Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

KEWENANGAN TINDAK MEDIK DOKTER SPESIALIS BEDAH INDONESIA

PENGURUS PUSAT PERHIMPUNAN D O K T E R SPESIALIS BEDAH INDONESiA (PP IKABI) 2013

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

KEWENANGAN TINDAK MEDIK DOKTER SPESIALIS BEDAH INDONESIA

PENGURUS PUSAT PERHIMPUNAN D O K T E R SPESIALIS BEDAH INDONESIA (PP IKABI) 2013

Tim Editor dan Kontributor

Tim Editor

: Paul L. Tahalele (Ketua) Djoni Darmajaya (Sekretaris) Fathema J. Rahmat Audi Asadul Islam H.N. Nazar Henry Boyke Sitompul

Kontributor : 1. Ketua Presidium PP I K A B I : Paul Tahalele 2. Sekretaris Jenderal PP I K A B I : Djoni Darmajaya 3. Ketua PP PABI: Urip Murtedjo 4. Ketua PP I K A B D I : Nurhayat Usman 5. Ketua PP PERABOI: Sonar S. Panigoro 6. 7. 8. 9. 10.

Ketua PP PESBEVI : R. Suhartono Ketua PP PABOI: Rizal Pohan Ketua PP l A U I : Chaidir Mochtar Ketua PP PERPEBSI : Setyo Widi Nugroho Ketua PP PERBANI : Purwadi

11. Ketua PP H B T K V I : Maizul Anwar 12. Ketua PP PERAPI: Asrofi S. Surachman

Saran, keluhan dan laporan pengaduan kelalaian tindak medik dapat ditujukan kepada Pengurus Pusat I K A B I Gedung Wisma Bhakti Mulya ~ lantai 4 - 4 0 1 - C Jl. Kramat Raya 160 Jakarta Pusat 10430 Telp&Fax. 021 -3916774 Website : www.ikabi.org Email, [email protected], [email protected] (Ketua), [email protected] (Sekjen), [email protected] (Ketua Komisi Legislasi & Advokasi)

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Kata Pengantar

Dengan semangat kebersamaan dan rasa kepemilikan serta tanggung jawab pada profesi bedah, akhimya terbit buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia (2013) oleh PP IKABI. Penulisan buku ini didasarkan: 1. UUD 1945 Pasal 28 H Ayat 1, Pasai 34 Ayat 3 mengenai upaya mensejahterakan masyarakat Indonesia 2.

UU No. 29 Tahun 2004 Tentang Praktik Kedokteran Pasal 4 Ayat 1, Pasal 44 Ayat 1 mengenai upaya penjagaan mutu pelayanan kedokteran

3. Standar Akreditasi Rumah Sakit versi 2012 mengenai penerbitan surat penugasan klinis Buku ini merupakan rangkuman tindak medik yang mengacu pada standar pelayanan medis 10 organisasi profesi kedokteran di dalam lingkungan bedah (10 OPLB) yang berada di dalam satu wadah organisasi IKABI berdasarkan Clinical Classification of Disease 9"* Revision Clinical Modification (ICD-9-CM, 1992), sedangkan diagnostik penyakit berdasarkan International Statistical Classification ofDisease and Related Health Problems (ICD-10 tahun 1992 & 1994) tidak tercantum dalam buku ini tetapi mengikuti setiap tindak medik. Disamping itu, buku ini berisi sepuluh kesepakatan yang telah ditangani oleh para ketua PP IKABI, 10 OPLB, Majelis - Kolegium llmu Bedah Indonesia dan 10 Kolegium llmu Bedah yang terkait, dan juga berisi Tata Cara Pembuatan Surat Penugasan Klinis serta contohnya dan disclaimer atau penyangkalan. Terbitnya buku ini telah mendapat apresiasi, dukungan dan arahan dari Ibu Menteri Kesehatan R I , Ketua Umum PB IDI, Ketua Persi dan Ketua K K l , untuk itu Tim Editor menyampaikan terima kasih. Rincian tindak medik yang tertera di dalam buku ini dapat dipakai sebagai acauan atau pedoman untuk menerbitkan surat penugasan klinis kepada dokter spesialis bedah, staf medis yang bekerja di suatu rumah sakit oleh Direktur Rumah Sakit atau Kepala Unit Pelaksana Kesehatan. Semoga buku ini berguna bagi pelayanan kesehatan di Indonesia dan selanjutnya diharapkan dapat ditinjau, dievaluasi dan diperbaharui dalam waktu 5 tahun mendatang sesuai dengan perkembangan ilmu bedah.

Selamat bekerja dan mengabdi Jakarta, 20 Mei 2013

Tim Editor Paul L. Tahalele (Ketua)

Daftar Isi

Tim Editor dan (Contributor

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Kata Pengantar

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Daftar Isi

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Sambutan Ketua Presidium PP IKABI

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Sambutan Ketua Umum Pengurus Besar Ikatan Dokter Indonesia

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Sambutan Ketua PERSI

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Sambutan Konsil Kedokteran Indonesia

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Sambutan Menteri Kesehatan Republik Indonesia

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Surat Pemyataan Kesepakatan IKABI, Sepuluh OPLB, dan M-KIBI

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Tata Cara Pembuatan Surat Penugasan Klinis dan White Paper Berdasarkan Rincian Clinical Previlege dan Clinical Appointment Dokter Spesialis Bedah Indonesia

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Penyangkalan atau disclaimer

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Berita Acara PP PABI dan PP IKABI

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Daftar Kompetensi dan Kewenangan Klinik Dokter Spesialis Bedah Umum (PABI)

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Berita Acara PP IKABDI dan PP IKABI

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Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Konsultan Bedah Digestif (IKABDI)

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Berita Acara PP PERABOI dan PP IKABI

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Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Konsultan Bedah Onkologi (PERABOI)

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Berita Acara PP PESBEVI dan PP IKABI

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Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Vaskuler dan Endovaskuler (PESBEVI)

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Berita Acara PP PABOI dan PP IKABI

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Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Bedah Orthopedi & Traumatologi (PABOI)

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Berita Acara PP I AUi dan PP IKABI

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Daftar Kompetensi dan Kewenangan Klinis Dokter Spesialis Urologi (lAUI)

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Sambutan Ketua Presidium PP IKABI Empat puluh lima tahun yang lalu (1967), berdiri organisasi profesi kedokteran Ikatan Ahli Bedah Indonesia (IKABI) pada Kongres Nasional Pertama IKABI di Semarang dengan motto : Sutiksna Husada Sudarma Marga '^Plsau untuk kebajikanûntuk perikemanusiaan". Saat itu semangat kebersamaan dan rasa kolegialitas sesama dokter ahli bedah Indonesia ditunjukkan dalam pelayanan kesehatan kepada rakyat Indonesia dengan menggunakan pisau kcbajikan. Dengan bcrjalannya waktu, IKABI terfragmentasi dan lahirlah 10 anak organisasi IKABI atau OPLB (Organisasi Profesi Kedokteran dalam Lingkungan Bedah) seperti PABOI, lAUI, PERSPEBSl, PERBANI, PESBEVI, IKABDI, PERABOI dan terakhir PABI. Dalam profesi kedokteran, potensi IKABI yang menghimpun dokter spesialis bedah Indonesia merupakan suatu kekuatan yang besar apabila bersatu. Pada tahun 2000 muncul spirit bersatu dalam ilmu dan pengabdian bagi seluruh dokter spesialis bedah Indonesia dan 12 tahun kemudian dalam Konferensi Kerja IKABI di Jakarta, 27 Oktober 2012, spirit yang sama terwujud dalam bentuk-bcntuk pemyataan kesepakatan bersama IKABI dan 10 OPLB bersama Majelis Kolegium llmu Bedah Indonesia serta kolegium llmu Bedah yang terkait tentang Ciinical Previlege dan Clinical Appointment dalam pelayanan kasus bedah dengan mengutamakan patient safety. PP IKABI menyambut gembira dengan mengucapkan syukur kehadirat Tuhan Y M E atas terbitnya buku KewenanganTindak Medik dan kesepakatan diantara Dokter Spesialis Bedah Indonesia yang didasari niat yang tulus dari semua stake holder IKABI. Mari kita semua bekerja mengabdi dan melayani penderita kasus bedah per primum non nocere dengan bertanggungjawab secara ber-martabat, ber-etika dan ber-moral sesuai Sumpah Hippocrates yang pernah diucapkan saat dilantik menjadi dokter. Selamat mengabdi dan melayani. Jakarta, 4 Maret 2013

Ketua Presidium PP IKABI

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Tanggal 19 April 2013

Sambutan Ketua Umum Pengurus Besar Ikatan Dokter Indonesia

Salam hormat, Dalam menjalankan profesinya, setiap dokter diwajibkan tunduk kepada aturan profesi. Hal ini terkait dengan tanggung jawab profesi untuk melindungi masyarakat yang menerima layanan serta melindungi dokter sebagai pemberi pelayanan. Dalam hal pelayanan, berdasarkan kewenangan yang tertera dalamUndang-undang Nomor 29 Tahun 2004 Tentang Praktik Kedokteran, organisasi profesi diwajibkan menyusun Standar Profesi. Dalam standar profesi disebutkan adanya Standar Pendidikan yang disusun oleh Kolegium, Standar Kompetensi yang disusun oleh Perhimpunan, Standar Etik atau Kode Etik oleh Majelis Kehormatan dan Etika Kedokteran (MKEK), serta Standar Pelayanan yang disusun oleh organisasi profesi disahkan oleh Kementerian Kesehatan. Terkait dengan pelayanan dokter di klinis, standar kompetensi erat kaitannya dengan apa yang berhak dilakukan oleh dokter. Untuk selanjutnya hal ini bisa disebut kewenangan klinis dimana hal ini mutlak menjadi kewenangan dan tanggungjawab perhimpunan terkait beserta kolegiumnya untuk membuat aturan yang baku sebagai acuannya. Untuk selanjutnya hal tersebut menjadi dasar dalam peranan profesi untuk menjaga mutu layanan anggotanya. Dengan terbitnya Buku Kewenangan Tindak Medik Dokter Spesialis Bedah yang telah disusun oleh PP IKABI, mutu layanan dokter spesialis bedah dapat lebih terarah serta terbina dengan baik. Peranan PP IKABI dalam menjaga mutu layanan anggotanya sangat membantu peranan IDI sebagai induk organisasi. Kami ucapkan terima kasih dan penghargaan yang setinggi-tingginya atas terbitnya buku ini, semoga buku ini dapat memberikan manfaat yang sebesar-besamya bagi profesi dokter dan terutama bagi rakyat. Salam Sehat Indonesia.

Ketua Umum

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Tanggal 2 April 2013

Sambutan Ketua PERSI

Terbitnya buku kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia yang diprakarsai oleh PP IKABI patut kita sambut dengan gembira dan perasaan syukur karena merupakan prestasi sekaligus kcpedulian organisasi profesi bedah (IKABI) dalam mengamalkan Undang-Undang RI No 29 tentang Praktik Kedokteran dalam rangka meningkatkan mutu pelayanan medis. Sebagaimana diketahui bahwa dalam standar akreditasi rumah sakit versi 2012 rumah sakit harus yakin bahwa setiap'staf medis yang bekerja di rumah sakitnya, memiliki kualifikasi dan kompetensi yang sesuai dengan kebutuhan pasien dan dalam implemcntasinya, direktur rumaii sakit diminta menerbitkan surat penugasan Idinik dengan rincian kewenangan klinik bagi setiap staf medis yang bekerja di rumah sakitnya. Buku ini diharapkan dapat menjadi acuan bagi direktur dan komite medis rumah sakit dalam mengatur pemberian kewenangan klinik (ciinical previleges) dalam bentuk surat penugasan klinik dan rincian kewenangan klinik bagi setiap staf medis di rumah sakit masing-masing, yang sudah barang tentu akan sangat berdampak positif pada mutu pelayanan rumah sakit dan keselamatan pasien. Perhimpunan Rumah Sakit Seluruh Indonesia (PERSI) menyampaikan rasa terima kasih kepada IKABI bersama 10 OPLB yang dengan semangat kebersamaan dapat menyatukan pendapat antar profesi bedah, dalam hal pemberian kewenangan klinis bagi dokter bedah, PERSI juga memberikan apresiasi atas pcran yang dilakukan PPIKABI sebagai organisasi profesi kedokteran unmk menerbitkan buku kewenangan tindak medik ini. Semoga hal ini dapat diikuti oleh organisasi profesi kedokteran lainnya. Sclamat berjuang demi peningkatan mutu pelayanan medis dan rumah sakit serta keselamatan pasien

Ketua PERSI Dr. Sutoto, dr. M.Kes

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KONSIL K E D O K T E R A N INDONESIA THE INDONESIAN MEDICAL COUNCIL SAMBUTAN

Assalamualaikum Wr Wb Salam Sejahtera

Pemberlakuan Undang-Undang Nomor 29 Tahun 2004 tentang Praktik Kedokteran telah memerlihatkan kejelasan bentuk pembinaan keprofesian bidang Kedokteran. Hal ini sejalan dengan dinamika yang terjadi dalam dunia kedokteran saat ini, termasuk dalam bidang pendidikan dan praktik kedokteran. Pengaturan-pengaturan yang dilakukan semua bermuara pada keselamatan pasien, melalui pembinaan keprofesian dan pemantapan kepastian hukum, baik bagi pasien maupun dokter. Standar Pendidikan dan Standar Kompetensi sebagai acuan, ditetapkan dan disahkan oleh Konsil Kedokteran Indonesia. Kewenangan Klinik dan ""clinical appointment merupakan bagian teknis dalam tatanan praktik. Namun, tumpang tindih kompetensi sulit untuk dielakkan. Dibutuhkan semangat kesejawatan yang amat kental untuk dapat membangkitkan integrasi dan sinkronisasi dalam pelayanan kedokteran. Dalam sisi inilah Konsil Kedokteran Indonesia menilai bahwa komunitas Bedah telah menunjukkan kemampuan untuk mengatasi masalah ini. Buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini selain menjabarkan pembagian kewenangan dan tanggung jawab, terlebih telah menunjukkan kearifan dalam memahami kesejawatan dan pembinaan keprofesian. Konsil Kedokteran Indonesia mengucapkan Selamat, kepada pengurus Pusat Perhimpunan Dokter Spesialis Bedah Indonesia, khususnya kepada para penanggungjawab, editor serta kontributor buku dan, Mejelis Kolegium Bedah Indonesia. Semoga langkah ini menjadi contoh bagi kita semua dan menjadi acuan bagi seluruh Dokter Bedah di Indonesia.

Sekretariat:

Jl. Teuku Cik Ditiro No. 6 Gondangdia Menteng, Jakarta Pusat Teip. :(021) 31923181, 31923191, 31923193, 31923197. 31923198,Fax.:(021) 31923186

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via email tanggal 17 Mei 2013

MENTERI KESEHATAN REPUBLIK INDONESIA

SAMBUTAN MENTERI KESEHATAN R E P U B L I K INDONESIA

Undang-Undang No 36 tahun 2009 tentang Kesehatan, Pasal 5 Ayat 2, mengamanatkan bahwa kesehatan adaiah hak setiap warga Negara. Setiap warga ncgara berhak atas pelayanan kesehatan yang aman, bermutu, dan terjangkau yang dilayani oleh tenaga kesehatan yang kompeten. Menurut Riset Fasilitas Kesehatan tahun 2011, dokter spesialis bedah hanya ada di 79,6% Rumah Sakit Umum Pemerintah. Oleh karena itu, tambahan dokter spesialis bedah sangat diperlukan agar peningkatan akses masyarakat pada pelayanan medik spesialistik yang komprehensif dan bermutu dapat terwujud. Selanjutnya, penjelasan Undang-Undang Nomor 44 tahun 2009 tentang Rumah Sakit, Pasal 3 huruf b, menyatakan bahwa tindakan pembedahan harus diberikan secara professional dengan mengutamakan keselamatan pasien (patient safety), termasuk asesmen, identifikasi, dan manajemen risiko terhadap pasien dalam pelayanan medik spesialistik. Karena jumlah dokter spesialis bedah di Indonesia masih terbatas, maka tindakan pembedahan dapat dilakukan oleh dokter umum yang telah dibekali kompetensi tambahan atau dokter spesialis bedah umum. Untuk maksud tersebut dan demi keselamatan pasien, diperlukan pengaturan kewenangan tindakan medik secara bijak antara Direktur Rumah Sakit, Komite Medik, dan para dokter spesialis bedah yang memberikan pelayanan pembedahan di lingkungan kerja tersebut. Saya menyambut baik terbitnya buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini dan menyampaikan apresiasi kepada IKABI yang telah menyusun buku ini dan memberikan kewenangan kepada dokter umum dan dokter bedah umum. Dengan demikian, keterbatasan ketersediaan dokter spesialis bedah dapat diatasi. Untuk selanjutnya, hendaknya dilakukan pemutakhiran isi buku ini, sesuai perkembangan ilmu dan teknologi kedokteran dalam tindakan pembedahan. Semoga buku ini bermanfaat dan dijadikan pedoman bagi peningkatan mutu pelayanan dokter spesialis bedah di Indonesia oleh seluruh fasilitas pelayanan kesehatan dalam memberikan pelayanan dan melaksanakan tindakan pembedahan.

dr. NafsiahlMbUi, Sp.A., M.PH.

Jl. H.R. Rasuna Said Blok X5, Kav 4-9 Jakarta 12950 Telepon/Faksimile (021) 5201591 XV

IKATAN DOKTER INDONESIA PERHIMPUNAN DOKTER SPESIALIS BEDAH INDONESIA

IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl, Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774 Website: www. ikabj.org Email • ppikabi@yahoo,com

Susunan Pengurus PP. IKABI

Periode 2012-2014 DBwan Pertimbangan Prof. Dr. SjacnsiibKJatat, SpB SpB-KBD DI. Sowarao hlartôwasA). SpB SpeTKV

M^HiEmtaPwMMhit

Nomor : 50/PP-IKABI/XI/2012 Lamp. : Daftar Kompetensi 10 (sepuluh) OPLB Hal : Clinical Previlege & Clinical Appointment dalam pelayanan kasus bedah

Jakarta, 27 Oktober 2012

Prol, Dr. Muchlis Rami!, SoB(Kl-Onk

K^tuiPraildlum ProT. DR. Dr Paul Tahalele, SpB.SpBTKV WiltllK«>u«IKrtuiTinXllh Df R. SuhartofW. SpBKBV WiMI mw Prol. DR Df Sunaryo Hardjowidjoto, SpB SpU

Kepada Yth. Ibu Menteri Kesehatan RI Kementerian Kesehatan Republik Indonesia Jin. H.R.Rasuna Said Blok X.5 Kav, 4-9 Kuningan Jakarta Selatan 12950

Prof. DR Dr. Suwaryji Suganiji. SpB SpU KituUIKlS) Prol. Dr. EtTOI U. Hutagalung. SpB SpOT Pwtldium Dr. Urip Murtedjo, SpB PGD Pal Med. ECU Dr. Rizal Potwn, SpB SpOT DI. Sonar Soni Panigoro, SpB K.Onk Dr. Patriot Muslim, SpU Or Poerwadi, SpB SpBA Dr R Suhartooo. SpBKBV Dr. SelyowHli Nugroho, Sp6 SpBS Dr. Nuitiayal Usman, SpB KBD Dr. Maizul Arwar. SpB TKV Dr. Ishandono Dacfilan, Msc, SpB, SpBP-RE(K) SefcreUril Jtndefil Dr. Djoni Damad)a|a. SpB MARS WlklLStllitD Dr. Agung Prasmom, SpB SpBTKV.MARS Bindihira Dr Barlian Suledja. SpB K
Dr. Nurtia/al Usman, Sp6 K60 Dr. Erawan Wtradisiina, SpB K8D Dr. Henry Boyke Silompul, SpB Dr InztaArtii, SpB

Dengan hormat. Bersama ini kami PP IKABI bescrta 10 organisasi profesi dalam lingkungan bedah (OPLB), yaitu Pabi, Paboi, Peraboi, lAUl, HBTKVI, Perbani, IKabdi, Perapi, Perspebsi, Pesbevi dan Majelis KIBI menyampaikan surat pemyataan kesepakatan tentang clinical privilege dan clinical appointment dalam pelayanan kasus bedah dengan maksud untuk mencegah konfiik kepentingan profesi bedah dalam pelayanan kesehatan dan mendukung Program Pemerintah C/Q Kcmentrian Kesehatan RI mcnsukseskan program BPJS 2014 dan program MRA 2015 serta program-program yang lain. Selanjutnya apabila Ibu Menteri Kesehatan RI berkenan dan tidak berkeberatan. kami mcmohon pemyataan sikap kami didukung penuh oleh Menteri Kesehatan Rl dan ditcruskan kepada instansi yang terkait. Semoga sikap pemyataan ini dapat mensejahterakan rakyat Indonesia dan menjaga mutu pelayanan kasus bedah. Demikian surat ini kami sampaikan untuk dipertimbangkan tindak lanjutnya, Atas kerjasama yang diberikan kami mengucapkan terima kasih. Hormat Kami,

B*b»i

KMIIII globaHsasi & P i w Dr dr Falhema D Rachmal, Spfl SpBTKV Dr. Huntal Simamora. SpBP-RE

Komisi Komunikasi dan Publlkasi DR. Dr. Yefla Munad|al. SpB SpBP-RE(K| Prol. DR. Dr. Sr Maliawan, SpBS (K) Dr Iskandar Budianla. SpB SpBA Komisi Hubunqan D I I O T Ntgeri Prof DR DrAndiAsadul Islam, SpeS Dr. Boyke Sumantn, SpU Dr. Emir T Pasaribu SpB.Onk Homlgl Prtayanan Ambiilinc* 118 Dr. ZA Isma, SpB Dr.AolSatia,Sp6KBD ttriHilil T f i i i m DR. Dr. Achrnad Hklayat, Sp6 Dr. B. Surioko, SpB DR. Dr. Triwahyu Mumi, SpB SpBTKV

Dr. Paid Tahalele Ketua PP IKABI

3joni Darmadjaja, SpB [ 3n PP IKABI

Tembusan: - Dirjen BUK Kemenkes RI Kepala dinas Kesehatan Propinsi, Kabupaten dan kota Ketua Persi Pusat dan Daerah Ketua KKl - Ketua PB IDI Ketua Asosiasi RS Pendidikan Direktur RS Di seluruh Indonesia Ketua Arsada (Asosiasi RS Daerah) Ketua ARSI (Asosiasi RS Swasta Indonesia) Arsip

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I

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IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl, Kramal R a y a 160, Jakarta P u s a l 10430, Telp & Fax. 021 - 3916774 Websjle: www ikabi.org Email : ppikabi@yahoo com

Susunan Pengurus PP. IKABI Periode 2012-2014 D w a n Pertlmbanqan Prof. Dr. Sjamsuhidajat, SpB.SpB-KBD Dr. Soerarso htarc^slto, Spe.SpBTKV

Surat Pemyataan Kesepakatan IKABI dan 10 OPLB bersama Majelis Kolegium llmu Bedah Indonesia Tentang Clinical Previlege dan Clinical Appointment dalam pelayanan kasus bedah

Prof. Dr. Muchlis Ramli, Sp6{K)-0nk KttuiPfWtdlum Prof. DR. Dr. Paul TahaWe, SpB.SpBTKV WifcllKrtuafKrtuiTarolllh Dr. R. Suharlono. SpBKBV Wakll K*tua Prof. DR Dr Surtaryo Hartôwidiolo, SpB SpU K B I U I Pumi Prof. DR. Dr. Suwartdi Sugandi, SpB SpU KetuaJJKlfi] Prof. Dr. Errol U. Hutagalung, SpB SpOT

buldium Dr. Unp Murted)a, SpB PGD Pal Med, ECU Dr. Rizal Pohan, SpB SpOT Dr. Sorar Soni Pamgoro, SpB K.Orli Or Patrol Muslim, SpU Dr. Poemodi. SpB SpBA Dr. R Sutiarlono, SpBKBV Dr. Setyowkli Nugroho. SpB SpBS Dr. Nurhayat Usman, SpB KBD Dr Maizul Amiar SpB TKV Dr. IsharHJono Dachlan, Msc, SpB, SpBP-RE(K) Sekretaili Jandtnl Dr D|oni Darmadjaja, SpB MARS Wakll SaktHi Or. Agung Prasmono, SpB SpBTKV MARS

Dasar Pemikiran: Perkembangan ilmu bedah di Indonesia berjalan begitu cepat, selaras dengan itu terjadi fragmentasi pelayanan kasus bedah dimana masing-masing disiplin ilmu bedahnya berada dibawah otoritas organisasi profesi bedah terkait dan saat ini telah mencapai 10 organisasi profesi dalam lingkungan bedah ( OPLB ) didalam wadah federasi IKABI Dalam pelayanan kasus bedah, pendekatan holistik seringkali diabaikan dan yang menonjol adaiah fragmentasi tsb. yang mana tidak mcmbawa keuntungan bagi profesi bedah itu scndiri maupun bagi kesejahteraan rakyat Indonesia, bahkan sering terjadi konflik kepentingan yang berdampak pada kesehatan dan keselamatan penderita. Konfiik kepentingan yang scmpit dalam pelayanan kasus bedah juga akan merugikan atau menghambat program pemerintah C/Q Kementrian Kesehatan RI dalam mcnsukseskan Program BP.IS 2014 dan Program MRA 2015 serta mungkin juga program Kementerian Kesehatan RI lainnya.

