle or flap graft, not otherwise specified 82.8 other plastic operation
12.485.355
8.403.235
12.485.355
on hand, kontracture
M24.59 contracture unspecified site
82.3 other excision of soft tissue of hand;
12.485.355
polidactili
Q69 polidactyli
84.03 amputation and disarticulation of finger: 86.66 homograft to skin
8.403.235
Raw surface, defek soft tissue,
L98.9 other disorders of skin and
82.8 other plastic operation
8.403.235
sural flap, semua tindakan flap
subcutaneous tissue, not elsewhere
Traumatic amputasi perlu replantasi
S68.9 traumatic amputasion of wrist and hand level S55.1 injury of radial artery at forearm leve
on hand 86.72 pedicle or flap graft, not otherwise spesified 84.22 finger reattachment 86.72 pedicle or flap graft, not otherwise spesified
8.403.235
Trauma (Fracture) No 1.
Keterangan Non union perlu bone graft
ICD 10 Diagnosis M84.90 disorder of continuity of
ICD 9 Prosedur 78.69 bone graft
Plafon 8.403.235
2.
Fracture clavikula
86.66 homograft to skinsite 79.30 ORIF,unspecified
3.835.376
3.
Fracture clavikula dengan cedera kepala
bonefracture , unspecified S42 of shoulder and upper arm S.06.9 intracranial injury S42 fracture of shoulder and upper arm
79.30 ORIF,unspecified site
7.691.543
4.
Fracture tibia/fibula
S82.21 Fracture of shaft tibia
79.36 ORIF , tibia and fibula
21.963.542
tibia prox/plateu
5.
Fracture distal tibia
S82.2 Fracture of shaft tibia
79.36 ORIF
21.963.542
6.
Fracture femur
S72.31 fracture shaft femur
79.35 ORIF , femur
7.
Fracture radius
S52.3 fracture shaft radius
79.32 ORIF , radius and ulna
Klas 1= 8.898.656 Klas 2 = 7.627.420 Klas 3 = 6 .356.183 12.485.355
8.
Fracture ulna
S52.2 fracture shaft ulna
79.32 ORIF , radius and ulna
12.485.355
9. Fr antebrachii 10. Fracture humerus
S52.7 fracture shaft forearm S42.3 fracture shaft humerus
79.32 ORIF , radius and ulna 79.31 ORIF humerus
12.485.355 12.485.355
11. Fracture pada tangan, metacarpal, phalang 12. Fracture subtrochanter femur perlu ORIF
S62 fracture at wrist and hand level
79.34 ORIF phalank of hand
12.485.355
S72.2 subtrochanteric fracture of femur
79.35 ORIF , femur
Klas 1= 8.898.656 Klas 2 = 7.627.420 Klas 3 = 6 .356.183
13. Fracture intercondylar femur,
14. Fracture intertrochanter femur
S72 fracture shaft femur
M81.65 Osteoporosis S72.14 Intertrochanteric fracture of femure
79.35 ORIF , femur
Hip implant : 6000.000 Klas 1= 8.898.656 Klas 2 = 7.627.420 Klas 3 = 6 .356.183
79.35 ORIF , femur
Knee implant : 6000.000 Klas 1= 8.898.656 Klas 2 = 7.627.420 Klas 3 = 6 .356.183
Hip implant : 6000.000 12.485.355
15. Fracture galeazi
S52.3 fracture shaft radius
79.32 ORIF , radius and ulna ;
16. Fracture montegia
S52.2 shaft ulna
79.32 ORIF , radius and ulna ;,
12.485.355
17. Fracture prksimal humerus,neck humerus
S42.20 fracture of upper end of humerus
79.31 ORIF humerus
12.485.355
18. OA Sendi lutut perlu TKR
M17.4 other secondary gonarthrosis , bilateral M19.26 secondary of the joint , lower leg
81.54 Total Knee Replacement
5.978.592
19. OA Sendi perlu TKR
M17.4 other secondary gonarthrosis , bilateral M19.26 secondary of the joint , lower leg
81.47 other repair of knee
Klas 1: 30.748.959 Klas 2:26.353.251 Klas 3: 21.963.542
20. OA sendi Hip perlu THR
M19.26 secondary of the joint , lower leg
81.51 Total Hip Replacement
Knee replacement 3.000.000 5.978.592
21. OA Sendi perlu THR
M19.26 secondary of the joint , lower leg
81.40 Repair of hip, not elsewhere classified
Klas 1= 8.898.656 Klas 2 = 7.627.420 Klas 3 = 6 .356.183 Hip implant :
22. Fracture collum femur,
M81.65 Osteoporosis
81.40 Repair of hip, not
Klas 1= 8.898.656
S72.0 fracture of head and neck of femur
23. Fracture plateau tibia 24. Fracture acetabulum
S82 Fracture of tibia ) S32.4 fracture acetabulum
elsewhere classified
79.36 ORIF , tibia and fibula 79.30 ORIF , unspecified site 05.9 other operation on nervous system
Klas 2 = 7.627.420 Klas 3 = 6 .356.183 Hip implant : 3000.000 21.963.542 11.164.055 Hip implant :
25. Fracture pedis,metacarpale,ankle 26. Fracture patella
S82.90 Fracture of lower leg , including ankle 822.1 fracture of patella,open
79.37 ORIF tarsal,metatarsal
6000.000 8.855.736
81.44 patellar stabilization
21.963.542
27. Infeksi pada sendi,
M01 direct infection of joint in infectious and parasitic disease classified elsewhere
81.9 other operation on joint structure 86.66 homograft to skin
28. Infeksi tulang, tromboemboli
M86 Osteomyelitis,
29. Dislokasi pinggul
S73.0 Dislocationand sprain of joint and ligament of hip
79.6 debridement of open fracture site ; 86.72 pedicle or flap graft, not otherwise specified 79.75 closed reduction of dislocation , hip
30. Dislokasi bahu
S43.0 Dislocation and sprain of joint and ligament of shoulder
79.71 closed reduction of dislocation shoulder
1.948.000
31. Dislokasi siku
S53.1 Dislocation and sprain of joint and ligament of elbow
79.72 closed reduction of dislocation , elbow
1.948.000
3481.352
32. Fracture neglected
M84.9 disorder of continuity of bone,unspesified
78.4 other repair of plastic operation of bone 78.70 osteoclasis,unspecified site 86.66 homograft to skin
33. Ruptur Tendon Achilles
Paediatrik (kelainan dan fracture pada anak < 15 th) No 1.