BWMMM li Dr. Bartian Sutedfa, SpB Komltl Organlgatl. Lefllalagi dan Advokasi Dr HN Nazar, SpB Dr Chandra Svaras, SpB

Dr. Nurttayal Usman. SpB KBD Dr. Eraww Wradjsufia. SpB KBD Or. Henry Boyke Sftompul, SpB Dr. Inzta Arts, SpB KWPIJI Globalisasi S Pasar Bibas Dr. dr Fathema D Rachmat. SpB SpBTKV Dr. Hunlal Sirramora, SpBP-RE

OR. Dr^Wh MuIITcliaL'spB s"paP-RE(K) Prof. DR. Dr. Sn Maliawar, SpBS (K) Dr. Iskandar Bu{banla. Sp8 SpBA Koffii»i Hubunyin Dalam Hegert Prol DR. Dr Andi Asadul Islam, SpBS Dr Boyke Sumanin, SpU Dr Ermr T Pasanbu SpB Onk Komisi Pelayanan Amtailanca 118 Dr ZA Isma, SpB Or Agi Salna, Sp6 KBD KombI Trauma OR. Dr Achmad Hidayat, SpB Dr B Sunoko, SpB DR. Dr. Trtwahyu Mumi, SpB SpBTKV

Hal ini perlu dicegah dan dicari jalan keluar demi menjaga martabat dan kehormatan dokter Indonesia sesuai sumpah Hippocrates. Berdasarkan pemikiran diatas. kami para stakeholder IKABI perlu bekerjasama unmk mencapai dan mempertahankan mutu pelayanan kesehatan khususnya di bidang pembedahan dalam kerangka menyediakan fasilitas dan pelayanan kesehatan yang layak dalam upaya menyejahterakan masyarakat Indonesia sesuai dengan amanat UUD'45 pasal 28 H ayat 1 dan pasal 34 ayat 3 serta upaya penjagaan mutu pelayanan kedokteran sesuai amanat UU No.29 tahun 2004 tentang praktik kedokteran pasal 4 ayat 1 dan pasal 44 ayat 1 Isi pemyataan kesepakatan: Berdasarkan hal tsb.diatas, Perhimpunan Dokter Spesialis Bedah Indonesia ( I K A B I ) melalui Konker tanggal 27 oktober 2012 di Jakarta bersama 10 anak organisasi OPLB dan Majelis Kolegium Ilmu Bedah serta Kolegium Ilmu Bedah yang terkait Indonesia menyatakan bahwa:

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia I X I X


IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Kramal R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774 Website: www.ikabi.org E m a i l : [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014 Dewan Pertim ban flan Prol. Df. Sjamsuhidajat, SpB.SpB-KBD Dr. Soerarso Hardjowaslto, SpB.SpBTKV Majelis Etik APenaselial Prof. Dr. Muchlis Ramli, Sp8(K]-0nk Ketua Presldlunn Prof. DR. Dr. Paul Tahalele, SpB SpBTKV Wakll Katua/Kfllua Taroilih Dr. R. Suhartono. SpBKBV Wakll Ketua Prof DR. Df Sunaryo Hard|owidjolo, SpB SpU Ketua Puma Prof. DR. Dr. Suwardi Sugandi, SpB SpU Ketua MKtBI Prof. Dr Errol U. Hulagalurg, Sp8 SpOT Presidium Dr Urip Murtedjo, SpB PGD Pal Med, ECU Dr. Rizal Polian, SpB SpOT Dr Sorar Son Panigoro, SpB K.Onk Df Patriot Muslim, SpU Dr. Poerwadi, SpB SpBA Dr. R Suhartono, SpBKBV Dr Setyowidi NugnDho, SpB SpBS Dr. Nurhayat Usman, SpB KBD Dr Maizul Anwar. SpBTKV Dr. Ishandono Dachlan, Msc, SpB, Sp6P-RE(K) Sakretaris Jenderal Dr. Djoni IDarniadjaja, SpB MARS Wakll Sekjen Dr Agung Prasmono, SpB SpBTKVMARS Bendahara Dr Bariiar Suted|a, SpB Komisi OrBanisasi. Legislasi dan Advokasi Dr. HN Nazar, SpB Dr Chandra Svaras, SpB Komisi Profesi Bedah. Asuransi dan Perpajahan Dr Nurhayat Usman, SpB KBD Dr, Erawan Wiradlsuria, SpB KBD Dr Henry Boyke Sitompul, SpB Dr. Inzta ArCI, SpB Komisi Globalisasi & Pasar BBIMS Dr. dr Fathema D Rachmat, SpB SpBTKV Dr. Huntal Simamora, SpBP-RE Komisi Komunikasi dan Publika?i DR. Dr Yefta fûnadjat. SpB Sp8P-RE(K) Prof. DR. Dr Sri Maliawar. SpBS (K) Dr. Iskandar Sudianta. SpB SpBA Komisi Hubungan Dalam Neqerl Prof DR Dr And Asadul Islam, SpBS Dr. Boyke Sumanlri, SpU Dr. Emir T Pasaribu SpB.Onk Komisi Pelayanan Ambulance 11B Dr. ZA Isma, SpB Dr. Agi Satria, SpB KBD Komisi Trauma DR. Dr. Achmad Hidayat, SpB Dr. B. Suroko, SpB DR. Dr. Tnwahyu Mumi, SpB SpBTKV

1. Perlu ditegakkan ketertiban dan disiplin dalam menjalankan pelayanan kesehatan disetiap tempat pelayanan kesehatan (rumah Sakit, klinik,poIiklinik ) berdasarkan kompetensi yang dipunyai oleh masing-masing Dokter Spesialis Bedah sesuai dengan yang digariskan oleh organisasi profesi bedah yang terkait beserta kolegiumnya dalam bentuk clinical privilege (Kewenangan tindak medik sesuai kompetensi dokter spesialis bedah) yang dipertimbangkan/diterbitkan oleh komite medik masing-masing Rumah Sakit. 2. Clinical previlege yang dimaksud dipakai sebagai pedoman pelaksanaan clinical appointment oleh masing - masing Direktur Rumah Sakit diseluruh Indonesia yang sesuai dengan SDM dan sarana - prasarana yang tersedia untuk kepentingan, keselamatan dan keamanan penderita. 3. Setiap Dokter Spesialis Bedah yang bekerja di suatu RS harus taat dan mendukung penuh dalam memajukan pelayanan kesehatan di RS yang terkait dengan membuat komitmen berupa pemyataan kesediaan dan kesanggupan secara tertulis untuk melayani penderita sesuai daftar penyakit/kasus yang disepakati bersama dengan direktur RS dalam bentuk clinical appointment dan tidak menyimpang dari daftar kewenangan yang telah dibuat oleh masing-masing anak organisasi bedah (OPLB) didalam Federasi IKABI, bisa lebih banyak atau bahkan mungkin lebih sedikit dari jumlah dan jenis kasus yang ditetapkan oleh OPLB-OPLB . 4. Setiap Direktur RS menilai outcome / kinerja Dokter Spesialis Bedah yang bekerja di dalam RS tsb. dan mengambil langkah2 kebijakan sesuai performance yang dimnjukkan dokter yang terkait ( menegur atau bahkan melarang melakukan suatu tindakan medis tertentu apabila terjadi penyimpangan dari standar pelayanan yang berlaku atau menyebabkan terjadinya kerugian/ kecelakaan penderita . 5. Dalam menerapkan clinical appointment masing-masing disiplin ilmu bedah, para Dokter Spesialis Bedah dihadapkan dengan adanya kasus tumpang tindih baik interen ( didalam profesi bedah sendiri) maupun eksteren ( dengan disiplin ilmu kedokteran yang lain ). Tumpang tindih kasus bedah tidak bisa kita hindari, namun kita harus menghargai dan menghormati bersama termasuk tidak dibenarkan saling melarang atau meng-klaim. Setiap tindakan bedah sehamsnya di dasari kompetensi yang telah ditetapkan oleh masing2 organisasi profesi kedokteran yang terkait. 6. Dalam menghadapi kasus tumpang tindih diharapkan ada pengaturan yang tepat dan bijak dari Direktur RS misalnya dengan membangun kerjasama antar profesi dalam 1 unit kerja ( panitia ad hoc ) atau pengaturan kerja berdasarkan waktu setiap hari atau setiap minggu bergantian dalam menangani kasus-kasus yang sama tetapi berbeda profesinya atau mengadakan diskusi kasus yang sama diantara

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia B

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IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-iantai 4 - 401-C Jl. Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax, 021 - 3916774 Websile: www.1kabi.org E m a i l : [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014 Oewan Pertimbangan Prof. Dr. Siamsuhidajat, SpB.SpB-KBD Dr Soerarso Hardjowasilo, SpB.SpBTKV M^lelis Ellk&Penasehat Prof. Dr Muchlis Ramli, SpB(K)-Onk Ketua Presidium Prof. DR. Dr. Paul Tahalele, SpB SpBTKV Wakll Ketua/KetuaTerpilih Dr R. Suliartopo, SpBKBV Wakll Ketua Prof. DR. Dr. Sunaryo Hardjowidjoto, SpB SpU Ketua Puma Pml OR. Dr Suwandi Sugandi. SpB SpU Prof. Dr. Erroi U. Hutagalung, SpB SpOT Presidium Dr Urip Murtedjo, SpB PGD Pal Med, ECU Dr. Rizal Pohan, SpB SpOT Dr. Sonar Soni Panigoro, SpB K.Oni< Dr Patriot Muslim, SpU Dr. Poenwadi, SpB SpBA Or. R Suhartono, SpBKBV Dr Setyowidi Nugroho, SpB SpBS Or Nurhayat Usman, SpB KBD Dr. Maizul Anwar, SpB TKV Dr Ishandono Dachlan, Msc, SpB, Sp8P-RE(K)

para dokter yang terkait berdasarkan modul pembelajaran dan pencapaiannya seharusnya sama, dimana modul - modul tersebut telah diterbitkan oleh masingmasing Kolegium Ilmu Bedah. 7. Selain penanganan kasus tumpang tindih, pengaturan clinical privilege oleh Komite Medik dan ciinical appointment oleh Direktur Rumah Sakit juga akan berdampak pada pemerataan jasa pelayanan medis yang telah ditetapkan berdasarkan pengaturan atau ketentuan BPJS secara adil dan proporsional 8. Kami mendukung sepenuhnya Program Pemerintah C/Q Kemenkes RI antara lain menyukseskan pelaksanaan BPJS 2014 dan MRA 2015 serta program-program yang lain. 9. Apabila terjadi permasalahan sebagai akibat diterapkannya clinical previlege & clinical appointment, kami organisasi profesi kedokteran IKABI beserta 10 OPLB bersedia turut menyelesaikan sesegera mungkin setclah mendapat laporan dari Direktur RS yang terkait, atau laporan dari pihak lainnya 10. Pemyataan kesepakatan ini disertai lampiran daftar kompetensi dari 10 OPLB dan diharapkan dapat mendukung serta mempercepat akselerasi tercapainya masyarakat Indonesia sehat dan sejahtera serta menjaga mutu pelayanan kesehatan.

Sekretaris Jenderal Dr Djoni Darmadjaja, SpB MARS

Dr. Agung Prasmono, SpB SpBTKV.MARS

Dr. Barlian Suledja, Sp8 Komlil Organisasi. Legislasi dan Advokail Or. HN Nazar. SpB Or. Chandra Si/aras. SpB Komisi Profesi Bedah. Asuransi dan Peiyalakan Dr. Nurhayat Usman, SpB KBD Dr. Erawan Wiradlsuria, SpB KBD Dr. Henry Boyke Sitompul, SpB Dr Inzta Arbi, SpB Komisi Globalisasli Pasar Bebas Or dr. Fathema D Rachmal. SpB SpBTKV Dr Huntal Simamora, SpBP-RE Komisi Komunikasi dan Publlkasi OR. Dr. Yefta Munadjal, SpB SpBP-RE(K) Pml. DR. Dr. Sri Maliawan, SpBS fK) Dr, Iskandar Budianla, SpB SpBA Komisi Hubungan Dalam Negerl Prof DR Dr Andi Asadul Islam, SpBS Dr. Boyke Sumanlri, SpU Df Emir T Pasaribu S|^,Onk Komisi Pelayanan Ambulance 118 Dr. ZA Isma. SpB DrAgi Satria, SpB KBD Komisi Trauma DR. Dr Achmad Hidayat, SpB Dr. B Sunoko, SpB OR. Dr. Triwahyu Mumi, SpB SpBTKV


I

xxili


IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl, Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774 Website, www.ikabi.org Email [email protected]

Susunan Pengurus PP IKABI Periode 2012-2014 Q w a n Pw1lmbMig*n Prof Or Siamsuhidajat, SpB.SpB-KBD Dr Soerarso Hard|Owasito, SpB.SpBTKV Manila Ellk a Peniiehal Prof. Dr Muchlis Ramli, SpB(Kl-Onli

KmitEnttMlum

Jakarta, 27 Oktober 2012 Yang bertanda tangan dibawah ini adaiah Ketua PP IKABI dan para Ketua 10 OPLB serta Ketua Majclis Kolegium Ilmu Bedah Indonesia dan para Ketua 10 Kolegium Ilmu Bedah Indonesia :

Prof. OR Or Paul Tahalele, SpB.SpBTKV

WiKIIKilutf
1. Ketua PP IKABI 2. Ketua PABI

Prof. DR. Dr. Sunaryo Hardjowidfoto, SpB SpU

3. Ketua IKABDI 4. Ketua PERABOI 5. Ketua PESBEVI

Kilua Puma Prof. DR. Or. Suwandi Sugandi. SpB SpU

prof. Dr Errol U. Hutagalung, SpB SpOT

Df. Urip Murtedjo, SpB PGD Pal Med, ECU Dr. Rizal Ponan, SpB SpOT Dr Sonar Som Panigoro. SpB K Onli Dr Patnol Muslim, SpU Dr. Poenivadi SpB SpBA Dr. R Suhanono, SpBKBV Dr. SelyowHJi Nugroho, SpB SpSS Dr. Nurhayat Usman, SpB KBD Dr. Maizul Arwar, SpB TKV Dr. Ishandono Oachlar, Msc, SpB, SpBP-RE(K) Sekretirii Jendir i l Dr Djoni Dam^djaja. SpB MARS WMtl
Dr. Badiar Sutedja, SpB Komlil Organiiwl. Legislasi dan Advokisi Dr. HN Nazar, SpB Dr. Chandra Svaras, SpB Kwnlsl Profisi Bettah. Atunnil d m Perp^kin Dr. Nurhayat Usman, SpB KBD Dr. Erawan Wiradisuna, SpB KBD Dr. Henry Boyke Silompul, SpB Dr Inzta Arbi, SpB

HomliiQIolwliHtl&PiHrBttm Or dr. Fathema 0 Rachmat, SpB SpBTKV Dr. Hunlal Simamora, SpBP-RE Komisi Kamunikasi dan P u b l l k i » l DR. Dr. Yefta Munadjat, SpB SpBP-RE(K) Prof. OR. Or Sr Maliawar. SpBS (K) Dr. Isitandar Budianla, SpB SpBA

6. 7. 8. 9.

Ketua Ketua Ketua Ketua

PABOI lAUI PERSPEBSI PERBANI

10. Ketua PERAPI 11. Ketua HBTKVI 12. Ketua MKIBI 13. Ketua KIBI 14. Ketua Kolegium Ilmu Bedah Digestif 15. Ketua Kolegium Ilmu Bedah Onkologi 16. Ketua Kolegium Ilmu Bedah Vaskuler 17. Ketua Kolegium Ilmu Bedah Orthopaedi 18. Ketua Kolegium Ilmu Bedah Urologi 19. Ketua Kolegium llmu Bedah Plastik, Rekonstruksi dan Estetika 20. Ketua Kolegium Ilmu Bedah Saraf 21. Ketua Kolegium Ilmu Bedah Anak 22. Ketua Kolegium llmu Bedah Toraks Kardiak dan Vaskuler

Paul Tahalele Urip Murtedjo Nurhayat Usman Sonar Panigoro R Suhartono Rizal Pohan Chaidir Mochtar Setyo Widi Nugroho Purwadi Asrofi S SUrachman Maizul Anwar Errol U Hutagalung Aryono D Pusponegoro Benny Philipi Dimyati Achmad Hilman Ibrahim Errol U Hutagalung Rayni Umbas David Perdana K Padmosantjojo Amir Thayeb Jusuf Rahmat

Komlii Hubungin Dilam Htgerl Prof DR. Dr Ardi Asadul Islam, SpBS Or. Boyke Sumanin, SpU Or. Emr T PasanlHj SpB.Onk Komisi Pelayanin Amhu^•n^:^ 1 H Dr. ZA isma, SpB Or Agi Satra, SpB KBD

HOTIHIIIMHI OR. Or Achmad Hidayat. SpB Dr B. Sunoko. SpB DR. Or. Triwahyu Mumi, SpB SpeTKV


XXV


IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Kramat R a y a 160, Jakarta Pusat 10430, Telp & Fax, 021 - 3916774 Website: www.ikabi.org Email

Susunan Pengurus PP IKABI Periode 2012-2014 Dawan Pertim banaan Prof. Df Sjamsuhidaial. SpB SpB-KBD Dr Soerarso Hardjowasilo, SpB SpSTKV WajelisEtlkSPenasehat Prof. Dr Muctihs Rarrli, SpB|KJ-Onli

[email protected]

Jakarta, 27 Oktober 2012 Demikian pemyataan ini kami buat dengan sebenamya.

No.

Ketua Preskllum

KETUA

OPIB PP IKABI

Prof. OR. Dr. Paul Tatialele. SpB SpBTKV Wakll Kelua/Ketua Terpllih Dr. R. Suharlono, SpBKBV

PP PABI

VHMiKetm Prof DR. Dr. Suraryo Hardjowidjolo. SpB SpU

PP IKABDI

KBtua Puma Prof. OR. Or Suwandi Sugandi. SpB SpU

PP PERABOI

Ketua MKIBI

3 JOM^

S'(fAî<î^

PKif. Dr Etrol U Hutagalung, SpB SpOT Presidium

PP PESBEVI

Dr Urip MuftedfO, SpB PGD Pal Med, ECU Dt Rizal Potian. SpB SpOT Or Sonar Soni Panigoro, SpB K.Orli Df. Patriot Muslim. SpU Dr Poenwadi, SpB SpBA Dr R Sufiarlono, SpBKBV Dr. Setyowidi tûgroho, SpB SpBS Dr Nuftwyal Usman, SpB KBD Dr Maizul Anwar, SpBTKV Dr. istandono Dacfilan. Msc, SpB, Sp6P-RE(K)

^ p.. SUHARTOtÔ

PP PABOI

PP lAUl

Or. Djoni Dwmadja)a, SpB MARS Wakil Sekjen Dr Agung Prasmono, SpB SpBTKVMARS

PP PERSPEBSI

Dr Barlian SulBd|a. SpB

PP PERBANI

Kwnlsl Ofganlsisi. leaislaii dan Advokasi Dr. HN Nazar. SpB Dr. Chandfa Svaras. SpB Komisi Profeii Bedah. Asuransi dan Perpajakan Dr. Nurhayal Usman, SpB KBD Or. Erawan Wiradisuria, SpB KBD Or. Henry Boyke Silompul, SpB Dr Inzta ArtH, SpB

PP HBTKVI

10

PP PERAPI

dir.

Komlil Globallsasi A Pilar Bebas Dr. dr Falhema D Rachmal, SpB SpBTKV Dr Huntal Simamora, SpBP-RE Komisi Komunikasi dan Publikasi DR Dr Yefta Munadjat, SpB SpBP-RE(K) Prof DR. Dr Sri Maliawan, SpBS (K) Or iskandar Budianta, SpB SpBA Hubungan Dalam I Prof DR DrAndiAsadul Islam, SpBS Dr. Boyke Sumantri, SpU Dr Emir T Pasanbu SpB.Onk Komlil PetayafMn Ambulanca 118 Or ZA Isma. SpB DrAgi Satra, SpB KBD Komlil Trauma DR. Dr. Achmad fWayal. SpB Dr. B. Sunoko, SpB DR Dr Tnwahyu Mumi, SpB SpBTKV


XXVII


IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-iantai 4 - 401-C Jl Kramat R a y s 160, Jakarta P y s s t 10430. Telp & Fax. 021 - 3916774 Website: www.iKabi.org E m a i l : [email protected]

Susunan Pengurus PP IKABI Periode 2012-2014

\)v*t*n Partlmbangan Prof. Dr Sjamsufiidaiat, SpB.SpB-KSD Dr. Soerarso Hardiowasito, SpB SpBTKV

MAJELIS KOLEGIUM ILMU BEOAH UMUM INDONESIA

Kelua

Mi|ill» EHk a Penaaehel Prof. Dr. Muchlis Ramli. SpB(K)-Onk Ketua PrtBldlum Prol. DR. Dr. Paul Tahalele, SpB.SpBTKV Wakll KetuafKatuaTaroiilh Dr. R. Suhartono, SpBKBV

Prof, DR, Or Sunaryo Hardjowidjolo. SpB SpU Katui Puf ni Prof. OR. Or. Suwandi Sugandi, SpB SpU

Prof. Or, Errol U, Hutagalung, SpB SpOT l^miJlum Dr. Urip Muftfldjo, SpB PGD Pal Med. ECU Dr. Rizal Pohan. SpB SpOT Dr. Sonar Soni Panigoro, SpB K.Onk Dr Patnol Muslim, SpU Dr. Poerwadi, SpB SpBA Dr. R Suharlono, SpBKBV Or. Setyowidi Nugroho, SpB SpBS Or Nurhayal Usman, SpB KBD Dr. Maizul Anwar, SpB TKV Dr Ishandono Dachlan, Msc, SpB. SpBP-RE(Kj SekretirliJendenl Dr Djoni Damiadjaja. SpB MARS

WiUIMbm Or Agung Prasmono, SpB SpBTKV MARS

Buulitiiri Dr Barlian Suledja, SpB Komisi OfganNfsl. Iêglslasl dan Advokail Dr. HN Nazar, SpB Dr Chandra Svaras, SpB

Vkm\l>\ PnM

Asuransi dan Perpajakan

Or, Nurtieyat Usman, SpB KBD Dr. Erawan Wiradisuria, SpB KBD Dr Henry Boyke Sitompul, SpB Or Inzta Arbi, SpB Komisi Globallsasi A Pasar Bebis Or df. Fathema D Rachmat. SpB SpBTKV Dr, Huntal Simamora. SpBP-RE

KOLEGIUM ILMU BED AH INDONESIA a. Koi^fum Ihrni Bedah D«Mt»f b. Kot^him llmu Bedah Onkologi c Kolegium flmu Bedah Vaskuler & Endovaskuler

»-

fHiUpri

Kolegkim llmu Orthopaedi Kolegium llmu Urologi Kolegium flmu Bedah Ptastik, Rekonstruksi dan Estetika Kolegium llmu Bedah Saraf Ktriegium Iknu Bedah Anak Kolegium Ibmi Bedah Toraks Kardiak dan Vaskuler

^ i>r hworWt^cW 9y^1fM

Komisi KomunlliMt din Publlhisl DR. Dr YeflB Munadjat. SpB SpBP-RE(K] Prof. OR, Dr Sri Maliawan, SpBS (K) Dr. Iskandar Budianla, SpB SpBA Komlii Hulmngan Dalam Hufirl Prof DR, Df, Andi Asadul Islam, SpBS Dr Boyke Sumanin. SpU Dr. Emir T Pasaribu SpB.Onk Kwnlil P t l i y n i n AmbulMHina Or ZA Isma, SpB Dr Agi Satria. SpB KBD Komisi Trauma DR. Dr Achmad Hidayat, SpB Dr. B. Sunoko, SpB OR. Or Tnwahyu Mumi, SpB SpBTKV


I

xxlx

Tata Cara Pembuatan Surat Penugasan Klinis dan White Paper Berdasarkan Rincian Clinical Previlege dan Clinical Appointment Dokter Spesialis Bedah Indonesia

1. Kerangka Dasar Pembuatan Surat Penugasan Klinis 1.1 Kewenangan tindak medik dalam pelayanan kesehatan yang tertera didalam undang-undang No. 29 tahun 2004 tentang Praktek Kedokteran berdasarkan amanat UUD.45 pasal 28 H ayat 1 dan pasal 34 ayat 3 tentang upaya mensejahterakan masyarakat Indonesia 1.2

Profesi yang mengacu pada standar pendidikan dan modul pembelajaran yang diterbitkan oleh Kolegium Ilmu Bedah masing-masing Organisasi Profesi Kedokteran dalam Lingkungan Bedah (OPLB) yang disyahkan oleh K K l

1.3 Standar Kompetensi dan Standar Pelayanan yang disusun oleh Organisasi Profesi Kedokteran OPLB 1.4 Standar Etik atau Kode Etik yang dikeluarkan oleh Majelis Kehormatan dan Etika Kedokteran (MKEK) 1.5 Standar akreditasi Rumah Sakit Versi 2012 1.6 Visi,Misi,Azas dan Tujuan IKABI 2012 1.7

Sepuluh kesepakatan (10) OPLB dan Kolegium Ilmu Bedah yang terkait pada KOnker IKABI 27 Oktober 2012

2.

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia diberikan kepada dokter masing-masing sebagai staf medis di rumah sakit yang terkait dengan rincian kewenangan klinik yang meliputi: 1.1 Penegakkan diagnosis penyakit bedah sesuai klasifikasi ICD 10 (anamnesis dan pemeriksaan klinik yang terarah,dilengkapi dengan pemeriksaan penunjang seperti laboratorium,pencitraan USG, ekokardiografi, ecg, endoskopik,biopsy/FNAB,dll). 1.2 Memberikan terapi dalam bentuk tindakan bedah dan non bedah (kasus bedah tanpa operasi seperti tetanus,trauma capitis, trauma toraks, trauma abdomen, kolik abdomen, dll), termasuk terapi penunjang yang lain (pemberian antibiotika rasional, analgesik, nutrisi, cairan elektrolit, terapi kemo, dll). 1.3 Melakukan perawatan kasus bedah akut dan elektif serta kasus bedah kronik 1.4 Mendeteksi dan menangani komplikasi durante dan pasca operatif 1.5 Melakukan terapi rehabilitasi kasus bedah dan follow upnya. 1.6 Member! konsultasi, informasi,edukasi (KIE) pada pasien maupun keluargannya 1.7 Mencatat semua proses asuhan medis pada semua kasus bedah dalam dokumen rekam medis. 1.8 Sebelum melakukan semua tindakan bedah invasif & non invasif harus membuat informed consent yang ditandatangani bersama dokter & penderita/keluarganya. 1.9 Dalam melaksanakan setiap prosedur tindakan bedah harus mengikuti standar patient safety, misalnya: time out sebelum melakukan tindakan medis.

1

3. Bagan Alur Pengajuan Pembuatan Surat Penugasan Klinis (White Paper) 3.1

Dokter yang telah bekerja disuatu rumah sakit Dokter,Staf medis ybs.

Membuat secara tertuHs rincian kewenangan tindak medis sesuai acuan Organisasi Profesi Kedokteran OPLB dan Kolegium llmu Bedah yang terkait Rincian tertulis tsb. diajukan kepada Ketua SMF llmu Bedah

V Ketua SMF l.Bedah

Melakukan penelitian kebenaran dokumen yang berisi kompetensi dokter ybs. serta menyepakati tindak medis yang dapat dilakukan dokter ybs. di SMF I. Bedah Semua dokumen diajukan kepada Komite Medis Rumah Sakit

V Komite Medis RS Sub Komite Kredensial

Melakukan verifikasi dan validasi serta evaluasi akhir semua dokumen dokter ybs. Memberi rekomendasi kepada Direktur Rumah Sakit

V Direktur Rumah Sakit

V Dokter,Staf Medis ybs.

2

Bersama dokter ybs. menandatangani berita acara yang berisi rincian kewenangan klinik yang telah disepakati berdasarkan rekomendasi Komite Medis Menerbitkan surat Penugasan Klinis kepada dokter ybs. Menyerahkan surat Penugasan Klinis kepada Ketua SMF 1. bedah

I Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

3.2

Dokter Baru yang akan melamar bekerja disuatu rumah sakit Dokter ybs.

V Direktur R.S.

Melamar ke Direktur RS dengan tembusan ketua SMF l.Bedah Membawa surat penempatan Membuat secara tertulis rincian kewenangan tindak medis sesuai acuan Organisasi Profesi Kedokteran OPLB dan Kolegium Ilmu Bedah yang terkait

Menyerahkan semua dokumen lamaran dan surat penempatan serta dat\ar rincian kewenangan tindakan medis kepada Komite Medis RS

V Komite Medis R S Panitia Kredensial

V Direktur Rumah Sakit

V Dokter, ybs.

Melakukan verivikasi dan validasi Memberi rekomendasi kepada Direktur RS

Bersama dokter ybs.menandatangani berita acara yang berisi rincian kewenangan klinik yang telah disepakati berdasarkan rekomendasi Komite Medis Menerbitkan surat Penugasan Klinis kepada dokter ybs. Menyerahkan surat penugasan klinis kepada Ketua SMF Lbedah

1 - Tata Cara Pembuatan Surat Penugasan Klinis I

Penyangkalan atau disclaimer

Buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini adaiah merupakan rangkuman dari sejumlah tindakan medis yang dapat dilakukan oleh dokter spesialis bedah Indonesia yang mengacu pada standar pelayanan medis 10 organisasi Profesi Kedokteran dalam Lingkungan Bedah (OPLB), yang dapat dijadikan acuan atau pedoman oleh rumah sakit dalam hal ini adaiah Direktur rumah sakit bersama Komite Medis rumah sakit dalam menerbitkan surat penugasan klinis pada setiap dokter spesialis bedah, staf medis yang ada di rumah sakit tersebut. Buku Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia ini tidak berisi informasi rincian secara lengkap tentang setiap tindakan bedah seorang dokter spesialis bedah Indonesia. Setiap kasus/penyakit bedah yang ditangani memerlukan ketersediaan sarana/fasilitas kesehatan maupun alat kesehatan pendukung, hal tersebut sangat bervariasi termasuk ketidaklengkapannya atau ketidaksempumaannya. Buku ini tidak menghilangkan hak Direktur rumah sakit untuk memberikan penugasan klinis yang melebihi ataupun mengurangi dari daftar yang ada kepada staf medis rumah sakit, tergantung situasi yang dihadapi rumah sakit dalam pengadaan SDM medis, termasuk pemberian kewenangan klinis tindakan pembedahan kepada dokter spesialis bedah umum atau dokter umum yang telah dilatih dan diberi kompetensi tambahan (setelah melalui konsultasi dan koordinasi dengan Komite Medis rumah sakit). Buku ini tidak memberikan jaminan atas keberhasilan suatu tindakan operasi dengan hasil yang baik, sempuma dan memuaskan bagi penderita karena tingkat kesulitan penanganan diagnostik maupun terapi bedah setiap kasus bedah terutama kasus yang sulit sangat bervariasi, maka disarankan di antara para dokter yang terlibat pada penanganan suatu kasus bedah untuk bekerja sama secara tim dan atau melakukan konsultasi dan rujukan (mjukan pasien, rujukan ilmu dan rujukan dokter ahli), apabila dokter yang bersangkutan merasa tidak menguasai atau ragu dalam menegakkan diagnostik maupun terapi bedah. Untuk melengkapi dan menyempumakan mutu pelayanan kesehatan kepada penderita bedah diperlukan juga buku Pedoman Nasional Praktek Kedokteran (PNPK), Standar Pelayanan Medis, Panduan Praktek klinik (PPK), Clinical Pathway, Clinical Guidelines, standar prosedur operasional (SPO), dan Iain-lain. Apabila terjadi suatu kejadian akibat tindakan dokter hal itu, mempakan tanggungjawab dokter yang bersangkutan dan Direktur Rumah Sakit.

4

I



IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Kfamat Raya 160. Jakarta Pusat I M S O , Telp & Fax. 021 - 3916774 Website: www.ikabi.org E m a i l : [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014 Dewan Pertimbangan Prof Dr. Sjamsutiidaial, SpB SpB-KBD Dr. Soerarso Hardjowasilo. SpB.SpBTKV Majelit Ellk t Panatahat Prof Dr. Muchlis Ramli, SpB(K|-Onk Ketua PfeakMum Prof DR Dr Paul Tahalele. SpB.SpBTKV

BERITA ACARA Yang bertanda tangan dibawah ini Nama Jabatan

: Dr Urip Murtedjo, SpB.PGD Pa! Med, ECU : Ketua PABI Periode 2010-2014

Dr R. Suhartono, SpSKBV

Prof. DR. Dr Sunaryo Hardjowidioto, SpB SpU Katua Puma Prof. DR. Dr. Suwandi Sugandi, SpB SpU

KatuLMKIBI

Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PABI kepada : Nama Jabatan

Prof. DI. Emol U. Hutagalung. SpB SpOT Dr Urip Murtedjo. SpB PGD Pal kted. ECU Dr Rizal Pohan. SpB SpOT Or Sonar Sara Panigoro, SpB K.Onk Dr Patriot Mu5lim, SpU Dr. Poerwadi, SpB SpBA Dr R Suhartono. SpBKBV D' Setyowidi Nugroho. SpB SpBS Dr Nurtiayat Usman. SpB KBD Dr M a « u l Anwar. SpB TKV Dr. Ishandono Dachlan. Msc. SpB, SpBP-RE{K}

: Dr Djoni Darmadjaja, SpB.MARS : Sekretaris Jenderal IKABI Periode 2012-2014

Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis Bedah Indonesia. Jakarta, 11 Februari 2013

Seltfttiris Jenderal Dr. Djoni Darmadj^, Sp8 MARS Wakil Stktan Dr. Agung Prasmono, SpB SpBTKV.MARS Bendahara Dr Barlian Sutedja, SpB Komiti Organitaal. Leglilail dan Advokasi Dr HN Nazar. SpB Dr Charxlra Svaras SpB

Dr. Urip Murtedjo, SpB.PGD Pal Med, ECU

Dr. Djoril Darmadjaja, SpB.MARS

Ketua PABI

Sekjen IHABI

Komlal Profeei Bedah. Aauransi dan Pefp^lakan Or. Nurhayat Usman, SpB KBD Dr Erawan Wiradisuna. SpB KBD Or Henry Boyke Sitompul, SpB Dr Inzta Arbi, SpB Komlil Globallwl t, Paaar Bebai Dr dr Fathema D Rachmal. SpB SpBTKV Dr Huntal Simamora. SpBP-RE Konrtil ttoimintoil dan PuMikaU DR. Dr. Yalta MunadjaL Sp6 SpBP-RE(K) Prof. OK. Dr. Sn Maliawan, SpBS (K) Dr Iskandar Budianta, SpB SpBA Komlil Hnt)tjpajp Dalam Nageri Prot DR Dr Andi Asadul Islam, SpBS Df. Boyke Sumantri, SpU Dr. Emir T Pasanbu SpB.Onk Komlil Palavanan Amtwlance 118 Dr. ZA Isma. SpB Dr.AgiSalha.SpB KBD Komtei Trauma OR. Or Achmad Hidayat, SpB Dr B. Sunoko. SpB DR Dr. Tnwahyu Mumi, SpB SpBTKV


5

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIK DOKTER SPESIALIS BEDAH UMUM (PABI) DAN TUMPANG TINDIH TINDAKAN DENGAN DOKTER SPESIALIS BEDAH YANG LAIN

DAFTAR KOMPETENSI & KEWENANGAN K L I N I K D O K T E R SPESIALIS BEDAH UMUM (PABI) DAN TUMPANG TINDIH TINDAKAN DENGAN D O K T E R SPESIALIS BEDAH YANG LAIN

NO t 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 NO

Jenis Tindakan Dokter Spesialis Bedah Umum

ICD.9 C M

Bidang Bedah Digestif Laparotomi Torako-laparotomi (darurat) Penutupan perforasi usus kecil & besar Pembuatan stoma (gastrostomi, ileostomi, sigmoidostomi, jejunostomi) Rektoskopi/Anuskopi Laparoskopik diagnostik. (darurat) Reseksi dan anastomosis usus kecil & besar Penanggulangan trauma hepar (darurat): hepatorafi & hepatektomi ' Splenektomi (total & parsial) Drenase pankreatitis (darurat) Pankreatektomi (partial & darurat) Eksleriorisasi usus kecil & besar Appendektomi terbuka Appendektomi laparoskopik Kolesistektomi terbuka Kotesistektomi laparoskopik Gastroenterostom i Gastrektomi (partial) Hemikolektomi (kiri & kanan) Hemiotomi (Inguinal, Femoralis, Umbilikal) Hemoroidektomi Fistulektomi, fistulotomi (Fisura ani) Operasi Miles Operasi Hartmann Reseksi Anterior sigmoid Pasang *'T" tube saluran empedu RouxenY anatomosis usus kecil Bypass enterotomi (usus kecil & besar) Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Bedah Anak

54.1 34.02 + 54.11 46.73,46.75 43.19, 46.21,46.10, 46.41 48.29,49.21 54.2! 45.3,45.8,45.90 50.61,50.4, 50.22 41.5,41.43 52.01 52.6, 52.59, 52.7 46.01,46.03 47.0 47.01 51.22 51.23 43.7,44.39 43.89 45.73,45.75 53, 53.0, 53.1,53.2, 53.3,53.4 49.4, 49.46 49.12,49.11 48.5 45.75 45.76 51.43 45.91 45.02,45.03 ICD-9CM

29 30 31 32

Laparotomi Toraks - laparotomi Penutupan perforasi usus kecil & besar Pembuatan stoma (gastrostomi, ileostomi, sigmoidostomi.

54.1 34.02 & 54.11 46.73,46.75 43.19,46.21,46.10, 46.41

33

jejunostomi) Operasi hernia diafragmatika traumatik (abdominal approach, thoracic

53.7, 53.8

34 35 36

approach) Selioplasti Hemiotomi (Inguinal, Femoralis, Umbilikal) Ligasi tinggi hidrokel (round ligament, spermatic cord, tunica

54.71 53, 53.0, 53.1,53.2, 53.3, 53.4 56.19,63.1,61.2

vaginalis)

2 - Berita Acara PP PABI dan PP IKABI

I

9

37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

NO

Jenis Tindaltan Dokter Spesialis Bedali Umum Bidang Bedah Anak Operasi invaginasi (laparotomi, millcing, reseksi usus, appendectomy) Operasi tumor retroperitoneal Operasi PSARP lerbatas Operasi omfalokel - siloplasti Operasi kriptorkhismus - orchidopexy Operasi hipospadia Repair Hernia diafragmatika kongenital/kel. Diafragma kongenital Operasi Willems tumor - nefrektomi Anoplasti sederhana (cut back) Circumsisi Operasi piloromiotomi Spleenektomi (total & parsial) Detorsi torsi testis & orkidopeksi Anastomosis tarik trobos Operasi kelainan umbilikus - hernia umbilikus Eksisi higroma Eksisi limpangioma Appendektomi Jenis Tindakan Dokter Spesialis Bedah Umum

55 56 57 58 59 60 61 62 63 64

Bidang Bedah Onkologi Biopsy insisional/biopsy of breast Ekstirpasi tumor jinak mamma Ekstirpasi tumor jinak kulit/jaringan lunak lainnya Ekstirpasi tumor jinak parotis Salphingo oophorektomi bilat pada kanker payudara Mastektomi simpleks Mastektomi subkutaneus Mastektomi radikal Modifikasi mastektomi radikal Strumektomi (lobectomy & thyroidectomy)

65 66 67

Tiroidektomi pada Ca Radikal neck dissection (RND) (classical) Parotidektomi

68 69 70 71 72

Operasi tumor jaringan lunak Eksisi luas dan rekonstruksi sederhana (breast) Flap-rekonstruksi kulit/otot Kemoterapi dan terapi paliatif yang lain Pemasangan kemoport Jenis Tindakan Dokter Spesialis Bedah Umum

NO. 73 74 75 76 77 10

Bidang Bedah Kepala-Leher Tindakan pada trauma jaringan lunak wajah (debridement, jahit, rekonstruksi) Trakheostomi Repair fraktur mandibula .h;r;> -j-tsi'sxi^ Repair fraktur maksila Repair fraktur zigoma I Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

ICD-9 C M 54.11, 46.80, 45.62/45.79, 47.0 54.4 49.79 53.49, 53.41 (dengan prostesis) 62.5 58.45 53.7, 53.8 55,51 (unilat), 55.54 (bilat) 49.79 64.0 (pria), 71.4 (wanita) 43.3 41.5,41.43 62.5 48.65 53.4 40.29 40.29 47.0,47.01 (laparoskopik)

ICD-9 C M 85.1! (close), 85.12 (open) 85.41 86.3 26.30 65.61 85.4! (unilat), 85.42 (bilat) 85.34 85.45 (unilat),85.46 (bilat) 85.43 06.2 (L-total), 06.4 (T-total), 06.39 (LAT-parsial) ' 06.4 (total), 06.39 (parsial) 40.40 26.30, 26.32 (complete-radical), 26.31 (parsial) 83.49 85.2 &85.7/85.8 (breast) 86.89 (kulit),3.83 (tendon) 99.25 38.93 ICD-9 C M 86.28, 86.5, 86.6-8 31.1 76.75, 76.76 76.73, 76.74 76.71,76.72

Jenis Tindakan Dokter Spesialis Bedah ITmum 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 ! 00 101 102 103 104

Bidang Bedah Kepala-Leher Repair fraktur nasal Biopsi insisional/biopsi cubit (soft tissue) Biopsi kelenjar getah bening Ekstirpasi kista duktus tireoglosus Ekstirpasi tumor jinak parotis Strumektomi (lobectomy & thyroidectomy)

21.71,21.72 83.21 40.11 06.7 : ;•i 26.30 06.2 (L-total), 06.4 (T-total), 06.39 (L/T-parsiai) 06.4 (total), 06.39 (parsial) Tiroidektomi pada Ca Radikal neck dissection (RND) (classical) 40.40 Parotidektomi 26.30, 26.32 (complete-radical), 26.31 (parsial) Operasi tumor jaringan lunak (kista dermoid, higroma leher, dll) 83.49 Eksisi luas dan rekonstruksi sederhana (skin/subcutaneous tissue) 86.2 & 86.5-86.8 (skin/ subcutaneous tissue) 25.2 Hemiglossektomi Reseksi mandibula 76.31 (parsial), 76.42 (total), 76.4! (dengan rekonstruksi) Eksisi tumor jinak rongga mulut 27.49 Eksisi & marsupialisasi ranula 26.2,26.21 Eksisi kista bronkiogenik 32.09,32.01 (endoskopik) Mandibuiektomi marginalis 76.3! (parsial), 76.42 (total), 76.41 (dengan rekonstruksi) 22.62 Ekskokleasi kista rahang 86.89 (kulit), 3.83 (tendon) Flap rekonstruksi kulit/otot 27.54 Labioplasti 27.6 Palatoplasti 86.04 Insisi abses maksilofasial Insisi flegmon dasar mulut 27.0 25.1 Eksisi Makroglosia Prenolektomi pada tongue tie 25 Release tortikolis (Reseksi M . Stemocleidomastoideus) 83.45 Kemoterapi 99.25 Jenis Tindakan Dokter Spesialis Bedah Umum

105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121

ICD-9 C M

Bidang Bedah Toraks Kardiak Dan Vaskular Torakotomi (darurat) Fiksasi internal iga . Pemasangan WSD/drainase toraks Perawatan trauma toraks konservatif Rekonstruksi vaskular perifer (trauma) Perikardiosenlesis terbuka (darurat) Reseksi iga Simpatektomi torakal Simpatektomi lumbal/simpatektomi periarterial Stripping varises, eksisi varises, ligasi - komunikan Operasi A-V shunt (Brecia - Cimino) Operasi jendela toraks Perawatan varises non bedah (injeksi skleroterapi) Operasi aneurisma perifer Debridement, amputasit gangren diabetik atau penyakit y.I. Eksisi hemangioma Embolektomi perifer darurat

ICD-9 C M 34.02,34.11 79.39 34.04 39.59 37.0 77.91 05.2 05.23 38.5 39.27 39.59 39.92 39.52 84.91 38.6 38.0

2 - Berita Acara PP PABI dan PP IKABI I

11

122 123 124 125

Jenis Tindaltan Dokter Spesialis Bedali Umum Bidang Urologi Punksi buli - buli/sistostomi Kateterisasi/businasi Nefrektomi Repair urehtra, ureter, ginjal (trauma)

126 Orkhidektomi 127 Ureterostomi ekstema (darurat) 128 Repair ruptur buli - buli 129 Vasektomi 130 Sistoskopik, endoskopik diagnostik 131 Section alta 132 Hidrokelektomi 133 Insisi Infiltrat urin 134 Insisi perirenal abses 135 Drenase pionefrosis 136 Nefrostomi 137 Prostatektomi terbuka

138 Ligasi tinggi Varikokel 139 Nefrolitotomi 140 Pielolitotomi 141 Operasi Hipospodia 142 Repair Kriptorkhismus (orkhidopeksi) 143 Ureterolitotomi 1/3 tengah & proximal 144 Urethralitotomi 145 Urethrostomi ekstema 146 Uretero-ileo shunt

147 148 149 150 151 152 153 154 155 156 157

Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Bedab Plastik, Rekonstruksi dan Estetika Debridement luka bakar Repair fraktur tulang hidung Repair fi^tur tulang mandibula Repair fraktur tulang maksila Tandur alih kulit Release kontraklur Eksisi keloid Labioplasti Palatoplasti Operasi hipospadi Flap kulit/otot

ICD-9 C M 57.1 57.94 55.51 (unilat), 55.54 (bilat) 56.82 (ureter), 58.41 (urethra), 55.89 (ginjal) 62.3, 62.41 56.61 57.81 63.73 57.33 57.19 63.1 (spermatic cord), 69.19 (round ligament), 61.2 (tunica vaginalis) 86.04 59.09 55.01,54.19, 54.91 55.02 60.2 ( t r a n s u r e t r a l ) , 60.3 (suprapubic), 60.4 (retropubic), 60.5 (radical), 60.6 (other) 63.1 55.01 55.01 58.45 62.5 56.2 58.0 56.61 56.7! ICD-9 C M 86.28 21.7,21.71 (closed), 21.72 (open) 76.75.76.76 76.73, 76.74 86.6 86.84 86.3 27.54 27.62 58.45 86.70

Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Bedah Orthopaedi 158 Tindakan Reposisi tertutup dan immobilisasi 159 Debridement fraktur terbuka gr M i - I I I 160 Fiksasi ekstemal 161 Amputasi ekstrimitas

ICD-9 C M 93.59 V 79.60 93.59 84.0 (upper limb), 84.1 (lower limb)

12

I Kewenangan Tindak Medik Dokler Spesialis Bedah Indonesia

NO. 162

Jenis Tindalon Dokter Spesialis Bedah Umum Bidang Bedah Orthopaedi Disartikulasi sendi kecil dan sedang

84.13 (ankle), 84.06 (elbow)^ 84.01 (finger), 84.02 (thumb), 84.11 (toe), 84.04 (wrist) 93.44 83.88 84.18 (hip), 84.08 (shoulder),

163 Pemasangan traksi (skeletal, skin, Glisson) 164 Tendon repair 165 Disartikulasi sendi besar: panggul, bahu, lutut 166 167 168 169 170 171 172 173 NO. 174 175 176 177 178 NO.