Keterangan Reposisi dan pasang gip ekstremitas atas dengan GA
ICD 10 Diagnosis S62.80 fracture at wrist and hand level
ICD 9 Prosedur 79.04 closed reduction of fracture without internal fixation
Plafon 1.948.000
2
Reposisi dan pasang gip ekstremitas bawah dengan GA
S82.7 fracture of lower leg
79.07 closed reduction of fracture without internal fixation
1.948.000
3
Rekonstruksi ibu jari kaki , halux valgus
M20.1 halux valgus/acquired
82.89 other plastic operation on hand 77.51 other buninectomy
8.855.731
4
Fracture neglected
M84.9 disorder of continuity of bone,unspesified
5
Kelainan congenital,CTEV,Blount
Q66.3 other congenital varus
78.4 otherof repair operation boneof plastic 78.70 osteoclasis,unspecified site 86.66 homograft to skin 78.4 other repair of plastic
12.485.355
6
disease
deformities of feet,
operation of bone
Pemanjangan tulang
Q66.3 other congenital varus deformities of feet,
78.3 limb lengthening procedure
21.953.542
Tumor Tulang No 1.
Keterangan Biopsi tumor
ICD 10 Diagnosis D21.9 other benign neoplasm and other soft tissue
ICD 9 Prosedur 80.31 biopsy of joint structure
plafon 2.049.737
2
Eksisi tumor Amputasi tumor di atas lutut(above knee)
82.29 excision of other lesion of hand 84.17 amputation above knee/transfemoral
12.485.355
3
4
Amputasi tumor di bawah lutut (below knee)
84.15amputation below knee
9.099.400
5
Eksisi luas (wide eksisi)
C40.9 malignant neoplasm of bone and articular cartilage of limb,. C40.9 malignant neoplasm of bone and articular cartilage of limb,. S85.0 injury of popliteal artery C40.9 malignant neoplasm of bone and articular cartilage of limb,. S85.0 injury of popliteal artery D49.2 neoplasm of unspecified behavior of bone , soft tissue , skin S85.0 injury of popliteal artery
12.485.355
6
Fraktur dengan tumor tulang
77.60 local excision of lesion or tissue of bone unspecified site 86.66 homograft to skin 79.3 ORIF
7.
Operasi tumor ganas
C40.9 malignant neoplasm of bone and articular cartilage of limb,. C40.9 malignant neoplasm of bone and articular cartilage of limb,. S85.0 injury of popliteal artery
86.66 homograft to skin 78.4 other repair of plastic operation of bone; 86.72 pedicle or flap graft, not otherwise spesified
9.099.400
8.403.235
8
Ganti sendi pada kasus tumor tulang/AMP
C79.9 secondary malignant neoplasm of unspecified site
81.40 repair of hip
8.403.235
Arthroscopy , Shoulder (bahu) dan Knee (lutut) No 1.