ICD-9 C M

84.16 (knee) 79.3 Reduksi Terbuka dan fiksasi interna (ORIF): 79.35, 79.36 - Nailing: Femur, Tibia - Plate & Screw: Femiu^, Tibia, Radius, Ulna, Humerus, Ciavicula 79.35, 79.36, 79.32, 79.32, 79.31, 79.33 79.03, 79.06 - K. Wire: Tangan dan Kaki (Carpalia, Tarsalia, Phalanx) 93.56 Tension band wiring (tbw): Olecranon, Patella, Ankle 77.40 Biopsi Tulang 93.53 Perawatan CTEV konservatif (serial gips) 77.60 Sekwesterektom i/guttering Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Bedah Saraf Pusat dan Perifer

77.10 01.24 02.02 04.79 01.59

Boor hole Trepanasi trauma (fraktur cranium, EDH) Reposisi fraktur impresi Repair saraf perifer Eksisi meningokel & mielokel (sederhana) Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Traumatologi

ICD-9 C M

ICD-9 C M

54.1 179 Laparotomi 34.02 & 54.11 180 Torako-laparotomi 181 Penutupan perforasi sederhana 46.73, 46.75 43.19, 46.21,46.10, 46.41 182 Pembuatan stoma (gastrostomi, ileostomi, kolostomi, sigmoidostomi, jejunostomi) 48.29, 49.21 183 Rektoskop i/anuskop i 54.21 184 Laparoskopik diagnostik 45.79, 45.90 185 Reseksi dan anastomosis usus 50.69 186 Penanggulangan trauma hepar (darurat) 187 Splenektomi 41.5 188 Drenase pankreatitis (darurat) 52.01 189 Pankreasektomi (partial & darurat) 52.59 190 Eksteriorisasi 46.03 191 Tindakan reposisi tertutup dan immobilisasi 93.5 192 Debridement fraktur terbuka gr I-Il-III 79.6 193 Fiksasi ekstemal 93.59 194 Amputasi ekstrimitas 84.0 (upper limb), 84.1 (lower limb) 84.13 (ankle), 84.06 (elbow), 195 Disartikulasi sendi kecil dan sedang 84.01 (finger), 84.02 (thumb). 196 197

Reduksi terbuka dan fiksasi intema - Nailing: femiu^, tibia

84.11 (toe), 84.04 (wrist) 79.3 79.35, 79.36


13

198

Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Traumatologi - Plate & Screw: femur, tibia, radius, ulna, humerus, ciavicula

199 - K. Wire: tangan dan kaki (carpalia, tarsalia, phalanx) 200 Tension band wiring (tbw): olecranon, patella, ankle 201 Disartikulasi sendi besar: panggul, bahu, lutut 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 NO.

Tendon repair Pemasangan traksi (skeletal, skin, glisson) Tindakan pada trauma jaringan lunak wajah (debridement, jahit,

4 79.35, 79.36, 79.32, 79.32, 79.31,79.33 79.03, 79.06 79.36, 79.06 84.18 (hip), 84.08 (shoulder), 84.16 (knee) 83.88 93.44 86.28, 86.5, 86.6-8

rekonstruksi) Trakheostomi 31.1 Repair fraktur mandibula 76.75, 76.76 Repair fraktur maksila 76.73, 76.74 Repair fraktur zigoma 76.71, 76.72 Repair fraktur nasa! 21.71, 21.72 Torakotomi 34.02 Fiksasi internal iga 78.51 Pemasangan WSD/drainase toraks 34.04 Perawatan trauma toraks konservatif 86.59 Rekonstruksi vaskular perifer 39.59 Perikardiosentesis terbuka 37.0 Debridement luka bakar 86.28 Operasi Hernia diafragmatika traumatik (abdominal approach, 53.7,53.8 thoracic approach) Boor hole 77.10 Trepanasi trauma (Fraktur cranium, EDH) 01.24 Fraktur reposisi impresi 02.02 Repair saraf perifer 04.79 Eksisi meningokel & mielokel (sederhana) 01.59 Kateterisasi/businasi 57.94 Nefrektomi 55.51 (unilat), 55.54 (bilat) Repair urehtra, ureter, ginjal 56.82 (ureter), 58.41 (urethra), 55.89 (ginjal) Orkhidektomi 62.3 (unilat), 62.41 (bilat) Ureterostomi ekstema 56.61 Repair ruptur buli - buli 57.81 Sistostomi 57.1 Jenis Tindakan Dokter Spesialis Bedah Umum

ICD-9 C M

230

Bidang Bedah Yang Lain Pemasangan akses vena (antara lain C VP, cut down incision, kanulasi

38.95, 89.62, 38.94, 39.93

231

vena) Pemasangan akses arteri (antara lain: kanulasi untuk hemodialisis.

38.91

232 234 235 236

monitor tekanan arteri) Insisi abses (termasuk submandibular abses, dll) Perawatan selulitis, infeksi jaringan lunak Penangganan gigitan ular & binatang yang lain Perawatan luka(steril, kontaminasi, infeksi, gangren) pada umumnya

86.0 86.0 86.0 86.27, 86.22

237

(toilet, debridement, necrotomy, irigasi, vacuum, jahit) Penangganan tetanus

14


NO. 238 239 240 241 242

Jenis Tindakan Dokter Spesialis Bedah Umum Bidang Bedah Yang Lain Pemberian nutrisi, elektrolit, dll Penangganan kasus bedah akut, kritis, life saving Operasi Trigger Finger Operasi Finger Tip Injury (Rhinoplasty tip) Penangganan kasus bedah dengan anestesi lokal atau anestesi blok

^ ICD-y CIVI 96.6 82.11 21.86

berikut terapi nyeri


15


IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Ktamal R a y a 160, Jakarta Pusat 10430, Telp & Fax, 021 - 3916774 Website www.ikabi.org Email . [email protected]

Susunan Pengurus PP. (KABI Periode 2012-2014 Dtwan Pitimbinqan Pnl Dr Sfamsuhidaiat, SpB.SpB-KBO Dt. Soerarso Hardiowasito, Spe.SpBTKV

Prof Dr.

v!^^^^S^^^

KttuaPfwklkim Prof. DR. Dr. Paul TahaWe, SpB.SpBTKV

BERITA ACARA Yang bertanda tangan dibawah ini Nama : Dr Nurhayat Usman, SpB.KBD Jabatan

: Ketua IKABDI Periode 2012-2015

WahllKatuiftlrtuaTafrillh Dr. R. Suharloflo. SpBKBV

Prof. DR. Dr. Sunaryo Hardjowidjolo, SpB SpU Katua Puma Prof. DR. Dr. Suwandi Sugandi. SpB SpU Kitua MKIBI Prof. Dr. Enol U. Hutagalung, SpB SpOT

Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi IKABDI kepada: Nama : Dr Djoni Darmadjaja, SpB.MARS Jabatan

: Sekretaris Jenderal IKABI Periode 2012-2014

Pf«*l

Dr. Agung Prasmono, SpB SpBTKV.MARS B«fw>ahara Dr Barlian Suledja. SpB Komisi Organiaaii. Lagitlaii dan Advokasi Dr. HN Nazar, SpB Dt. Chandra Svaras, SpB

Dr Nurhayat Usman, SpB.KBD Ketua IKABDI

Dr. Djoni 1 >armadjaja, SpB.MARS Sekjen IKABI

Kotnlal Profetl Sedah. Aturanal dan Perpafakan Dr Nurhayat Usman, SpB KBD Dr. Erawan Wiradisuna, SpB KBD Dr. Henry Boyke Sitompul, SpB Dr Inzta Arbi, SpB Komiil Globalliait S Paiar Bebas Dr. dr Fathema D Rachmal, SpB SpBTKV Dr Huntal Srmamora, SpBP-RE Komlil KommUfcil dan PuMkMl DR. Dr Yefla Munad|at, SpB SpBP-ft£(K) Prof DR. Dr. Sri Maliawan, SpBS (K) Dr. Iskandar Budianla. SpB SpBA KonWai Huburtgan Dalam I Prof. DR. Dr. Andi Asadul Islam, SpBS Dr Boyke Sumanlri. SpU Dr. Emir T Pasaribu SpB.Onk Komlal Palayanan Ambulance 118 Dr ZA Isma, SpB Dr Agi Satna. SpB KBD Komlal Trauma DR Dr Achmad Hidayal, SpB Dr B Sunoko, SpB DR Dr Triwahyu Mum, SpB SpBTKV


17

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH KONSULTAN BEDAH DIGESTIF (IKABDI)

19

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS D O K T E R SPESIALIS BEDAH KONSULTAN BEDAH D I G E S T I F (IKABDI)

NO. JENIS TINDAKAN UPPER GASTROINTESTINAL Oesophageal Surgery 1 Oesophagectomy,gastric interposition 2 Oesophagectomy, colonic interposition 3 Oesophagectomy, free jejunal graft 4 Heller procedur (Oesophageal myotomy) Oesophageal (Retlux/moti lity) 5 Fundoplication 6 Para-oesophageal Hernia Repair

ICD 9-CM 42.4: other (42.40), partial (42.41), total (42.42) 42.55 42.7 44.66 Abd. approach (53.7), thoracic/thoracoabdominal approach (53.80)

7

Epiphrenic diverticulectomy

8 9

Oesophageal myotomy + fiindoplasty Zenker's diverticulectomy (Open) Gastric Surgery 10 Total Gastrectomy (D I node dissection) 11 Total Gastrectomy (D2 node dissection) 12 Distal Gastrectomy (DI node dissection) 13 Distal Gastrectomy (D2 node dissection) 14 Proximal Gastrectomy (D 1 node dissection) 15 Proximal Gastrectomy (D2 node dissection) 16 Gastric tumour, Local excision Laparoscopy 17 Oesophagectomy 18 Gastrectomy 19 Fundoplication 20 Oesophageal myotomy + fundoplasty Endoscopy 21 Diagnostic Upper Gl endoscopy 22

Endoscopy with biopsy

23

Therapeutic Upper GI endoscopy

Diverticulectomy esophagus (42.31), endoscopic (42.33) 42.7

43.9 43.9 43.6 43.6 43.5 43.5 43.42 42.40 43.5-9 44.65/44.66 42.7 Gaster (44.13), duodenum (45.13), esophagus (42.23) Bile duct (51.14), bronchus (33.24), cardioesophagel junction/gaster (44.14), large intest/caecum/sigmoid/ colon (45.25), small intest /duodenum/jejunum (45.14), endometrium (63.16), esophagus (42.24), gallbladder (51.14), ileum (45.15), larynx (31.43), pancreas (52.11), pancreatic duct (52.14), rectum (48.24),

3 - Berita Acara PP IKABDI dan PP I K A B I I

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NO. JENIS TINDAKAN Bariatric Surgery and Other 24 Gastric Band (Laparoscopic) 25 Gastric Band (Removal) 26 Gastric Band (Revision) 27 Tube Gastrectomy (Laparoscopic or Open)

I C D 9.CM

Open - for decompression intestine (96.07), for feeding (96.6/96.35)

28 29 30 31 32

Roux en Y Gastric Bypass (laparoscopic) Roux en Y Gastric Bypass (open) Roux en Y Gastric Bypass (revisional) Splenectomy Jejunostomy/Gastrostrostomy Adjimctive Thoracic Operations 33 Thoracoscopy 34 Thoracotomy for gut interposition 35 Conventional right thoracotomy COLORECTAL 36 Procedures for Haemorrhoids 37 Excisional haemorrhoidectomy, open or closed and variant 38

Stapled haemorrhoidopexy (PPH) Anal abscess/Fistula 39 Incision and drainage of abscess 40 Anal fistulotomy or fistulectomy 41 Seton treatment of fistula 42 Endorectal/endoanal flap repair of fistula 43 Repair of recto-vaginal fistula (other than flap repair) Other proctological procedures 44 Lateral internal sphincterotomy 45 Injection of botulinum toxin to anal sphincter 46 Excision perianal lesion (skin tag, haematoma, viral warts etc) 47

44.39, high (44.31) 44.5 Total (41.5), partial (41.43) 46.41,43.19 - endoscopy (43.11) 34.21 34.02

Reduction (49.41), injection (49.42), cauterization (49.43), destruction by cryotherapy (49.44), ligation (49.45), excisi (49.46) 49.45

Excision/lay open/flap repair Pilonidal sinus

disease 48 Excision lexteriorisation hidradenitis suppurativa 49 Transanal procedures 50 Transanal excision of tumour 51 Transanal endoscopic microsurgery (TEM) 52 Anoplasty for stricture or ectropion 53 Transanal repair of rectocoel 54 Stapled Transanal Rectal Resection (STARR) Surgical procedures for incontinence 55 Sphincter repair 56 Graciloplasty 57 Sacral nerve stimulation insertion 58 Artificial bowel sphincter

22


49.93/49.11 49.11/49.12 Anal (49.73), rectum (48.73) 70.73

49.6 Perianal tissue (49.04), skin tags (49.03) 86.21

49.79 70.52

49.79, suture laceration (49.71) Neurostimulator (03.93)

fSO. JENIS TINDAKAN Prolapse procedures 59 Perineal repair of rectal prolapse (Delorme, Altemeier) 60 Transabdominal resection or fixation of rectal prolapse Colonoscopy/flexible sigmoidoscopy 61 Diagnostic colonoscopy 62 Colonoscopy and Sigmoidoscopy polypectomy 63 Colonoscopic decompression of volvulus or pseudobstrucfion 64 Colonoscopic dilatation and/or metal stent insertion Colonoscopic endomucosal resection of tumour Segmental colonic or ileo-colic resection 65 Ileocolic resection 66 Right hemi colectomy 67 ' Transverse colectomy 68 Wedge colon resectio 69 Left hemi colectomy 70 Sigmoid colectomy 71 Hartmann's resection Anterior Resection 72 Anterior resection of rectum for benign and neoplastic disease 73 Rectal resection as part of abdomino-perineal resection of rectum Perineal rectal resection 74 As part of abdomino perineal resecfion 75 As part of proctectomy for inflammatory bowel disease Total colectomy 76 Whole of abdominal colon, with or without anastomosis 77 Excludes colectomy as part of ileo-anal pouch procedure Rectal resection with colo-anal /ileoanal anastomosis 78 Low anterior resection with colo-anal anastomosis 79 Hand sewn to anal canal +/- colonic pouch 80 Stapled to anal canal +/- colonic pouch 81 Rectal resection +/- total colectomy with ileo pouch-anal anastomosis Stoma procedure 82 Creation, revision or closure of colostomy 83 Creation, revision or closure of ileostomy Laparoscopic Procedure 84 Colectomy 85 Rectal Resection

I C D 9-CM Wanita: 71.79, suture laceration (71.71) Laki-laki: 86.89, suture laceration (86.59)

45.23

Reseksi ileum (45.62), ileocolectomy (45.73) 45.73 45.74 Partial (45.79), total (45.8) 45.75 45.76 45.75 48.63 48.5

45.8

48.63

46.10,46.43,46.52 46.21-46.22,46.41,46.51

3 - BeritaAcaraPP IKABDI dan PP IKABI I

NO. 86

JENIS TINDAKAN Rectal Prolapse Tracheostomy 87 Cricothyroidostomy (needle/surgical) HPB (HEPATOPANCREATICO BILIARY) Liver Procedure 88 Wedge excision OrSegmentectomy 89 Right Hepatectomy 90 Left lateral Hepatectomy (segments 2,3,4) 91 Left Hepatectomy (segments 2,3) 92 Unroofing Liver Cyst open 1 Laparoscopic 93 MelastatectomylNon anatomical resection 94 Ablative treatment (eg RFA) for liver tumour 95 Laparoscopic Hepatectomy 96 Liver Transplantation Gallbladder Surgery 97 Open Cholecystectomy 98 Open Cholecystectomy + IOC 99 Open Cholecystectomy + CBD Exploration 100 Laparoscopic Cholecystectomy 101 Laparsocopic Cholecystectomy + CBD exploration 102 Choledochoscopy 103 Transduodenal sphincteroplasty 104 Bilio-Enteric Bypass 105 Resection of Choledocal Cyst Pancreas and Duodenum 106 Transduodenal resection 107 Pancreatic duct sphincteroplasty 108 Pancreaticoduodenectomy

I C D 9-CM

Temporary/percutant (31.1), permanent (31.2)

Partial (50.22), total (50.4) 50.22 50.22 50.22 50.0 50.29 50.29 Auxiliary (50.51), other (50.59) 51.22 51.22+87.54 51.22+51.51 /endoscopy (51.11) 51.23 51.23+51.51 /endoscopy (51.11) 51.11 Anal (49.79), bladder neck (57.85), pancreas (51.83), sphincter of oddi (51.83)

Partial (45.62), total (45.63) Total (52.6), partial: proximal (52.51), radical (52.7), radical subtotal (52.53)

109 110 111 112 113 114 115 116 117 118 119 120 121 122 123

24

Retroperitoneal node dissection Distal pancreatectomy Central pancreatectomy Enucleation of pancreatic endocrine tumour Total pancreatectomy Duodenal preserving pancreatectomy (Begers) Freys procedure Pancreaticojejunostomy Pseudocyst gastrostomy/Enterostomy External drainage pseudocyst Pancreatic necrosectomy (Open/Percutaneous) Local excision duodenal tumour Duodenal exclusion procedures Pancreatic Duct sphincteroplasty Laparoscopic Pancreatectomy

59.0 52.52 52.22, endoscopic (52.21) 52.6

52.96 43.19/endoscopic (43.11), 46.39, loop (46.01), 43.0 52.3, by anastomosis (52.4)


Partial (45.62), total (45.63) 51.83


IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Kramal R a y a 160. Jakarta P u s a l 10430, Telp & Fax. 021 - 3916774 Website www ikabi.org Email [email protected]

Susunan Pengurus PP IKABI Periode 2012-2014 DtWM Partimbanqan Prof. Dr. Sjainsuhklâl, SpB.SpB-KBD Dr Soerarso Hardjowasito, SpB SpBTKV Wajellg Etik a Penaaehal Prof. Dr Muctilis Ramli. SpB(K)-Ork Ketua Prwidium


: Dr Sonar Soni Panigoro, SpB.K.Onk : Ketua PERABOI

Prof. DR. Dr. Paul Tahalete. SpB.SpBTKV Wakll KluanCaluiTaipHUi Dt. R. Suhartono. SpBKBV Wakll Ketua Prof. DR. Dr. Sunaryo Hardjowidjolo, SpB SpU Ketua Puma Prof. DR. Dr. Suwandi Sugandi, SpB SpU Prof. Or. Errol U. Hutagahjng. SpB SpOT

Or. Unp Murtedjo, SpB PGD Pal Med, ECU Dr. fiizal Polian, SpB SpOT Df. Sonar Son Panigonj. SpB K Onk Dr Patriot Muslim. SpU Dr. Poenvadi. SpB SpBA Dr R Suharlono, SpBKBV Dr Selyowidi Nugrodo. SpB SpBS Dr Nurtiayat Usman, SpB KBD Dr Maizul Anwar, SpB TKV Dr Ishandono Dachlan, Msc, SpB. SpBP-REIK)

Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PERABOI kepada: Nama Jabatan



SekratartoJanderal Or. Ojoni Dannadjaia, SpB MARS WimSafctan* Dr. Agung Prasmono. SpB SpBTKV.MARS

Or Barlian Suledja, SpB Kwnlsl Organisasi. Legialasi dan Advokasi Dr. HN râzar, SpB Or C t » n d r a Svaras, SpB Komwl Prolesl Bedah. tamimi

Dr Sonar Soni Panigoro, SpB.K.Onk Ketua PERABOI

Dr. Djoni Dirmadjaja, SpB.MARS Sekjen IKABI

daw

Dr. (Nurhayal Usman. SpB KBD Or. Erawan Wiradisuria. SpB KBD Dr. Henry Boyke Silompul, SpB Dr. Inzta Arbi. SpB Komiai GlotMliaaai S, Paiar Bebai Dr. dr Fathema D Rachmat. SpB SpBTKV Dr. Hunlal Simamora, SpBP-RE Komlal K . » n u n i k a » l dan Publlkasi OR. Dr Yefta Munadjat. SpB SpBP-RE[K) Prof. DR. Dr Sr Maliawan. SpBS (K) Dr. Iskandar Budianla, SpB SpBA Komtol Hubungan Dalam Negri Prof DR. Dr Andi Asadul Islam, SpBS Dr BoyVe Sumanin, SpU Dr. Emir T Pasaribu SpB.Onk Komisi Pelayanan Ambulance 118 Dr ZA Isma, SpB DrAgi Satria, SpB KBD Komiai Traunq OR. Or Actimad hMayal, SpB Or B. Sunoko, SpB DR. Dr Triwtfiyu Mumi, SpB SpBTKV


25

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH KONSULTAN BEDAH ONKOLOGI (PERABOI)

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DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS D O K T E R SPESIALIS BEDAH KONSULTAN BEDAH ONKOLOGI (PERABOI)

NO 1 2 3 4 5 6 7 8 9 10 11 12

J E N I S TINDAKAN Biopsi Jarum Halus Biopsi Core Aspirasi Kista Biopsi Eksisional Biopsi Incisional Reshaping untuk torus/ tumor tulang Ekstirpasi tumor jinak kulit Eksisi Tumor Jinak Payudara Tracheostomi Ekstirpasi Tumor Jinak Jaringan Lunak Ekstirpasi tumor jinak kulit Eksisi kelenjar getah bening

13 14 15 16 17 18

Potong flap Eksisi Mamae abberant Mastektomi simpel Salphingo oophorektomi bilat CWL, anthrostomi Eksisi kelenjar liur submandibula

19 20 21

Lobektomi tiroid Eksisi luas lokal Eksisi Kista branchiogenik

22 23 24 25 26 27 28 29 30

Eksisi sentinel lymph node Mastektomi subkutan Isthmolobektomi Tiroidektomi subtotal Near total tiroidektomi Parotidektomi superficialis Debulking Pembedahan kompartemental partial Mandibuiektomi marginalis

I C D 9-CM 85.1 i(on breast: percutan), 85.12 (open) 85.1 l(on breast: percutan), 85.12 (open) 85.91 (breast) 85.11(on breast: percutan), 85.12 (open) 85.11(on breast: percutan), 85.12 (open) 86.3, 85.21 (kulit payudara) 85.21 31.1 83.39 86.3, 85.21 (kulit payudara) 40.22 (mammary), 40.29 (external), 40.59 (radical), 40.3 (regional) 86.71 85.24 85.41 (unilat), 85.42 (bilat) 65.61 22.39 26.30 (salivary gland), 26.32 (total/ radical), 26.31 (partial) 06.2 (total), 06.39 (partial) 85.41 (breast), 86.3 (skin) 32.09

(bronchogenic),

32.01

(endoscopic) 85.34 (unilat), 85.36 (bilat) 06.2 06.39 06.4 26.31 (partial), 26.32 (complete/radical)

76.31 (partial), 76.42 (total), 76.41 (with reconstruction)

31 32 33 34 35 36 37 38 39 40 41 42

Rekonstruksi sedang(STSG, FTSG,Flap lokal) Maksilektomi partialis Eksisi kista duktus tiroglosus Mastektomi Radikal Klasik Mastektomi Radikal Modifikasi Breast Conserving Surgery Parotidektomi Radikal Parotidektomi Totalis Mandibuiektomi Totalis Hemipelvektomi Hemimandibulektomi Eksisi Luas Radikal

86.69 77.8 06.7 85.45 (unilat), 85.46 (bilat) 85.43 (unilat), 85.44 (bilat) 85.21 26.32 26.32 76.42 84.19 76.31 85.41 (breast), 86.4 (skin radical) 4 - Berita Acara PP PERABOI dan PP IKABI I

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NO 43 45 46 47 48 49 50 51

JENIS TINDAKAN Hemiglosektomi Glosektomi Totalis Maksilektomi Totalis Total tiroidektomi Diseksi Leher Radikal Diseksi Leher Modifikasi/ Fungsional Diseksi KGB Pelvis Diseksi KGB Inguinal

52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86

Operasi Commando Pembedahan Forequater Pembedahan Kompartemental Rekonstruksi Mayor TRAM FLAP (Rekonstruki Payudara pasca kemoterapi) LD FLAP (Payudara) Endoscopy Tiroidektomi Endoskopy Diagnostik keganasan kepala dan leher Persiapan Kemoterapi Pembuatan prolokol kemoterapi Evaluasi efek kemoterapi Advancement of pedicle graft Angkat (remove) jahitan abdomen. Angkat (remove) jahitan kepala dan leher Angkat (remove) jahitan thorax Angkat (remove) jahitan trunkus Angkat (remove) WSD Angkat tracheostomy Aspirasi hygroma Aspirasi seroma Biopsi pembuluh darah Chemoport Chest tube Debridement Eksisi kulit untuk graft Free skin graft Full thickness skin graft ke tempat lain Full thickness skin graft ke tangan Graft otot atau fascia Immunoterapi Implantasi zat kemoterapeutik Infus elektrolit Injeksi antibiotik Injeksi BCG untuk kemoterapi Injeksi biological response modifier sebagai antineoplastik

87 88 89 90 91 92 93

seperti interleukin dll Jahit arteri Jahit laserasi dinding dada Jahit vena Kemoterapi Laparoskopi oovorektomi bilat Laparotomi explorasi Memotong dan mempersiapkan pedicle graft atau flap

30


I C D 9-CM 85.2 25.3 77.9 06.4 40.40 40.41 (unilat), 40.42 (bilat) 40.24 (deep/superficial), 40.54 (radical), 40.3 (regional) 76.31

85.7 (total) 85.7 06.1

86.72 97.83 97.38 97.43 97.84 97.41 97.37 86.01 86.01 38.21 86.07 34.04 86.28 86.91 86.60 86.63 86.61 83.82 00.15 00.10 99.18 99.21 99.25 99.28

39.31 34.71 39.32 99.25 65.53 54.11 86.71

NO 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124

JENIS TINDAKAN Menempelkan pedicle atau flap graft ke tangan Menempelkan pedicle atau flap graft ke tempat lainnya Oophorectomy bilat Parenteral infus Pedicle or flap graft Pengukuran badan Revisi pedicle atau flap graft , . Skin graft ke tangan (yg lain) Tendon graft Toilet tracheostomy Tracheostomy permanent Tracheostomy temporer Transfer otot atau transplantasi Transfusi blood expander seperti dextran Transfusi packed cells Transfusi trombosit Transfusi whole blood perioperatif Pemeriksaan manual payudara Insisi kulit mammae/Mastotomy/Mammotomy Closed biopsy mammae Eksisi jaringan mammae yang tidak dapat diklasifikasikan Eksisi lokal mammae seperti lumpektomi/jar. Fibrotik Quadrantectomy Subtotal mastektomi Eksisi jaringan mammae ektopik seperti nipple acessoris Eksisi nipple Mammoplasty unilat Bilat mammoplasty Masteclomi subkutan unilateral disertai inplant Mastectomy subkutan bilateral disertai inplant Extended simple mastectomy unilat/Modified Radical

125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143

Mastectomy (MRM) Extended simple mastectomy bilat Extended radical mastectomy unilat Extended radical mastectomy bilat Jahit laserasi mammae Split thickness graft mammae Full thickness graft mammae Pedicle graft mammae Muscle flap graft mammae Transposisi nipple Rekonstruksi nipple lainnya Mammoplasty lainnya Aspirasi mammae Injeksi agent terapeutik ke dalam mammae Revisi inplant mammae Removal inplant mammae Insersi breast tissue expander Removal of breast tissue expander Rekonstruksi total payudara Eksisi FAM

I C D 9-CM 86.73 86.74 ''^ •' 65.51 99.15 86.70 93.07 86.75 86.62 83.81 96.55 31.21 31.1 83.77 99.08 99.04 99.05 99.00 89.36 85.0 85.11 85.2 85.21 85.22 85.23 85.25 85.24 85.31 85.32 85.33 85.35 85.43 85.44 85.47 85.48 85.81 85.82 85.83 85.84 85.85 85.86 85.87 85.89 85.91 85.92 85.93 85.94 85.95 85.96 85.7 85.21

4 - Berita Acara PP PERABOI dan PP IKABI I

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NO 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194

32

JENIS TINDAKAN Eksisi mammae ektopik Debulking Transverse Rectus Abdominis Musculocutaneus (TRAM Flap) Latissimus Dorsi Flap Biopsi kulit dan jaringan subkutan Prosedur diagnostik kulit dan jaringan subkutan lainnya Disartikulasi hip joint Disartikulasi knee joint Amputasi above knee Amputasi below knee Amputasi dan disartikulasi jari tangan Amputasi dan disartikulasi ibu jari tangan Disartikulasi wrist joint Disartikulasi elbow Amputasi forearm Amputasi humerus Disartikulasi shoulder joint Amputasi jari kaki Amputasi kaki ' Disartikulasi ankle joint Biopsi soft tissue Eksisi ganglion dari tendon seath kecuali tangan Eksisi kista Baker Bursektomi Bursectomy tangan ^vio>.:r:LEksisi ganglion wrist joint Eksisi radikal lesi di kulit Debulking soft tissue tumor Aspirasi thyroid (percutaneus needle drainage) Reopening thyroid Aspirasi biopsi (percutaneus) thyroid Open biopsy thyroid Biopsi parathyroid Lobektomi unilat Partial substernal thyroidectomy Eksisi lesi thyroid Isthmektomi Partial thyroidectomy Total thyroidectomy Complete substernal thyroidectomy Eksisi thyroid lingual Total Parathyroidektomi Partial Parathyroidectomy Division of thyroid isthmus Ligasi pembuluh darah thyroidea ; •'•rN-:Jahit kelenjar thyroid Reimplantasi jaringan thyroid Reimplantasi jaringan parathyroid Operasi lain kelenjar thyroid r Operasi lain kelenjar parathyroid Debulking thyroid . " -


I C D 9-CM 85.24 85.20

.•

85.7 85.7 86.11 86.19 84.18 84.16 84.17 84.15 84.01 84.02 84.04 84.06 84.05 84.07 84.08 84.11 84.12 84.13 83.21 83.31 83.39 83.5 82.31 82.21 86.4 86.4 06.01 06.02 06.11 06.12 06.13 06.2 06.51 06.31 06.39 06.39 06.4 06.52 06.6 06.81 06.89 06.91 06.92 06.93 06.94 06.95 06.98 06.99 06.31

^^ I

JENIS TINDAKAN NO 195 Debulking Parathyroid 196 Open biopsi (insisi biopsi) sinus nasal 197 Radical maxillary antrotomy (Caldwell-Luc Approach) 198 External maxillary antrotomy lainnya 199 Insisi ginggiva atau tulang alveolar 200 Biopsi ginggiva 201 Biopsi alveolar 202 Prosedur diagnostik gigi, ginggiva dan alveoli lainnya Eksisi lesi jaringan ginggiva 203 204 Closed biopsi lidah 205 Open biopsi (insisi biopsi) lidah 206 Prosedur diagnostik lidah lainnya Eksisi lesi jaringan lidah 207 208 Glossektomi radikal Biopsi tulang palatum 209 Biopsi uvula dan palatum molle * 210 211 Biopsi bibir 212 Prosedur diagnostik lainnya dari rongga mulut 213 ' Eksisi lokal lesi jaringan tulang palatum 214 Eksisi luas (wide excisi) lesi jaringan tulang palatum Eksisi luas lesi bibir 215 216 Eksisi lainnya dari jaringan bibir 217 Insisi uvula 218 Eksisi uvula 219 Hemimaxillektomi 220 Rekonstruksi mandibula lainnya 221 Bone graft untuk tulang wajah 222 Insersi implant sintetik pada tulang wajah Remove internal fixasi dari tulang wajah ^ 223 224 Caldwell operation 225 Eksisi ranula 226 Eksisi epulis 227 Mandibulotomi di ramus 228 Mandibulotomy di simfisis 229 Osteotomi segmental maxilla 230 Osteotomi total maxilla 231 Eksisi mukosa buccal 232 Jahit laserasi lidah 233 Repair dan operasi plastik lidah lainnya 234 Eksisi kelenjar sublingual 235 Insisi kelenjar ludah atau salurannya 236 Closed biopsi kelenjar ludah atau salurannya 237 Open biopsi (insisi biopsi) kelenjar ludah atau salurannya 238 Prosedur diagnostik kelenjar ludah lainnya 239 Marsupialisasi kista kelenjar liur 240 Eksisi kelenjar liur lainnya 241 Sialoadenektomi Parsial 242 Sialoadenektomi Total (enbloc excision) 243 Jahit laserasi kelenjar liur 244 Jahit fistula kelenjar liur 245 Decompression of trigeminal nerve root 246 Division of trigeminal nerve

I C D 9-CM 06.89 22.12 22.31 22.39 24.0 24.11 24.12 24.19 24.31 25.01 25.02 25.09 25.1 25.4 27.21 27.22 27.23 27.29 27.31 27.32 27.42 27.43 27.71 27.72 76.39 76.43 76.91 76.92 76.97 24.91 26.29 24.31 76.62 76.64 76.65 76.66 27.49 25.51 25.59 26.30 26.0 26.11 26.12 26.19 26.21 26.29 26.31 26.32 26.41 26.42 04.01 04.02

4 - Berita Acara PP PERABOI dan PP IKABI I

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NO 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268

JENIS TINDAKAN Debulking kelenjar liur Parotidectomy parsial Parotidectomy total Parotidectomy Radikal Insisi stuktur limfatik Biopsi struktur limfatik Prosedur diagnostik lainnya dari struktur limfatik Eksisi deep cervical lymphnode Eksisi limfonodus mammaria interna Eksisi limfonodus axiller Eksisi limfonodus inguinal Simple excisi struktur limfatik lainnya Eksisi limfonodus regional Radical excision limfonodus axiller Radical groin dissection Radical excision limfonodus lainnya Ligasi ductus thoracicus Eksisi hygroma Completion Mastektomi Breast Conserving Surgery (BCS) Breast Conserving of Sentine Node Breast Conserving Surgery dengan Limposcintigraphy

269 270 271 272 273 274 275 276 277 278 279 280 281 282 283

(SNLP) RE BCS Sentinel node procedure pada breast Sentinel Node procedure pada melanoma Sentinel Node procedure pada KSS Head & Neck Ca Eksplorasi Discharge payudara Metastasektomi pada breast Ca metastasis Radioterapi intra operatif Crayosurgery Endoskopy Mastektomi Duchuloscopy Stereotacic guided wire biopsi BCS dengan tehnik reduksi mamae Banana flap tehnic rekonstruksi pada kanker kulit kepala Laringektomi Diseksi leher sentral

284 285 286 287 288 289 290 291 292 293 294 295

Enukleasi Bulbi pada keganasan Eviserasi bulbi pada keganasan Diseksi KGB Inguinal deep Rekonstruksi daun telinga pada keganasan Rekonstruksi palpebra pada keganasan iRecanalisasi cantus pada keganasan Rekonstruksi free flap pada keganasan Intra arterial infusion kemoterapi AffChemopart Bilas Chemopart Parotidektomi dengan rekonstruksi otot temporal Parotidektomi dengan rekonstruksi otot stemocleido mastoid flap

34


ICD 9-CM 26.31 26.31 26.32 26.32 40.0 40.11 40.19 40.21 40.22 40.23 40.24 40.29 40.3 40.51 40.54 40.59 40.64 40.29 85.41 (unilat), 85.42 (bilat) 85.21

92.29

30.29 (partial), 30.3 (total) 40.40 (radical), 40.41 (unilat), 40.42 (bilat)

40.3 18.71

f

flap

99.25

26.30 26.30

NO 296 297 298 299 300 301 302 303 304 305 306 307

JENIS TINDAKAN Parotidektomi ekstended Parotidektomi dengan graft + nervus Rekonstruksi bibir pada keganasan Rekonstruksi hidung dengan simple flap pada keganasan Rekonstruksi hidung dengan fi-ontal flap pada keganasan Rekonstruksi hidung dengan ft-ee Pungsi plura pada efl\isi akibat keganasan Pungsi ascites Eksisi limpangioma Eksisi Hemangioma Ligasi A Carotis ekstema Ligasi pedikel halmangionua

I C D 9-CM 26.30 26.30

flap

21.83 21.83 21.83

4 - Berita Acara PP PERABOI dan PP ! K A B ! I


IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C JL Kramal R a y a 160, Jakarta P u s a l 10430, Telp & Fax. 021 - 3916774 Website www Ikabi org E m a i l : [email protected]

Susunan Pengurus PR IKABI Periode 2012-2014 P«wio PwtimlanMn Prol Dr SjamsuMdaK Spe.SpS4(B0 Dr. Soerarso Hardjowasito, SpB.SpBTKV MalaHaEtlfc&P««aehal Prof. Dr Muchlis Ramli. SpB(K)-Orik KetMPftikllum Prof. DR. Dr. Paul Tatialele, SpB.SpBTKV

BERITA ACARA Yang bertanda tangan dibawah ini Nama : Dr R. Suhartono, SpBKBV Jabatan : Ketua PESBEVI Periode 2012-2014

IWifcll Ketuifltetua Teiplllh Dr. R. Sutiarlono, SpBKBV

Prof DR Dr Sunaryo Hanjjowidjoto. SpB SpU Ketua Puma Prof DR Dr Suwar>di Sugandi. SpB SpU ' Katua MKIBI Prof. Dr. Errot U. Hutagalung. SpB SpOT

Dr. Urip Murteô, SpB PGD Pal Med. ECU Dr. Rizal Pofian. SpB SpOT Dr Sonar Soni Panigoro, SpB K Onk Dr Palnol Muslim, SpU Dr. Poerwadi, SpB SpBA Dr R Sutiartono. SpBKBV Dr. Setyowidi Nugroho, SpB SpBS Dr Nurhayal Usman, SpB KBD Dr. Maizul Anwar. SpB TKV Dr. Ishandono Dachian. Msc, SpB, SpeP-RE(K)

Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PESBEVI kepada: Nama : Dr Djoni Darmadjaja, SpB.MARS Jabatan

: Sekretaris Jenderal IKABI Periode 2012-2014


Sakretirta Jenderal Dr Djoni Darmadja|a, SpB MARS Wakll Sekjert Dr. Agung Prasiwno, SpB SpBTKV MARS

Btoditiin Dr Barlian Sutedja. SfB Komisi Organisasi. leaialati Jwi A d w t a i l Dr HN Mazar, SpB Dr Chandra Svaras. SpB

Dr R. Suhartono, SpBKBV Ketua PESBEVI

Dr. Djoni parmadjaja, SpB.MARS Sekjen IKABI

Komisi Profesi Bedah. Asuransi dan Perpajakan Dr Nurhayat Usman, SpB KBD Or Erawan Wiradisuna. SpB KBD Dr Henry Boyke Silompul, SpB Dr. Inzta Arbi, SpB Komltl Globallsasi t Paiar Bebai Or Or Falhema D Rachmat, SpB SpBTKV Dr Huntal Sirrwmora. SpBP-RE Komiai KoffMinlkasi dan Publlkasi DR. Or. Yefta Munadjat, SpB SpBP-RE(K) Prof. DR. Dr. Sri Maliawan, SpBS {Kj Dr. Iskandar Budianta, SpB SpBA

PiOl. OR. Or Andi Asadul Islam. SpBS Dr. Boyke Sumantri, SpU Dr. Emir T Pasanbu SpB.Onk Kofftisi Pelayanan Ambulance 11B Or ZAIsma, SpB DrAgi Satria, SpB KBD Komisi Trauma OR Dr Achmad Hidayat, SpB Or B Sunoko, SpB DR Dr Triwahyu Mumi, SpB SpBTKV


37

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH VASKULER DAN ENDOVASKULER (PESBEVI)

39

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS D O K T E R SPESIALIS BEDAH V A S K U L E R DAN ENDOVASKULER (PESBEVI) I C D 9-CM (88.7) (39.92) (38.9) (39.98)

NO. JENIS TINDAKAN 1 Doppler examination 2 Sclerotherapy for varicose veins 3 Intravenous cannulation 4 Stop bleeding (direct pressure, pressure point. 5 6 7 8 9 10 11 12 13'

Pressure bandage) Fluid rescucitation Arteriography CT, MRI, ulrasound Infiltration anaesthesia Local nerve block Incision and drainage of abscess Wound cleaning Wound debridement with scalpel and scissors Injection of varices with sclerosant

14

To apply a dressing (sling, shoulder bandage, finger

15 16

Bandage, hand bandage) Treatment of leg ulcers To apply a dressing (leg bandage, foot bandage,

17 18 19

Ankle bandage, knee bandage) Brescia-Cimino fistula creation CDL for hemodialysis access, temporary and semipermanent Port A Cath/Celsite implantation for access in chemotherapy

(39.27) (38.95) (38.93)

20

or nutrition Management in emergency major vascular trauma: Control

(39.4)

21 22 23 24 25 26 27 28 29 30 31 32

Hemmorrhage Venous Cutdown in Vascular Access Peripheral Artery Cannulation Gradual External Compression in Vascular Disease Wound Management in Vascular Cases Anticoagulant Therapy in Vascular Cases Sclerotherapy Splenectomy in portal hypertension Simple vascular recontruction in peripheral artery trauma. Debridement and Amputation in Diabetic Foot Emergency Trombectomy/Embolectomy in Peripheral Artery Hemangioma Excision Varicose Veins: Treatment by Intervention Including

(38.94) (38.91) (93.56) (93.5) (99.1) (39.92) (total:4l.5, partial:41.43) (suture:39.31, dengan graft:39.58) (86.22+84.12) (38.0) (38.60) (39.92)

33 34

Sclerotherapy Phlebectomy Greater Saphenous Vein High Ligation, Stripping, Perforantes

(38.60) (38.80, 38.59)

35 36 37

Ligation Nonoperative Treatment of Chronic Venous Insufficiency Nonoperative management of chronic lymphedema Upper extremity amputation: Indication, Operative Technique

(93.56) (93.56) (84.0)

(99.1) (88.40) (87/88.7/88.9) (04.8) (04.81) (86.04) (96.59) (excise: 86.22) (esofagus (endoscopic):42.33, vein:39.92) (93.5) (86.22,86.28) (93.5)

and Perioperative Management

5 - Berita Acara PP PESBEVI dan PP IKABI I

41

NO. JENIS TINDAKAN 38 Lower extremity amputation:: Indication, Operative Technique and Perioperative Management 39 Diagnosis dan Tata Laksana Permasalahan Kaki Diabetik (Diabetic Foot Problems) Termasuk: Pathophysiology Ischemia, Neuropathy dan Infection, Antibiotic Treatment, Amputation Types Wound Management, Foot Care Tambahan yang Penting/Topik Kurikulum Non-Inti: Orthotic Management Penggunaan Terapi Endovaskuler pada Tata Laksana Penyakit Pembuluh Darah Perifer (39.7) Termasuk: 40 Lytic Therapy 41 Balloon Angioplasty 42 Endoluminal Stents 43 Stent Grafts 44 Angioscopy 45 Endoluminal Ultrasound 46 Embolization 47 48

Indikasi dan Hasil pada Simpatektomi pada Pasien dengan Penyakit Arteri Perifer Ruptured Abdominal Aortic Aneurysms

49 50

Thoracoabdominal Aortic Aneurysm Aortic Dissection: Perspectives for the Vascular/Endo vascular

51 52 53 54 55

Surgeon Lower Extremity Aneurysms Upper Extremity Aneurysms Splanchnic Artery Aneurysms Infected Aneurysms Treatment of Acute Intestinal Ischemia Caused by Arterial

62

Occlusions Endovascular Treatment of Renovascular Disease Open Surgical Repair of Renovascular Disease Repair of Extracranial Occlusive Lesions Carotid Angioplasty and Stenting Excisi Aneurysms of the Extracranial Carotid Artery: diagnosis and management Uncommon Disorders the Carotid Arteries: diagnosis and management Carotid Endarterectomy

63

Catheter-Based

64

Thrombosis Surgical Thrombectomy for Acute Deep Venous Thrombosis

65 66

Vena Caval Interruption Procedures The Surgical Treatment o f Deep Venous Valvular

56 57 58 59 60 61

Interventions for Acute Deep Venous

Incompetence

42


I C D 9-CM (84.1)

(84.12) (86.22/86.28)

(39.7) (39.7) (39.7) Abdominal (39.71), thoracic (39.73) (39.7) (39.7) (39.72) (thoracal: 05.29, lumbal: 05.23) (excisi artery: 38.60, rekonstruksi arteri: 39.31/39.58-dengan graft) (39.5) (39.91/00.55) (39.5) (39.5) (39.5) (39.5) (laparotomy+reseksi usus: 54.11+45.79/45.62) , (39.79) (39.24) (38.8) (39.59) (38.60/39.52) (43.1/39.8) (38.1) (39.93) (upper limb: 38.03, lower limb: 38.0/38.09) (38.7) (repair vein: 39.59)