Keterangan Infeksi sendi lutut,
ICD 10 Diagnosis M17.9 Gonarthrosis , unspecified M01.56 arthritis in other bacterial disease lower leg M35.4 diffuse fasciitis
ICD 9 Prosedur 81.47 other repair of knee
plafon 21.000.000
2
Bahu kaku/frozen shoulder/ adhesive capsulitis
M75.0 adhesive capsulitis of shoulder M35.4 diffuse fasciitis
80.21 arthroscopy shoulder
7.691.547
3
Mengeluarkan benda asing di lutut/loose bodies
M25.68 stiffness of joint M65.26 calcific tendinitis
81.47 other repair of knee
21.000.000
Debridement shoulder
M25.68 stiffness of joint M65.26 calcific tendinitis M35.4
80.21 arthroscopy shoulder;
Klas 3 = 7.691.547 Klass 2 =9226.000
4 5
diffuse fasciitis 6 7
Rotator cuff tear
M75.1 complete rotator cuff tear or rupture not specified as traumatic
Klass1: 10.768.160
80.21 arthroscopy shoulder; 80.49 division of joint,
9.229.852
M35.4 diffuse fascitis
ligament or cartilage of other specified site
8
Rupture meniscus
M23.2 dearrangement of meniscus due to old tear or injury
81.47 other operation of knee
21.000.000
9
Osteoarthritis lutut derajat ringan (1-2)/ artroscopy debridement
S83.2 tear of meniscus,current M35.8 other specified systemic involvement connective tissue
81.47 other operation of knee
21.000.000
Ligament ACL/PCL lutut putus
M23.61 other spontaneous disruption of ligament of knee, ACL /Anterior horn medial meniscus
81.47 other operation of cruciate ligament
Klas 3= 21.963.542 Klas 2= 26.356.251 Klas 1= 30.748.959
10 11
Implant knee : 6000.000 12 13
14
Ganti sendi lutut/ total knee arthroplasty/osteoarthritis derajat berat
Rematik di lutut derajat berat perlu ganti sendi
M17 osteoartritis of knee )
M05.661 rhaumatoid arthritis of left knee with involvement of other organ and system
81.47 other operation of knee
81.47 other operation of knee
Klas 1: 30.748.959 Klas 2:26.353.251 Klas 3: 21.963.542 Knee replacement 3.000.000 Klas 1: 30.748.959 Klas 2:26.353.251 Klas 3: 21.963.542 Knee replacement 3.000.000
15
Spine/ Tulang Belakang No 1.
Keterangan scoliosis
ICD 10 Diagnosis M41.55 scoliosis S25.9 injury of unspecified blood vessel of thorax M43.54 vertebral subluxation
ICD 9 Prosedur 81.60 , 360 degree spinal fusion, single incision approach 83.74 reattachment of muscle 77.31 other division of scapula, clavicle,and thorax (rib and sternum)
plafon 34.590.151
2
Spondilolisthesis, canal stenosis
M43.15 spondilolisthesis; M48.05 spinal stenosis M48.54 collapse vertebrae S25.8 injury of other blood vessel of thorax
Klass 3= 25.165.278 Klass 2= 30.000.000 Klass 1 = 35.231.390
3.
Tumor tulang belakang
C41.2 malignant neoplasm of vertebral column ; M48.05 spinal stenosis M48.54 collapse vertebrae S25.8 injury of other blood vessel of
03.09 other exploration and decompression of spinal canal 84.51 insertion of other spinal device; 81.62 fusion of 2-3 vertebrae 81.04 Dorsal fusion 03.09 other exploration and decompression of spinal canal 84.51 insertion of other spinal device;
thorax
81.62 Dorsal fusion of 2-3 vertebrae 81.04 fusion
M50.1 cervical disc disorder; M48.05 spinal stenosis M48.54 collapse vertebrae
03.09 other exploration and decompression of spinal canal
4
HNP/canal stenosis di cervical dengan tetraparese dengan implan
Klass 3= 25.165.278 Klass 2= 30.000.000 Klass 1 = 35.231.390
Klass 3= 25.165.278 Klass 2= 30.000.000 Klass 1 = 35.231.390
G82.4 flaccid tetraplegia
5
HNP/canal stenosis di thorakal/lumbal dengan implan
M51.1 thoraxic , thoracolumbal and lumbosacral intervertebral disc disorder; M48.05 spinal stenosis M48.54 collapse vertebrae S25.8 injury of other blood vessel of
84.51 insertion of other spinal device; 81.62 fusion of 2-3 vertebrae 81.04 Dorsal fusion 03.09 other exploration and decompression of spinal canal 84.51 insertion of other spinal device; 81.62 fusion of 2-3 vertebrae
thorax
81.04 Dorsal fusion
Klass 3= 25.165.278 Klass 2= 30.000.000 Klass 1 = 35.231.390
6
HNP/Canal stenosis di cervical tetraparese tanpa implan
M50.1 cervical disc disorder; M48.02 spinal stenosis M48.52 collapse vertebrae G82.4 flaccid tetraplegia
03.09 other exploration and decompression of spinal canal 81.62 fusion of 2-3 vertebrae 81.04 Dorsal fusion
25.165.278
7
HNP/canal stenosis di thorakal/lumbal tanpa implant
M51.1 thoraxic , thoracolumbal and lumbosacral intervertebral disc disorder; M48.05 spinal stenosis M48.54 collapse vertebrae
03.09 other exploration and decompression of spinal canal 81.62 fusion of 2-3 vertebrae 81.04 Dorsal fusion
19.950.055
8
Fraktur tulang belakang dengan implan
S32.7 fracture of lumbar spine and pelvis;
03.09 other exploration and decompression of spinal
Klass 3= 25.165.278 Klass 2= 30.000.000
M48.0 spinal stenosis M48.54 collapse vertebrae S25.8 injury of other blood vessel of thorax
canal 84.51 insertion of other spinal device; 81.62 fusion of 2-3 vertebrae 81.04 Dorsal fusion
Klass 1 = 35.231.390