NO. 67

JENIS TINDAKAN Surgical treatment of chronic occlusions o f iliac vein and

ICD 9-CM (38.8)

68

inferior vena cava Endovascular treatment of chronic occlusions of iliac vein and

(39.79)

69 70 71

inferior vena cava Endovascular treatment of vena cava occlusion Surgical treatment of superior vena cava syndrome Surgical treatment of chronic lymphedema and primary chylous

(39.79) (38.7) (40.9)

72 73 74 75 76 77 78

disorders Angioplasty Angioplasty/Stenting Angioplasty/Stenting Angioplasty/Stenting Angioplasty/Stenting Angioplasty/Stenting Aorta Surgery

for Mesenteric Artery Stenosis for Renal Artery Stenosis of PAD/PVD of Subclavian Artery of Vertebral Artery

79 Aortofemoral Bypass Grafting 80 , Atherectomy for PAD Atherectomy 81 Branched Aortic Stentgraft Repairs 82 Bypass Surgery for Venous Disease 83 Carotid Angiography 84 85 Carotid Artery Dissection Carotid Stenting 86 Carotid-Subclavian Bypass 87 88 Catheter-Directed Thrombolysis 89 Complex Aorta Surgery Diagnostic Angiography 90 Embolisation of Carotid Body Tumours 91 Endovascular Repair of Abdominal Aortic Aneurysms 92 Endovascular Repair of Thoracic Aortic Aneurysms 93 Endovascular Repair o f Thoracoabdominal Aortic 94 Aneurysms 95 Endovascular Surgery Endovenous Laser Therapy 96 Fenestrated Aortic Stentgraft Repairs 97 First Rib Resection 98 99 IVC Filter Placement Laser atherectomy for PAD/PVD 100 Minimally Invasive Aortic Surgery 101 Percutaneous Mechanical Thrombolysis 102 Repair of Venous Aneurysms 103 Resection of Carotid Body Tumours 104 Resection of Congenital Vascular Lesions 105 Surgery for Peripheral Arterial Disease (PAD) 106 Surgery for Peripheral Vascular Disease (PVD) 107 Surgery for Portal Hypertension 108 Surgery for Thoracic Outlet Syndrome (TOS) 109 Vascular Ultrasound 110 Venous angioplasty/stenting 111 Venous Thrombolysis 112

(39.50) (39.50) (39.50) (39.50) (39.50) (39.50) (reseksi + rekonstruksi: 35 39.31/39.58, 39.59) (39.58) (39.50) (39.50) (39.31) (39.59) (88.40) (39.91) (39.90) (39.22) (17.5) (38.34/38.44) (38.2) (38.8) (39.31) (39.31) (39.31) (39.7) (39.7) (39.7) (77.91) (00.63) (39.50) (39.7) (17.5) (39.52) (39.8) (38.6) (39.31/39.58) (39.31/39.58, 39.59) (39.2/41.5/41.43) (38.8) (00.2) (17.5) (99.1)

5 - Berita Acara PP PESBEVI dan PP IKABI I

43


IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl Kramal R a y a 160, Jakarta Pusat 10430, Telp S Fax. 021 - 3916774 Website: www.ikabi.org E m a i l : [email protected]

Susunan Pengurus PP IKABI Periode 2012-2014 Dawan Pailimbanqan Prol. Dr Sjamsjtiidajat, SpB SpB-KBD Dr Soerarso Hardjowasito, SpB SpBTKV

Maielt? Ellk ^ Panasehat Prof. Dr Muclilis Ramli, SpB(K)-Onl< Ketua Presidium Prof. DR. Dr Paul Tahaleie, SpB.SpBTKV

BERITA ACARA Yang bertanda tangan dibawah ini Nama : Dr Rizal Pohan, SpB.SpOT Jabatan : Ketua PABOI Periode 2012-2014

Wakil Ketua/Kelua Terpllih Dr R. Sutiartono, SpBKBV Wakil Ketua Prof. DR. Dr. Sunaryo Hardjowidjolo, SpB SpU Ketua Purna Prof. DR. Dr. Suwandi Sugandi, SpB SpU

Menyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PABOI kepada: Nama Jabatan

Ketua MKIBI Prof. Dr. Errol U. Hutagaiurg, SpB SpOT

: Dr Djoni Darmadjaja, SpB.MARS : Sekretaris Jenderal I K A B I Periode 2012-2014

Presidium Dr. Unp Murtedjo, SpB PGD Pal Med, ECU Dr Rizal Pohan, SpB SpOT Dr. Sonar Son PanigonD. SpB K Onk Dr. Patnot Muslim. SpU Dr. Poerrvadi. SpB SpBA Dr. R Suhanono, SpBKBV Dr Setyowidi Nugroho, SpB SpBS Dr Nurhayat Usman, SpB KBD Dr Maizui Anwar, SpB TKV Dr Ishandono Dachlan, Msc, SpB, SpBP-RE|K) Sekretaris Jenderal Dr. Djoni Darniadiaja, SpB MARS Wakil Sekjen Dr Agung Prasmono, SpB SpBTKV.MARS

Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis Bedah Indonesia. Jakarta, I I Februari 2013

Bendahara Dr Barlian Sutedja, SpB Komisi Organisasi. Legislasi dan Advokasi Dr HN Nazar, SpB Dr Chandra Svaras, SpB

Drîzal Poh^n, SpB.SpOT

Dr. Djoni Ifarmadjaja, SpB.MARS

Ketua PABOI

Sekjen IKABI

Komisi Profesi Bedah, Asuransi dan Perpajakap Dr. Nurhayat Usman, SpB KBD Or Erawan Wiradisuria, SpB KBD Dr Henry Boyke Sitompul, SpB Dr InzlaArt)!, SpB Komisi Globallsasi & Pasar Beba; Dr dr. Fathema D Rachmal, SpB SpBTKV Or Huntal Simamora. SpBP-RE Komisi Komunikasi dan Publlkasi DR. Dr. Yefta Munadjat, SpB SpBP-RE(K) Prol. DR. Dr. Sri Maliawan, SpBS (K) Dr Iskandar Budianta, SpB SpBA Komisi Hubungan Dalam Neqeri Prof. DR. Dr. Andi Asadul Islam, SpBS Dr. Boyke Sumantn, SpU Dr. Emir T Pasaribu SpB.Onk Komisi Pelayanan Ambulance 118 Dr ZAIsma. SpB DrAgi Satria, SpB KBD Komisi Trauma DR. Dr Achmad Hidayat. SpB D r B Sunoko. SpB DR. Dr Tnwahyu Mumi, SpB SpBTKV


45

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH ORTHOPEDI & TRAUMATOLOGI (PABOI)

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS D O K T E R SPESIALIS BEDAH ORTHOPEDI & TRAUMATOLOGI (PABOI) NO. 1 2

3 4 5 6 7 8 9 10

11

12

13 14 15 16 17 18

19

20 2! 22 23

JENIS TINDAKAN Procedures and interventions, Not Elsewhere Classified Computer assisted surgery [CAS], CT-free navigation, image guided navigation (IGN), imageless navigation. That without the use of robotic (s) technology. Code also diagnostic or therapeutic procedure. Excludes: robotic assisted procedures (17.41-17.49), stereotactic frame application only (93.59) Computer assisted surgery with CT/CTA Computer assisted surgery with MR/MRA Computer assisted surgery with fluoroscopy Imageless computer assisted surgery Computer assisted surgery with multiple datasets Other computer assisted surgery Computer assisted surgery NOS Other hip procedures Revision of hip replacement, both acetabular and femoral components. Total hip revision Code also any :removal of (cement) (joint) spacer (84.57), type of bearing surface, if known (00.74-00.77 Revision of hip replacement, acetabular component. Partial, acetabular component only That with : exchange of acetabular cup and liner, exchange of femoral head Code also any type of bearing surface, if known (00.74-00.77) Revision of hip replacement, femoral component. Partial, femoral component only That with : exchange of acetabular liner, exchange of femoral stem and head Code also any type of bearing surface, if known (00.74-00.77) Revision of hip replacement, acetabular liner and/or femoral head only Code also any type of bearing surface, if known (00.74-00.77) Hip bearing surface, metal-on-polyethylene Hip bearing surface, metal-on-metal Hip bearing surface, ceramic-on-ceramic Hip bearing surface, ceramic-on-polyethylene Other knee and hip procedures Note : Report up to two components using 00.81 - 00.83 to describe revision of knee replacements. I f all three components are revised, report 00.80 Revision of knee replacement, total (all components), Replacement of femoral, tibial, and patellar components (all components) Code also any removal of (cement) (joint) spacer (84.57) Revision of knee replacement, tibial component. Replacement of tibial baseplate and tibial insert (liner) Revision of knee replacement, femoral component. That with replacement of tibial insert (liner) Revision of knee replacement, patellar component Revision of total knee replacement, tibial insert (liner). Replacement of tibial insert (liner)

I C D 9-CM 00 0 0 J ^,

00.31 00.32 00.33 00.34 00.35 00.39 00,7 00.70

00.71

00.72

00.73 00.74 00.75 00.76 00.77 00.8

00.80

00.81 00.82 00.83 00.84

6 - Berita Acara PP PABOI dan PP IKABI I

49

NO. 24 25 26 27 28 29 30 31 32 33 34

35 36 37 38

39 40 41 42

43

44 45 46 47

JENIS TINDAKAN Resurfacing hip, total, acetabulum and femoral head. Hip resurfacing arthroplasty, total Resurfacing hip, partial, femoral head. Hip resurfacing arthroplasty, NOS. Hip resurfacing arthroplasty, partial, femoral head Resurfacing hip, partial, acetabulum. Hip resurfacing arthroplasty, partial, acetabulum Other procedures and interventions Transplant from cadaver. Code also organ transplant procedure (Massive Tissue Allograft) (Kh) Intra-operative neurophysiologic monitoring Operations on spinal cord and spinal canal structures Exploration and decompression of spinal canal structures Removal of foreign body from spinal canal (Cg) Reopening of laminectomy site (Cg) Other exploration and decompression of spinal canal Decompression : laminectomy, laminotomy. Expansile laminoplasty. Exploration of spinal nerve root, Foraminotomy. Code also any synchronous insertion, replacement and revision of posterior spinal motion preservation device(s), if performed (84.80-84.85) Division of intraspinal nerve root. Rhizotomy Diagnostic procedures on spinal cord and spinal canal structures Biopsy of spinal cord or spinal meninges (Cg) Excision or destruction of lesion of spinal cord or spinal meninges Curettage of spinal cord or spinal meninges Debridement of spinal cord or spinal meninges Marsupialization of cyst of spinal cord or spinal meninges Resection of spinal cord or spinal meninges Plastic operations on spinal cord structures Repair of spinal meningocele Repair of meningocele NOS Repair of spinal myelomeningocele Repair of vertebral fracture Elevation of spinal bone fragments Reduction of fracture of vertebrae Removal of bony spicules fi-om spinal canal (Cg) Other repair and plastic operations on spinal cord structures Repair of: diastematomyelia, spina bifida NOS, spinal cord NOS, spinal meninges NOS, vertebral arch defect Lysis of adhesions of spinal cord and nerve roots Injection of destructive agent into spinal canal Other operations on spinal cord and spinal canal structures Insertion of catheter into spinal canal for infusion of therapeutic or palliative Substances

I C D 9-CM 00.85 00.86 00.87 00.9 00.93 00.94 03 03.0 03.01 03.02 03.09

03.1 03.3 03.32 03.4

03.5 03.51 03.52 03.53

03.59

03.6 03.8 03.9 03.90

Insertion of catheter into epidural, subarachnoid, or subdural space of spine with intermittent or continuous infiasion of drug (with creation of any reservoir) 48

30

Code also any implantation of infusion pump (86.06) Injection of anesthetic into spinal canal for analgesia (Sd)


03.91

NO. 49

50 51 52 53 54 55 56

57 58 59

60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83

JENIS TINDAKAN Injection of other agent into spinal canal Intrathecal injection of steroid Subarachnoid perfusion o f refrigerated saline Implantation or replacement o f spinal neurostimulator lead(s) Code also any insertion of neurostimulator pulse generator (86.94-86.98) Removal of spinal neurostimulator lead(s) Code also any removal of neurostimulator pulse generator (86.05) Percutaneous denervation of facet Other Operations on cranial and peripheral nerves Incision, division, and excision of cranial and peripheral nerves Other excision or avulsion of cranial and peripheral nerves (Bs). Curettage of peripheral nerve Debridement of peripheral nerve. Resection of peripheral nerve. Excision of peripheral neuroma [Morton's] Diagnostic procedures on peripheral nervous system Open biopsy of cranial or peripheral nerve or ganglion Destruction of cranial and peripheral nerves Destruction of cranial or peripheral nerves by : cryoanalgesia,injection of neurolytic agent, radiofrequency, radiofrequency ablation Suture of cranial and peripheral nerves Lysis of adhesions and decompression of cranial and peripheral nerves Release of carpal tunnel Release of tarsal tunnel Other peripheral nerve or ganglion decompression or lysis of adhesions Peripheral nerve neurolysis NOS Cranial or peripheral nerve graft Transposition of cranial and peripheral nerves. Nerve transplantation Other cranial or peripheral neuroplasty Hypoglossal-facial anastomosis Accessory-facial anastomosis Accessory-hypoglossal anastomosis Other anastomosis of cranial or peripheral nerve Revision of previous repair of cranial and peripheral nerves Repair of old traumatic injury of cranial and peripheral nerves Other neuroplasty Injection into peripheral nerve Peripheral nerve injection, not otherwise specified Injection of anesthetic into peripheral nerve for analgesia Injection of other agent, except neurolytic Other operations on cranial and peripheral nerves Neurectasis Implantation or replacement of peripheral neurostimulator lead(s) Code also any insertion of neurostimulator pulse generator (86.94-86.98) Removal of peripheral neurostimulator lead(s) (Sd) Code also any removal of neurostimulator pulse generator (86.05) Incision, excision, and occlusion of vessels

I C D 9-CM 03.92 .f . 03.93 03.94 03.96 03.99 04 04.0 04.07

04.1 04.12 04.2

04.3 04.4 04.43 04.44 04.49 04.5 04.6 04.7 04.71 04.72 04.73 04.74 04.75 04.76 04.79 04.8 04.80 04.81 04.89 04.9 04.91 04.92 04.93 38


51

NO. 84

85 86

87

88 89 90 91 92

93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109

52

JENIS TINDAKAN The following fourthdigit subclassification is for use with appropriate categories in section 38.0, 38.1, 38.3, 38.5, 38.6, 38.8, and 38.9 according to site. Valid fourthdigits are in [brackets] at the end of each code/description. 0 unspecified site 3 upper limb vessels: Axillary, Brachial, Radial, Ulnar 8 lower limb arteries: Femoral (common) (superficial). Popliteal, Tibial 9 lower limb veins: Femoral, Popliteal, Saphenous, Tibial Incision of vessel [38.00-38.09]. Embolectomy, Thrombectomy Endarterectomy [38.10-38.16,38.18] Endarterectomy with: embolectomy, patch graft, temporary bypass during procedure, thrombectomy Code also any: number of vascular stents inserted (00.45-00.48), number of vessels treated (00.40-00.43), procedure on vessel bifurcation (00.44) Resection of vessel with anastomosis [38.30-38.39]. Angiectomy Excision of: aneurysm (arteriovenous) with anastomosis, blood vessel (lesion) with anastomosis Ligation and stripping of varicose veins [38.50-38.53, 38.55, 38.57, 38.59] Other excision of vessel [38.60-38.69] Excision of blood vessel (lesion) NOS Other surgical occlusion of vessels. Clamping of blood vessel, division of blood vessel, ligation of blood vessel, occlusion of blood vessels. Other operations on vessels Other shunt or vascular bypass Code also pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance, if performed (00.16) Other (peripheral) vascular shunt or bypass Suture of vessel Repair of laceration of blood vessel Suture of unspecified blood vessel Suture of artery (Bs) Suture of vein (Bs) Operation on bone marrow and spleen Bone marrow or hematopoietic stem cell transplant Bone marrow transplant, not otherwise specified Autologous bone marrow transplant without purging Allogeneic bone marrow transplant with purging. Allograft of bone marrow with in vitro removal (purging) of T-cel!s Allogeneic bone marrow transplant without purging. Allograft of bone marrow NOS Autologous hematopoietic stem cell transplant without purging Allogeneic hematopoietic stem cell transplant without purging Cord blood stem cell transplant Autologous hematopoietic stem cell transplant with purging. Cell depletion Allogeneic hematopoietic stem cell transplant. Cell depletion Autologous bone marrow transplant with purging. With extracorporeal purging of malignant ceils from marrow. Cell depletion


ICD 9-CM

38.0 38.1

38.3

38.5 38.6 38.8 39 39.2

39.29 39.3 39.30 39.31 39.32 41 41.0 41.00 41.01 41.02 41.03 41.04 41.05 41.06 41.07 41.08 41.09

NO. 110

JENIS TINDAKAN INCISION, EXCISION, AND DIVISION OF OTHER BONES The following fourth-digit subclassification is for use with appropriate categories in section 77-78 to identify the site. Valid fourth-digit categories are in brackets under each code. 0 unspecified site 1 scapula, clavicle, and thorax [ribs and sternum] 2 humerus

I C D 9-CM 77

-

3 radius and ulna 4 carpals and metacarpals 5 femur 6 patella

111 112 113 114 115 116 ! 17 118 119 120 121

122

123

124 125 126 127 128 129 130

7 tibia and fibula 8 tarsals and metatarsals 9 other. Pelvic bones. Phalanges (of foot) (of hand). Vertebrae Sequestrectomy (77.00-77.09) Other incision of bone without division. Reopening of osteotomy site (77.1177.19) Wedge osteotomy (77.21-77.29) Other division of bone, Osteoarthrotomy (77.31 -77.39) Biopsy of bone (77.41-77.49) Excision and repair of bunion and other toe deformities Bunionectomy with soft tissue correction and osteotomy of the first metatarsal Bunionectomy with soft tissue correction and arthrodesis Other bunionectomy with soft tissue correction Excision or correction of bunionetle. That with osteotomy Repair of hammer toe. Fusion of hammer toe, Phalangectomy (partial) o f hammer toe. Filleting of hammer toe Repair of claw toe. Fusion of claw toe, Phalangectomy (partial) of claw toe, Capsulotomy of claw toe. Tendon lengthening of claw toe Other excision, fusion and repair of toes. Cockup toe repair, Overlapping toe repair That with use of prosthetic materials Other bunionectomy. Resection of hallux valgus joint with insertion of prosthesis Local excision of lesion or tissue of bone (77.61-77.69) Excision of bone for graft (77.70-77.79) Other partial ostectomy (77.80-77.89), Condylectomy Total ostectomy (77.90-77.99) Other operations on bones, except facial bones Bone graft (78.00-78.09) Bone : bank graft, graft (autogenous) (heterogenous) That with debridement of bone graft site (removal of sclerosed, fibrous or necrotic bone or tissue). Transplantation of bone Code also any excision of bone for graft (77.70-77.79)

77.0 77.1 77.2 77.3 77.4 77.5 77.51 77.52 77.53 77.54 77.56

77.57

77.58

77.59 77.6 77.7 77.8 77.9 78 78.0


53

NO. 131

132

133

134 135

136

137 138 139

JENIS TINDAKAN Application of external fixator device (78.10-78.19) Fixator with insertion of pins/wires/screws into bone. Code also any type of fixator device, i f known (84.71-84.73) Limb shortening procedures (78.20,78.22-78.25, 78.27-78.29) Epiphyseal stapling. Open epiphysiodesis. Percutaneous epiphysiodesis. Resection/ osteotomy Limb lengthening procedures (78.30, 78.32-78.35, 78.37-78.39) Bone graft with or without internal fixation devices or osteotomy Distraction technique with or without corticotomy/osteotomy Code also any application of an external fixation device (78.10-78.19) Other repair or plastic operations on bone (78.40-78.49) Other operation on bone NEC. Repair of malunion or nonunion fracture NEC Internal fixation of bone without fracture reduction (78.50-78.59) Internal fixation of bone (prophylactic). Reinsertion of internal fixation device, Revision of displaced or broken fixation device. Removal of implanted devices from bone (78.60-78.69) External fixator device (invasive), Internal fixation device. Removal of bone growth stimulator (invasive). Removal of internal limb lengthening device. Removal of pedicle screw (s) used in spinal fusion Osteoclasis (78.70-78.79) Diagnostic procedures on bone, not elsewhere classified (78.80-78.89) Insertion of bone growth stimulator (78.90-78.99) Insertion of; bone stimulator (electrical) to aid bone healing, osteogenic

140

electrodes for bone growth stimulation, totally implanted device (invasive) REDUCTION OF FRACTURE AND DISLOCATION Includes : application of cast or splint reduction with insertion of traction device (Kirschner wire) (Steinmann pin) code also any: application of external fixator device (78.10-78.19) & type of fixator device, if known (84.71-84.73) The following fourth-digit subclassification is for use with appropriate categories in section 79 to identify the site. Valid fourth-digit categories are in [brackets] under each code. 0 I 2

unspecified site humerus radius and ulna, Arm NOS

3 4

carpals and metacarpals. Hand NOS phalanges of hand femur tibia and fibula. Leg NOS

5 6 7 8 9

tarsals and metatarsals, Foot NOS phalanges of foot other specified bone


NO. 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180

JENIS TINDAKAN Closed reduction of fracture without internal fixation (79.00-79.09) Closed reduction of fracture with internal fixation (79.10-79.19) Open reduction of fracture without internal fixation (79.20-79.29) Open reduction of fracture with internal fixation (79.30-79.39) Closed reduction of separated epiphysis. Reduction with or without internal fixation (79.40-.79.42, 79.45, 79.46, 79.49) Open reduction of separated epiphysis (79.50-79.52, 79.55, 79.56, 79.59). Reduction with or without internal fixation Debridement of open fracture site (79.60-79.69). Debridement of compound fracture Closed reduction of dislocation.

I C D 9-CM 79.0 79.1 79.2 79.3 79.4 79.5 79.6 79.7

Includes : closed reduction (with external traction device) Closed reduction of dislocation of unspecified site Closed reduction of dislocation of shoulder Closed reduction of dislocation of elbow Closed reduction of dislocation of wrist Closed reduction of dislocation of hand and finger Closed reduction of dislocation of hip Closed reduction of dislocation of knee Closed reduction of dislocation of ankle Closed reduction of dislocation of foot and toe Closed reduction of dislocation of other specified sites Open reduction of dislocation Includes : open reduction (with internal and external fixation devices) Open reduction of dislocation of unspecified site Open reduction of dislocation of shoulder Open reduction of dislocation of elbow Open reduction of dislocation of wrist Open reduction of dislocation of hand and finger Open reduction of dislocation of hip Open reduction of dislocation of knee Open reduction of dislocation of ankle Open reduction of dislocation of foot and toe Open reduction of dislocation of other specified sites Unspecified operation on bone injury Unspecified operation on bone injury, unspecified site Unspecified operation on bone injury, shoulder Unspecified operation on bone injury, elbow Unspecified operation on bone injury, wrist Unspecified operation on bone injury, hand and finger Unspecified operation on bone injury, hip Unspecified operation on bone injury, knee Unspecified operation on bone injury, ankle Unspecified operation on bone injury, foot and toe Unspecified operation on bone injury, other specified sites

79.70 79.71 79.72 79.73 79.74 79.75 79.76 79.77 79.78 79.79 79.8 79.80 79.81 79.82 79.83 79.84 79.85 79.86 79.87 79.88 79.89 79.9 79.90 79.91 79.92 79.93 79.94 79.95 79.96 79.97 79.98 79.99


55

NO. 181

JENIS TINDAKAN INCISION AND EXCISION OF JOINT STRUCTURES Includes : operations on : capsule of joint, cartilage, condyle, ligament, meniscus, synovial membrane The following fourth-digit subclassification is for use with appropriate categories in section 80 to identify the site: 0 unspecified site 1 shoulder 2 elbow 3 wrist 4 hand and finger Ship

I C D 9-CM 80

6 knee 7 ankle 8 foot and toe 182

183 184 185 186

187 188 189

9 other specified sites. Spine Arthrotomy for removal of prosthesis (80.00-80.09) Includes remova; of posterior spinal motion preservation (dynamic stabilization, facet replacemet, interspinous process) device (s) Code also any : insertion of (cement) (joint) (methylmethacrylate) spacer (84.56), removal of (cement)(joint) (methylmethacrylate) spacer (84.57) Other arthrotomy (80.10-80.19). Arthrostomy Arthroscopy (80.20-80.29) Biopsy of joint structure (80.30-80.39). Aspiration biopsy Division of joint capsule, ligament, or cartilage (80.40-80.49) Goldner clubfoot release, Heyman-Hemdon(Strong) correction of metatarsus varus Release of: adherent or constrictive joint capsule, joint ligament Excision, destrucfion and other repair of intervertebral disc Excision or destruction of intervertebral disc, unspecified. Unspecified as to excision or destruction Excision of intervertebral disc. Diskectomy, Removal of herniated nucleus pulposus Level: cervical, thoracic, lumbar (lumbosacral). That by laminotomy or hemi laminectomy.

80.0

80.1 80.2 80.3 80.4

80.5 80.50 80.51

That with decompression of spinal nerve root at same level. Requires additional code for any concomitant decompression of spinal nerve root at different level from excision site. Code also any: concurrent spinal fusion (81.00 - 81.09), 190

56

repair of the anulus fibrousus (80.53-80.54) Intervertebral chemonucleolysis With aspiration of disc fragments. With diskography. Injection of proteolytic enzyme into intervertebral space (chymopapain)


80.52

NO. 191

192

193 194 195 196 197 198 199

200 201

202

203

204

205

206

JENIS TINDAK AN I C D 9-CM Repair of the anulus fibrosus with graft or pi i >thesis, Anular disc repair, 80.53 Closure (sealing) of the annulus fibrosus deft :t Includes : microsurgical suture repair with >cial autograft, soft tissue reapproximation repair with tension bands, surgical mesh repair Code also any : application or administration of adhesion barrier substance, i f performed (99.77). Intervertebral discectomy, if performed (80.51). Locally harvested for graft (83.43) Other and unspecified repair of the anulus fibrosus, Anular disc repair. Closure 80.54 (sealing) of the anulus fibrosus defect). Microsurgical suture repair without fascial autograft. Percutaneous repair of the annulus fibrosus. Code also any : application or administration of adhesion barrier substance, i f performed (99.77), intervertebral discectomy, if performed (80.51) Other destruction of intervertebral disc. Destruction NEC, That by laser 80.59 Excision of semilunar cartilage of knee. Excision of meniscus of knee 80.6 Synovectomy, Complete or partial resection of synovial membrane (80.7080.7 80.79) Other local excision or destruction of lesion of joint (80.80-80.89) 80.8 Other excision of joint (80.90-80.99) 80.9 Repair and plastic operations on joint structures 81 Spinal fusion 81.0 Includes : arthrodesis of spine with : bone graft, internal fixafion. Code also any insertion of interbody spinal fusion device (84.51), any insertion of recombinant bone morphogenetic protein (84.52), any synchronous excision of (locally) harvested bone for graft (77.70-77.79), the total number of vertebrae fused (81.62-81.64) Spinal fusion, not otherwise specified 81.00 Atlas-axis spinal fusion. 81.01 Craniocervical fusion by anterior, transoral, or posterior technique. CI-C2 fusion by anterior, transoral, or posterior technique. Occiput C2 fusion by anterior, transoral, or posterior technique Other cervical fusion, anterior technique 81.02 Arthrodesis of C2 level or below : anterior (interbody) technique, anterolateral technique Other cervical fusion, posterior technique 81.03 Arthrodesis of C2 level or below :posterior (interbody) technique, posterolateral technique Dorsal and dorsolumbar fusion, anterior technique 81.04 Arthrodesis of thoracic or thoracolumbar region : anterior (interbody) technique, anterolateral technique Dorsal and dorsolumbar fusion, posterior technique 81.05 Arthrodesis of thoracic or thoracolumbar region : posterior (interbody) technique, posterolateral technique Lumbar and lumbosacral fusion, anterior technique. 81.06 Anterior lumbar interbody fusion (ALIF) Arthrodesis of lumbar or lumbosacral region : anterior (interbody) technique, anterolateral technique


57

NO. 207 208

209 210 211 212 213 214 215 216 217 218

219 220 221 222 223 224 225 226 227 228 229

230 231

232

233

JENIS TINDAKAN Lumbar and lumbosacral fusion, lateral transverse process technique Lumbar and lumbosacral fusion, posterior technique Arthrodesis of lumbar or lumbosacral region : posterior (interbody) technique,posterolateral technique Posterior lumbar interbody fusion (PLIF), Transforaminal lumbar interbody fusion (TLIF) Arthrodesis and arthroereisis of foot and ankle. Includes : arthrodesis of foot and ankle with : bone graft, external fixation device Ankle fusion, Tibiotalar fusion Triple arthrodesis. Talus to calcaneus and calcaneus to cuboid and navicular Subtalar fusion Midtarsal fusion Tarsometatarsal fusion Metatarsophalangeal fusion Other fusion of foot Subtalar joint arthroereisis Arthrodesis of other joint Includes: arthrodesis with : bone graft, external fixation device,excision of bone ends and compression Arthrodesis of unspecified joint Arthrodesis of hip Arthrodesis of knee Arthrodesis of shoulder Arthrodesis of elbow Carporadial fusion Metacarpocarpal fusion Metacarpophalangeal fusion Interphalangeal fusion Arthrodesis of other specified joints Refusion of spine. Includes :arthrodesis of spine with: bone graft, internal fixation,correction of pseudarthrosis of spine. Code also any insertion of interbody spinal fusion device (84.51), any insertion of recombinant bone morphogenetic protein (84.52), any synchronous excision of (locally) harvested bone for graft (77.70-77.79), the total number of vertebrae fused (81.62-81.64) Refusion of spine, not otherwise specified Refusion of atlas-axis spine, Craniocervical fusion by anterior, transoral, or posterior technique,ClC2 fusion by anterior, transoral, or posterior technique. Occiput C2 fiasion by anterior, transoral, or posterior technique Refusion of other cervical spine, anterior technique. Arthrodesis of C2 level or below :anterior (interbody) technique,

81.! 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.2

81.20 81.21 81.22 81,23 81.24 81.25 81.26 81.27 81.28 81.29 81.3

81.30 81.31

81.32

anterolateral technique Refusion of other cervical spine, posterior technique. Arthrodesis of C2 level or below : posterior (interbody) technique, posterolateral technique

58

ICD 9-CM 81.07 81.08


81.33 . - j ; , . •.•

N 234

235

236

237 238

239 240

241 242

243

244 245 246 247 248 249

250

251 252

O . ' JENIS TINDAKAN ' Refusion of dorsal and dorsolumbar spine, anterior technique. Arthrodesis of thoracic or thoracolumbar region : anterior (interbody) technique, anterolateral technique Refusion of dorsal and dorsolumbar spine, posterior technique. Arthrodesis of thoracic or thoracolumbar region : posterior (interbody) technique, posterolateral technique Refusion of lumbar and lumbosacral spine, anterior technique. Anterior lumbar interbody fusion (ALIF) Arthrodesis of lumbar or lumbosacral region : anterior (interbody) technique,anterolateral technique Refusion of lumbar and lumbosacral spine, lateral transverse process technique Refusion of lumbar and lumbosacral spine, posterior technique. Arthrodesis of lumbar or lumbosacral region : posterior (interbody) technique, posterolateral technique Posterior lumbar interbody fiasion (PLIF), Transforaminal lumbar interbody fusion (TLIF) Refusion of spine, not elsewhere classified Other repair of joint o f lower extremity Includes :arthroplasty of lower extremity with :extemal traction or fixation, graft of bone (chips) or cartilage, internal fixation device Repair of hip, not elsewhere classified Five-in-one repair of knee. Medial meniscectomy, medial collateral ligament repair, vastus medialis advancement, semitendinosus advancement, and pes anserinus transfer Triad knee repair. Medial meniscectomy with repair of the anterior cruciate ligament and the medial collateral ligament. O'Donoghue procedure Patellar stabilization. RouxGoldthwait operation for recurrent dislocation of patella Other repair of the cruciate ligaments Other repair of the collateral ligaments Other repair of knee Other repair of ankle Joint replacement of lower extremity Includes :arthroplasty of lower extremity with : external traction or fixation, graft of bone (chips) or cartilage, internal fixation device or prosthesis Total hip replacement. Replacement of both femoral head and acetabulum by prosthesis. Total reconstruction of hip. Code also any type of bearing surface, i f known (00.74-0 0.77) Partial hip replacement. Bipolar endoprosthesis.

81.34

81.35

81.36

81.37 81.38

81.39 81.4

81.40 81.42

81.43

81.44 81.45 81.46 81.47 81.49 81.5

81.51

81.52

Code also any type of bearing surface, if known (00.74 - 00.77) Revision of hip replacement, not otherwise specified Revision of hip replacement, not specified as to components(s) replaced, (acetabular, femoral or both) Code also any : removal of (cement)(joint) spacer (84.57), type of bearing surface, i f known (00.74-00.77)

81.53


59

NO. 253 254 255 256 257 258

JENIS TINDAKAN Total knee replacement. Bicompartmental, Tricompartmental, Unicompartmental (hemijoint) Revision of knee replacement,not otherwise specified Code also any removal of (cement) spacer (84.57) Total ankle replacement Replacement of joint of foot and toe Revision of joint replacement of lower extremity, not elsewhere classified Other procedures on spine Note : Number of vertebrae

I C D 9-CM 81.54 81.55 81.56 81.57 81.59 81.6

The vertebral spine consists of 25 vertebrae in the following order and number: Cervical : CI (atlas), C2 (axis), C3, C4, C5, C6, C7 Thoracic or Dorsal: T l , T2, T3, T4, T5, T6, T7, T8, T9, TIO, T l I , T12 Lumbar and Sacral: L I , L2, L3, L4, L5, SI • ' Coders should report only one code from the series 81.62 or 81.63 or 81.64 to show the total number of vertebrae fused on th epatient.

259 260 261 262

263

264

265 266 267 268 269 270 271

272 273 274 275

60

Code also the level and approach of the fiasion or refusion (81.00-81.08, 81.30-81.39) Fusion or refusion of 2-3 vertebrae Fusion or refusion of 4- 8 vertebrae Fusion or refusion of 9 or more vertebrae Percutaneous vertebroplasty. Injection of bone void filler (cement) (polymethylmethacrylate) (PMMA) into the diseased or fractured vertebral body Percutaneous vertebral augmentation Insertion of inflatable balloon, bone tamp, or other device displacing (removing) (compacting) bone to create a space (cavity) (void) prior to the injection of bone void filler (cement) (polymethylmethacrylate) (PMMA) or other substance. Arcuplasty, Kyphoplasty, Skyphoplasty, Spineoplasty Arthroplasty and repair of hand, fingers and wrist Includes: arthroplasty of hand and finger with : external traction or fixation, graft of bone (chips) or cartilage, internal fixation device or prosthesis Arthroplasty of metacarpophalangeal and interphalangeal joint with implant Arthroplasty of metacarpophalangeal and interphalangeal joint without implant Total wrist replacement Arthroplasty of carpocarpal or carpometacarpal joint with implant Arthroplasty of carpocarpal or carpometacarpal joint without implant Other repair of hand, fingers and wrist Arthroplasty and repair of shoulder and elbow Includes: arthroplasty of upper limb NEC with : external traction or fixation, graft of bone (chips) or cartilage, internal fixation device or prosthesis Total shoulder replacement Partial shoulder replacement Repair of recurrent dislocation of shoulder Other repair of shoulder. Revision of arthroplasty of shoulder


81.62 81.63 81.64 81.65

81.66

81.7

81.71 81.72 81.73 81.74 81.75 81.79 81.8

81.80 81.81 81.82 81.83

NO. 276 277 278 279 280 281 282 283 284

JENIS TINDAKAN Total elbow replacement Other repair of elbow Other operations on joint structures Arthrocentesis. Joint aspiration Injection of therapeutic substance into joint or ligament Suture of capsule or ligament of upper extremity Suture of capsule or ligament of ankle and foot Suture of capsule or ligament of other lower extremity Other repair of joint

285

Revision of joint replacement of upper extremity.

81.97

305 306

Partial, Removal of cement spacer, Total Other diagnostic procedures on joint structures Other Operations on muscle, tendon, and fascia of hand Includes :operations on : aponeurosis, synovial membrane (tendon sheath), tendon sheath Incision of muscle, tendon, fascia, and bursa o f hand Exploration of tendon sheath of hand. Incision of tendon sheath o f hand; Removal of rice bodies in tendon sheath of hand Myotomy of hand Bursotomy of hand Incision and drainage of palmar or thenar space Transplantation of muscle and tendon of hand Advancement of tendon of hand Recession of tendon of hand Reattachment of tendon of hand Reattachment of muscle of hand Other change in hand muscle or tendon length Other hand tendon transfer or transplantation Other hand tendon transposition Other hand muscle transfer or transplantation Other hand muscle transposition Reconstruction of thumb. Includes : digital transfer to act as thumb Code also any amputation for digital transfer (84.01, 84.11) Pollicization operation carrying over nerves and blood supply Other reconstruction of thumb. "Cocked-hat" procedure [skin flap and bone].

307 308 309 310 311 312 313 314 315 316 317 318

Grafts : bone to thumb skin (pedicle) to thumb Plastic operation on hand with graft or implant Tendon pulley reconstruction. Reconstruction for opponensplasty Plastic operation on hand with graft of muscle or fascia Plastic operation on hand with other graft or implant. Tendon graft to hand Other plastic operations on hand Transfer of finger, except thumb Repair of cleft hand Repair of macrodactyly Repair of mallet finger Other tenodesis of hand. Tendon fixation of hand NOS Other tenoplasty of hand. Myotenoplasty of hand Other plastic operations on hand. Plication of fascia. Repair of fascial hernia

286 287 288

289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304

ICD 9-CM 81.84 81.85 81.9 81.91 81.92 81.93 81.94 81.95 81.96

81.98 81.99 82

82.0 82.01 82.02 82.03 82.04 82.5 82.51 82.52 82.53 82.54 82.55 82.56 82.57 82.58 82.59 82.6 82.61 82.69 82.7 82.71 82.72 82.79 82.8 82.81 82.82 82.83 82.84 82.85 82.86 82.89


61

NO. 319 320 321 322 323 324 325 326 327

328 329 330 331 332 333 334 335 336 337 338

339 340 341 342 343 344

345 346 347 348 349 350 351 352 353

62

JENIS TINDAKAN Other operations on muscle, tendon, and fascia of hand Lysis of adhesions of hand. Freeing of adhesions of fascia, muscle, and tendon of hand Aspiration of bursa of hand Aspiration of other soft tissue of hand Injection of therapeutic substance into bursa of hand Injection of therapeutic substance into tendon of hand Other injection of locally-acting therapeutic substance into soft tissue of hand Other operations on muscle, tendon, and fascia of hand Operations on muscle, tendon, fascia, and bursa, except hand Includes :operations on : aponeurosis, synovial membrane of bursa and tendon sheaths,tendon sheaths Incision of muscle, tendon, fascia, and bursa Exploration of tendon sheath. Incision of tendon sheath. Removal of rice bodies from tendon sheath Myotomy Bursotomy. Removal of calcareous deposit of bursa Other incision of soft tissue. Incision of fascia Division of muscle, tendon, and fascia Achillotenotomy Adductor tenotomy of hip Other tenotomy. Aponeurotomy, Division of tendon. Tendon release. Tendon transection. Tenotomy for thoracic outlet decompression Fasciotomy. Division of fascia. Division of iliotibial band. Fascia stripping, Release of Volkmann's contracture by fasciotomy Other division of soft tissue. Division of muscle. Muscle release, Myotomy for thoracic outlet decompression. Myotomy with division, Scalenotomy, Transection of muscle Diagnostic procedures on muscle, tendon, fascia, and bursa, including that of hand Biopsy of soft tissue Other diagnostic procedures on muscle, tendon, fascia, and bursa, including that of hand Excision of lesion of muscle, tendon, fascia, and bursa Excision of lesion of tendon sheath. Excision of ganglion of tendon sheath, except of hand Excision of lesion of muscle Excision of: heterotopic bone, muscle scar for release of Volkmann's contracture, myositis ossificans Excision of lesion of other soft tissue. Excision of Baker's cyst Other excision of muscle, tendon, and fascia Excision of tendon for graft Other tenonectomy Excision o f : aponeurosis, tendon sheath, Tenosynovectomy Excision of muscle or fascia for graft Other fasciectomy Other myectomy. Debridement o f muscle NOS. Scalenectomy Other excision of soft tissue Bursectomy


I C D 9-CM 82.9 82.91 82.92 82.93 82.94 82.95 82.96 82.99 83

83.0 83.01 83.02 83.03 83.09 83.1 83.11 83.12 83.13 83.14 83.19

83.2 83.21 83.29 83.3 83.31 83.32

83.39 83.4 83.41 83.42 83.43 83.44 83.45 83.49 ; ^^-^

NO. 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374

375 376 377 378 379 380 381

382 383 384 385 386 387 388 389 390 391

JENIS TINDAKAN Suture of muscle, tendon, and fascia Suture of tendon sheath Delayed suture of tendon . Rotator cuff repair Other suture of tendon. Achillorrhaphy, Aponeurorrhaphy Other suture of muscle or fascia. Repair of diastasis recti Reconstruction of muscle and tendon Advancement of tendon Recession of tendon Reattachment of tendon Reattachment of muscle Tendon transfer or transplantation Other tendon transposition Muscle transfer or transplantation. Release of Volkmann's contracture by muscle transplantation Other muscle transposition Other plastic operations on muscle, tendon, and fascia Tendon graft Graft of muscle or fascia Tendon pulley reconstruction Release of clubfoot, not elsewhere classified. Evans operation on clubfoot Other change in muscle or tendon length. Hamstring lengthening. Heel cord shortening. Plastic achillotenotomy, Tendon plication Quadricepsplasty Other plastic operations on muscle. Musculoplasty, Myoplasty Other plastic operations on tendon. Myotenoplasty, Tendon fixation. Tenodesis, Tenoplasty Other plastic operations on fascia.

I C D 9-CM 83.6 83.61 83.62 83.63 83.64 83.65 83.7 83.71 83.72 83.73 83.74 83.75 83.76 83.77 83.79 83.8 83.81 83.82 83.83 83.84 83.85

83.86 83.87 83.88 83.89

Fascia lengthening, Fascioplasty, Plication of fascia Other operations on muscle, tendon, fascia, and bursa Lysis of adhesions of muscle, tendon, fascia, and bursa Insertion or replacement of skeletal muscle stimulator Implantation, insertion, placement, or replacement of skeletal muscle : electrodes, stimulator Removal of skeletal muscle stimulator Aspiration of bursa Aspiration of other soft tissue Injection of therapeutic substance into bursa Injection of therapeutic substance into tendon Injection of locally-acfing therapeutic substance into other soft tissue Other operations on muscle, tendon, fascia, and bursa. Suture of bursa Other procedures on musculoskeletal system Amputation of upper limb Upper limb amputation, not otherwise specified Amputation of upper limb Closed flap amputation of upper limb NOS. Kinepiastic amputafion of upper limb NOS Open or guillotine amputation of upper limb NOS. Revision of current traumatic amputation of upper limb NOS

83.9 83.91 83.92

83.93 83.94 83.95 83.96 83.97 83.98 83.99 84 84.0 84.00


63

NO. 392 393 394 395 396 397 398 399 400 401 402

403

404

405 406 407 408 409

410 411 412 413 414 415 416 417 418 419 420 421 422

64

JENIS TINDAKAN Amputation and disarticulation of finger Amputation and disarticulation of thumb Amputation through hand. Amputation through carpals Disarticulation of wrist Amputation through forearm. Forearm amputation Disarticulation of elbow Amputation through humerus. Upper arm amputation Disarticulation of shoulder Interthoracoscapular amputation. Forequarter amputation Amputation of lower limb Lower limb amputation, not otherwise specified. Closed flap amputation of lower limb NOS Kinepiastic amputation of lower limb NOS. Open or guillotine amputation of lower limb NOS Revision of current traumatic amputation of lower limb NOS Amputation of toe. Amputation through metatarsophalangeal joint. Disarticulation of toe. Metatarsal head amputation.

ICD 9-CM 84.01 84.02 84.03 84.04 84.05 84.06 84.07 84.08 84.09 84.1 84.10

84.11

Ray amputation of foot (disarticulation of the metatarsal head of the toe extending across the forefoot just proximal to the metatarsophalangeal crease) Amputation through foot. Amputation of forefoot. 84.12 Amputation through middle of foot. Chopart's amputation. Midtarsal amputation. Transmetatarsal amputation (amputation of the forefoot, including all the toes) Disarticulation of ankle 84.13 Amputation of ankle through malleoli of tibia and fibula 84.14 Other amputafion below knee. Amputafion of leg through fibia and fibula NOS 84.15 Disarticulation of knee. Batch, Spifier, and McFaddin amputation. 84.16 Mazet amputation. S.R Roger's amputation Amputation above knee. Amputation of leg through femur. 84.17 Amputation of thigh. Conversion of betow-knee amputation into aboveknee amputation. Supracondylar above-knee amputation Disarticulation of hip 84.18 Abdominopelvic amputation. Hemipelvectomy, Hindquarter amputafion 84.19 Reattachment of extremity 84.2 Thumb reattachment 84.21 Finger reattachment 84.22 Forearm, wrist, or hand reattachment 84.23 Upper arm reattachment. Reattachment of arm NOS 84.24 Toe reattachment 84.25 Foot reattachment 84.26 Lower leg or ankle reattachment. Reattachment of leg NOS 84.27 Thigh reattachment 84.28 Other reattachment 84.29 Revision of amputation stump. 84.3 Reamputation of stump, Secondary closure o f stump. Trimming of slump


NO. 423 424 425 426 427 428 429 430 431 432 433 434

435

436 437

438

439 440 441 442

443

444

^

'

JENIS TINDAKAN

• '

.-y-^r-:.

Implantation or fitting of prosthetic limb device Implantation or fitting of prosthetic limb device, not otherwise specified Fitting of prosthesis of upper arm and shoulder Fitting of prosthesis of lower arm and hand Fitting of prosthesis of arm, not otherwise specified Implantation of prosthetic device of arm Fitting of prosthesis above knee Fitting of prosthesis below knee Fitting of prosthesis of leg, not otherwise specified Implantation of prosthetic device of leg Implantation of other musculoskeletal devices and substances Insertion of interbody spinal fusion device Insertion of; cages (carbon, ceramic, metal, plastic or titanium), interbody fusion cage, synthetic cages or spacers, threaded bone dowels Code also refusion of spine (81.30 - 81.39). Code also spinal fusion (81.00 - 81.08) Insertion of recombinant bone morphogenetic protein. rhBMP. That via collagen sponge, coral, ceramic and other carriers Code also primary procedure performed : fracture repair (79.00-79.99), spinal fusion (81.00 - 81.08), spinal refusion (81.30-81.39)

84.4 84.40 84.41 84.42 84.43 84.44 84.45 84.46 84.47 84.48 84.5 84.51

Implantation of internal limb lengthening device with kinetic distraction

84.53

Code also limb lengthening procedure (78.30 - 78.39) Implantation of other internal limb lengthening device Implantation of internal limb lengthening device. Not Otherwise Specified (NOS) Code also limb lengthening procedure (78.30 - 78.39) Insertion of bone void filler Insertion of: acrylic cement (PMMA), bone void cement, calcium based bone void filler, polymethylmethacrylate (PMMA) Insertion or replacement of (cement) spacer. Insertion or replacement of joint (methylmethacrylate) spacer Removal of (cement) spacer. Removal of joint (methylmethacrylate) spacer Insertion of other spinal devices Replacement of spinal disc Includes : non-fusion arthroplasty of the spine with insertion of artificial disc prosthesis Insertion of spinal disc prosthesis, not otherwise specified. Replacement of spinal disc, NOS Includes: diskectomy (discectomy) Insertion of partial spinal disc prosthesis, cervical. Nuclear replacement device, cervical Partial artificial disc prosthesis (flexible), cervical. Replacement of nuclear disc (nucleus pulposus), cervical. Includes: diskectomy (discectomy)

84.52

84,54

84.55

84.56 84.57 84.59 84.6

84.60

84.61


65

NO. 445

446

447

448

449

450

451

452

453

454 455 456

66

JENIS TINDAKAN Insertion of total spinal disc prosthesis, cervical. Replacement of cervical spinal disc, NOS. Replacement of total spinal disc, cervical. Total artificial disc prosthesis (flexible), cervical. Includes : diskectomy (discectomy) Insertion of spinal disc prosthesis, thoracic. Artificial disc prosthesis (flexible), thoracic. Replacement of thoracic spinal disc, partial or total. Includes: diskectomy (discectomy) Insertion of partial spinal disc prosthesis, lumbosacral. Nuclear replacement device, lumbar Partial artificial disc prosthesis (flexible), lumbar. Replacement of nuclear disc (nucleus pulposus) lumbar. Includes: diskectomy (discectomy) Insertion of total spinal disc prosthesis, lumbosacral. Replacement of lumbar spinal disc, NOS Replacement of total spinal disc, lumbar. Total artificial disc prosthesis (flexible), lumbar. Includes : diskectomy (discectomy) Revision or replacement of artificial spinal disc prosthesis, cervical. Removal of (partial) (total) spinal disc prosthesis with synchronous insertion of new (partial) (total) spinal disc prosthesis, cervical. Repair of previously inserted spinal disc prosthesis, cervical Revision or replacement of artificial spinal disc prosthesis, thoracic Removal of (partial) (total) spinal disc prosthesis with synchronous insertion of new (partial) (total) spinal disc prosthesis, thoracic. Repair of previously inserted spinal disc prosthesis, thoracic Revision or replacement of artificial spinal disc prosthesis, lumbosacral. Removal of (partial) (total) spinal disc prosthesis with synchronous insertion of new (partial) (total) spinal disc prosthesis, lumbosacral. Repair of previously inserted spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal disc prosthesis, not otherwise specified Removal of (partial) (total) spinal disc prosthesis with synchronous insertion of new (partial) (total) spinal disc prosthesis. Repair of previously inserted spinal disc prosthesis Adjunct codes for external fixator devices Code also any primary procedure performed : application of external fixator device (78.10, 78.12-78.13, 78.15,78.17- 78.19) , reduction of fracture and dislocation (79.00-79.89) Application of external fixator device, monoplanar system Application of externa! fixator device, ring system. Ilizarov type, Sheffield type Applicafion of hybrid external fixator device. Computer (assisted) (dependent) external fixator device. Hybrid system using both ring and monoplanar devices


I C D 9-CM 84.62

84.63

84.64

84.65

84.66

84.67

84.68

84.69 '

84.7

84.71 84.72 84.73 '

NO. 457

458

459 460 461 462 463 464 465 466 467 468 469

470 471

472 473 474 475

476 477

JENIS TINDAKAN Insertion, replacement and revision of posterior spinal motion preservation device(s) Dynamic spinal stabilization device(s). Includes any synchronous facetectomy (partial, total) performed at the same level. Code also any synchronous surgical decompression (foraminotomy, laminectomy, laminotomy), if performed (03.09) Insertion or replacement of interspinous process device(s). Interspinous process decompression device(s). Interspinous process distraction device(s) Revision of interspinous process device(s). Repair of previously inserted interspinous process device(s) Insertion or replacement of pedicle-based dynamic stabilization device(s) Revision of pedicle-based dynamic stabilization device(s) Repair of previously inserted pedicle-based dynamic stabilization device(s) Insertion or replacement of facet replacement device(s). Facet arthroplasty Revision of facet replacement device(s). Repair of previously inserted facet replacement device(s) Other operations on musculoskeletal system Amputation, not otherwise specified Separation of equal conjoined twins Separation of unequal conjoined twins. Separation of conjoined twins NOS Other Operations on skin and subcutaneous tissue Includes : operations on : hair follicles, male perineum, nails, sebaceous glands, subcutaneous fat pads, sudoriferous glands, superficial fossae Incision of skin and subcutaneous tissue Aspiration of skin and subcutaneous tissue Aspiration of: abscess of nail, skin, or subcutaneous tissue. Hematoma of nail, skin, or subcutaneous tissue. Seroma of nail hematoma of nail, skin, or subcutaneous tissue, seroma of nail, skin, or subcutaneous tissue Injection or tattooing of skin lesion or defect. Injection of filling material, insertion of filling material, pigmenting of skin of filling material. Incision of pilonidal sinus or cyst Other incision with drainage of skin and subcutaneous tissue Incision with removal of foreign body or device from skin and subcutaneous tissue. Removal of carotid sinus baroreflex activation device. Remova! of loop recorder. Removal of neurostimulator pulse generator (single array, dual array). Removal of tissue expander(s) from skin or soft tissue other than breast tissue Insertion of totally implantable infusion pump. Code also any associated catheterization Insertion of totally implantable vascular access device [VAD]. Totally implanted port

I C D 9-CM 84.8

84.80

84.81 84.82 84.83 84.84 84.85 84.9 84.91 84.92 84.93 84.99 86

86.0 86.01

86.02 86.03 86.04 86.05

86.06 86.07


67

JENIS TINDAKAN Other incision of skin and subcutaneous tissue. Creation of thalamic stimulator pulse generator pocket, new site. Escharotomy. Exploration : sinus tract, skin & superficial fossa Relocation of subcutaneous device pocket NEC.

479 480 481 482 483 484 485 486 487 488 489 490

491

492

493 494 495 496 497 498 499 500 501 502 503 504

Reopening subcutaneous pocket for device revision without replacement. Undercutting of hair follicle Diagnostic procedures on skin and subcutaneous tissue Biopsy of skin and subcutaneous tissue Other diagnostic procedures on skin and subcutaneous tissue Excision or destruction of lesion or tissue of skin and subcutaneous tissue Excision of pilonidal cyst or sinus. Marsupialization of cyst Excisional debridement of wound, infection, or burn Removal by excision o f : devitalized fissue. necrosis, slough Removal of nail, nail bed, or nail fold Chemosurgery of skin, Chemical peel of skin Dermabrasion, That with laser Ligation of dermal appendage Debridement of nail, nail bed, or nail fold. Removal o f : necrosis, slough Nonexcisional debridement of wound, infection or bum. Debridement NOS. Maggot therapy Removal of devitalized fissue, necrosis and slough by such methods as : brushing, irrigation (underpressure), scrubbing, washing. Water scalpel (jet) Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue Destruction of skin by : cauterization cryosurgery, fulguration, laser beam. That with Z-plasty Radical excision of skin lesion Wide excision of skin lesion involving underlying or adjacent structure Code also any lymph node dissection (40.3-40.5) Suture or other closure of skin and subcutaneous tissue Replantation of scalp Closure of skin and subcutaneous fissue of other sites.adhesive (surgical) (tissue), staples, sutures Free skin graft. Includes : excision of skin for autogenous graft Free skin graft, not otherwise specified Full-thickness skin graft to hand Other skin graft to hand Full-thickness skin graft to other sites Hair transplant Heterograft to skin. Pigskin graft. Porcine graft Homograft to skin. Graft to skin of: amnionic membrane from donor skin from donor Dermal regenerafive graft. Artificial skin, NOS. Creation of "neodermis". Decellularized allodermis. Integumentary matrix implants. Prosthetic implant of dermal layer of skin. Regenerate dermal layer of skin

68


I C D 9-CM 86.09

86.1 86.11 86.19 86.2 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28

86.3

86.4

86.5 86.51 86.59 86.6 86.60 86.61 86.62 86.63 86.64 86.65 86.66 86.67

NO. 505 506 507 508

509 510 511 512 5i3 514 515 516

517 518 519 520 521 522 523 524

525

526

527 528

JENIS TINDAKAN Other skin graft to other sites Pedicle grafts or flaps Pedicle or flap graft, not otherwise specified Cutting and preparation of pedicle grafts or Elevation of pedicle from its bed. Flap design and raising.

flaps.

I C D 9-CM 86.69 86.7 86.70 86.71

Partial cutting of pedicle or tube. Pedicle delay Advancement of pedicle graft Attachment of pedicle or flap graft to hand Attachment of pedicle or flap graft to other sites. Attachment by: advanced flap, double pedicled flap, pedicle graft, rotating flap, sliding flap, tube graft

86.72 86.73 86.74

Revision of pedicle or flap graft. Debridement of pedicle or flap graft.

86.75

Defatting of pedicle or flap graft. Other repair and reconstruction of skin and subcutaneous tissue Repair for facial weakness Facial rhytidectomy, Face lift Size reducfion plastic operation. Liposucfion. Reduction of adipose tissue o f : abdominal wall (pendulous), arms (batwing), buttock, thights (trochanteric lipomatosis) Relaxation of scar or web contracture o f skin. Z-plasty of skin Correction of syndactyly Onychoplasty Other repair and reconstruction of skin and subcutaneous tissue Other operations on skin and subcutaneous tissue Excision of skin for graft. Excision of skin with closure of donor site Electrolysis and other epilation of skin Insertion of tissue expander. Insertion (subcutaneous) (soft tissue) of expander (one or more) in scalp (subgaieal space), face, neck, trunk except breast, and upper and lower extremities for development of skin flaps for donor use. Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable. Pulse generator (single array, single channel) for intracranial, spinal, and peripheral neurostimulator. Code also any associated lead implantation (02.93,03.93,04.92) Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable. Pulse generator (dual array, dual channel) for intracranial, spinal, and peripheral neurostimulator. Code also any associated lead implantation (02.93,03.93,04.92) Insertion or replacement of other neurostimulator pulse generator. Code also any associated lead implantation (02.93,03.93,04.92) Insertion or replacement of single array rechargeable neurostimulator pulse generator Rechargeable pulse generator (single array, single channel) for intracranial, spinal, and peripheral neurostimulator. Code also any associated lead implantation (02.93,03.93,04.92)

86.8 86.81 86.82 86.83

86.84 86.85 86.86 86.89 86.9 86.91 86.92 86.93

86.94

86.95

86.96 86.97


69

NO. 529

530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569

70

JENIS TINDAKAN Insertion or replacement of dual array rechargeable neurostimulator pulse generator Rechargeable pulse generator (dual array, dual channel) for intracranial,spinal, and peripheral neurostimulator. Code also any associated lead implantation (02.93,03.93,04.92) Other Physical therapy, respiratory therapy, rehabilitation, and related procedures Diagnostic physical therapy Functional evaluation Orthotic evaluation Prosthetic evaluation Manual testing of muscle function Range of motion testing Measurement of limb length Body measurement. Girth measurement, Measurement of skull circumference Electromyography Other diagnostic physical therapy procedure Physical therapy exercises Assisting exercise Other active musculoskeletal exercise Resistive exercise Training in joint movements Mobilization of spine Mobilization of other joints Other passive musculoskeletal exercise Breathing exercise Exercise, not elsewhere classified Other physical therapy musculoskeletal manipulation Manual and mechanical tracfion Ambulafion and gait training Fitting of orthotic device Training in use of prosthetic or orthotic device. Training in crutch walking Forced extension of limb Manual rupture of joint adhesions Stretching of muscle or tendon Stretching of fascia Other forcible correction of deformity Other physical therapy therapeufic procedures Assisted exercise in pool Whirlpool treatment Other hydrotherapy Diathermy Other heat therapy. Acupuncture with smouldering moxa, Hotpacks, hyperthermia NEC, Infrared Irradiation, Moxibustion, Paraffin bath Cardiac retraining Prenatal training. Training for natural childbirth


ICD 9-CIVI 86.98

86.99 93 93.0 93.01 93.02 93.03 93.04 93.05 93.06 93.07 93.08 93.09 93.1 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.2 93.21 93.22 93.23 93.24 . 93.25 93.26 93.27 93.28 93.29 93.3 93.31 93.32 93.33 93.34 93.35 93.36 93.37

NO. 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588

589 590 591

JENIS TINDAKAN Combined physical therapy without mention of the components Other physical therapy Skeletal traction and other traction Spinal traction using skull device. Traction using : caliper tongs, Crutchfield tongs, halo device, Vinke tongs Other spinal traction. Cotrel's traction Intermittent skeletal traction Other skeletal traction. Bryant's traction, Dunlop's traction, Lyman Smith traction, Russell's traction Thomas' splint traction Other skin traction of limbs. Adhesive tape traction, Boot traction. Buck's traction. Gallows traction Other immobilization, pressure, and attention to wound Application of plaster jacket Application of neck support. Application o f : cervical collar, Minerva jacket, molded neck support Application of other cast Application of splint. Plaster splint. Tray splint Dental wiring Application of pressure dressing. Application o f : Gibney bandage, Robert Jones' bandage, Shanz dressing Application of other wound dressing. Porcine wound dressing Application of pressure trousers. Application o f : anti-shock trousers, MAST trousers, vasopneumatic device Other immobilization, pressure, and attention to wound, Elastic stockings. Electronic gaiter. Intermittent pressure device, Oxygenation of wound (hyperbaric). Stereotactic head frame application, Strapping (non-traction), Velpeau dressing Osteopathic manipulative treatment Osteopathic manipulative treatment for general mobilization. General articulatory treatment Osteopathic manipulative treatment using high- velocity, lowamplitude forces. Thrusting forces

I C D 9-CM 93.38 93.39 93.4 93.41 93.42 93.43 93.44 93.45 93.46 93.5 93.51 93.52 93.53 93.54 93.55 93.56 93.57 93.58 93.59

93.6 93.61 93.62

592

Osteopathic manipulative treatment using low- velocity, high-

93.63

593 594 595 596 597 598 599 600 601 602 603

amplitude forces. Springing forces Osteopathic manipulative treatment using isotonic, isometric forces Osteopathic manipulative treatment using indirect forces Osteopathic manipulative treatment to move tissue fluids. Lymphatic pump Other specified osteopathic manipulative treatment Replacement and removal of therapeufic appliances Other nonoperative removal of therapeutic device Removal of retroperitoneal drainage device Removal of peritoneal drainage device Removal of abdominal wall sutures Removal of sutures from trunk, not elsewhere classified Removal of packing from trunk, not elsewhere classified

93.64 93.65 93.66 93.67 97 97.8 97.81 97.82 97.83 97.84 97.85

6 - Berita Acara PP PABOI dan PP IKABf

I

71

NO. 604 605 606 607 608 609 610 611 612

613 614 615 616 617 618 619

72

JENIS T I N D A K A N Removal of other device from abdomen Removal of other device from trunk Removal of external immobilization device. Removal of: brace, cast, splint Removal of other therapeutic device Nonoperative removal of foreign body or calculus Removal of other foreign body without incision Removal of foreign body, not otherwise specified Removal of superficial foreign body from eye without incision Removal of other foreign body without incision from head and neck. Removal of embedded foreign body from eyelid or conjunctiva without incision Removal of foreign body from vulva without incision Removal of foreign body fi"om scrotum or penis without incision Removal of other foreign body without incision from trunk except scrotum, penis, or vulva Removal of foreign body from hand without incision Removal of foreign body without incision from upper limb, except hand Removal of foreign body from foot without incision Removal of foreign body without incision from lower limb, except foot


ICD 9-CM 97.86 97.87 97.88 97.89 98 98.2 98.20 98.21 98.22

98.23 98.24 98.25 98.26 98.27 98.28 98.29


IKABI

Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl, Kiamat R a y a 160, Jakarta Pusat 10430, Telp & Fax. 021 - 3916774 Website; www.ikabi.org E m a i l : ppikabi@yahoo,com

Susunan Pengums PP IKABI Periode 2012-2014 Dewin Pertimbangan Prof. Dr, Sfamsuhidaial, Sp8 SpB-KBD Or. Soerarso Hardjowasito. SpB.SpBTKV Majelis Ellk g Penaiehat Prof. Dr. Muctilis Ramii, SpB(K)-Oil( Ketua PreiMluni

BERITA ACARA Yang bertanda tangan dibawah ini Nama : Dr Chaidir Arif Mochtar, SpU.PhD Jabatan

Prof Dfi. Dr. Paul Tatwiele, SpB.SpBTKV

: Ketua l A U I Periode 2012-2014

Wakll KeluaffCeluaTemlllh Or R Sutiartono, SpBKBV Wakll Ketua Prof. OR. Dr. Sunaiyo HanJjowdjoto, SeB SpU KrtuaPuma Prof. DR. Dr. Suwandi Sugandi. SpB SpU Prof. Dr Enol U. Hutagalung, SpB SpOT

Menyerahkan i berkas naskah asli daftar kewenangan klinis profesi lAUI kepada: Nama Jabatan


Dr. Unp Munedjo, SpB PGD Pal Med, ECU Dr Rizal Pohan, SpB SpOT Dr Sonar Soni Panigoro, SpB K.Onli Dr Patriot Muslim, SpU Dr Poerwadi, SpB SpBA Dr R Suharlono, SpBKBV Or. Setyowdi Nugroho. SpB SpBS Dr Nurtiayat Usman. SpB KBD Dr Maizul Anwar, S{>8 TKV Dr. Ishandono Dachlan, Msc, SpB. SpBP-RE(K)


Dr. Djoni Dannadjafa. SpB MARS Wakll SeKjen Dr. Aflung Prasmono. SpB SpBTKVMARS Baitdahara Dr Barlian Suledja, SpB Komlal Ofqanlaael. LegtelMl dan Advokasi Dr HN Nazar, SpB Dr Chandra Svaras, SpB

Dr Chaidir Arif Mochtar, SpU.PhD Ketua lAUI

Dr armadjaja, SpB.MARS Sekjen IKABI

Komlil ProfttI Bedah. Asuransi dan Patpaakari Dr. Nurtiayat Usman, SpB KBD Or Erawan Wiradisuna, SpB K80 Dr Henry Boyke Sitompul, SpB Dr Inzta Arbi, SpB K
DR. Or. Yefta Munadjal, SpB SpBP-RE(K) Prof. DR Dr. Sri Maliawan, SpBS (K) Dr Iskandar Budianta, SpB SpBA Komisi Hubungan Dalam Hegeri Prof DR Or Andi Asadul Islam, SpBS Dr. Boyke Sumantn, SpU DI Enur T Pasaribu SpB.Onk Komlal Petoynnn Ambulance 11B Or ZA Isma, SpB Dr Agi Salna, SpB KBD Komisi Trauma DR. Dr. Achmad Hidayat, SpB Dr. B. Sunoko, SpB OR. Dr Triwahyu Mumi, SpB SpBTKV


73

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS UROLOGI (lAUI)

75

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS D O K T E R SPESIALIS UROLOGI (lAUI) NO TINDAKAN OPERATIONS ON ADRENAL 1 Adrenalectomy (abdominothoracal) 2 Adrenalectomy

I C D 9-CM 07.29 07.22

OPERATIONS ON KIDNEY . 3 Nephrotomy and nephrostomy 4 Nephrotomy. Deroofing/unroofing cysta. Pyeionephrolithotomy 5 Nephrostomy 6 Percutaneous nephrostomy without fragmentation

55 ^ 55.0 55.01 55.02 55.03

7 8 9 10

Bivalve/anatropic nephrolithotomy Percutaneous nephrostomy with fragmentation Pyelotomy and pyelostomy Pyelotomy. Pyelolithotomy Pyelostomy

55.04 55.1 55.11 55.12

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Extended pyelolithotomy Diagnostic procedures on kidney. Pyelocalicotomy Nephroscopy Pyeloscopy. Diseksi kelenjar getah bening pelvis per laparoskopi Closed (percutaneous)(needle) biopsy of kidney Open biopsy of kidney Other diagnostic procedures on kidney Local excision or destruction of lesion or tissue of kidney Marsupialization of kidney lesion Open ablation of renal lesion or tissu Percutaneous ablation of renal lesion or tissu Laparoscopic ablation of renal lesion or tissu Other and unspecified ablation of renal lesion or tissue Other local excision or destruction of lesion or tissue of kidney Partial nephrectomy: Calycectomy, Wedge resection of kidney Complete nephrectomy

55.2 55.21 55.22 55.23 55.24 55.29 55.3 55.31 55.32 55.33 55.34 55.35 55.39 55.4 55.5

26

Nephroureterectomy. Nephroureterectomy with bladder cuff

55.51

27 28 29 30 31 32 33 34 35 36 37 38 39 40

Total nephrectomy (unilat) Nephrectomy of remaining kidney. Removal of solitary kidney Removal of transplated or rejected kidney. Radical Nephrectomy Bilat nephrectomy Transplant of kidney Renal autotransplantation Other kidney transplantation. Recipient transplantation Nephropexy. Fixation or suspension of movable (floating) kidney Other repair of kidney ^ Suture laceration of kidney/renoraphy Closure of nephrostomy and pyelostomy Closure of other fistula of kidney Reduction of torsion of renal pedicle Symphysiotomy for horseshoe kidney. Koreksi horseshoe kidney Anastomosis of kidney:

55.52 55.53 55.54 55.6 55.61 55.69 55.7 55.8 55.81 55.82 55.83 55.84 55.85 55.86

Nephropyeioureterostomy, Pyeloureterovesical anastomosis, Ureterocalyceal 41

anastomosis Correction of ureteropelvic junction. Pyeloplasty

55.87

7 - Berita Acara PP l A U I dan PP I K A B I

I

77

NO 42 43 44

TINDAKAN Other Other operation on kidney Decapsulation of kidney. Capsulectomy of kidney. Decortication of kidney.

I C D 9-CM 55.89 55.9 55.91

Nephrectomy for donor transplant 45

Percutaneous aspiration of kidney (pelvis). Aspiration of renal cyst.

55.92

46 47 48

Renipuncture. Punksi dan sklerosing kista ginjal Replacement of nephrostomy tube Replacement of pyelostomy tube Local perfusion of kidney

55.93 55.94 55.95

49

Other injection of therapeutic substance into kidney

55.96

50 51 52 53

Injection to renal cyst Implantation or replacement of mechanical kidney Removal of mechanical kidney other Recontruction of renovascular

55.97 55.98 55.99 39.50

OPERATION ON URETER 54 Transurethral removal of obstruction from ureter and renal pelvis

56 56.0

Removal of: blood clot, calculus, foreign body. From ureter or renal pelvis without incision. URS Ureteral meatotomy Ureterotomy

55 56

56.1 56.2

Incision of ureter for: drainage, exploration, removal of calculus Ureterolithotomy Ureterolithotomy proximal Ureterolithotomy distal Diagnostic procedures on ureter Ureteroscopy Closed percutaneous biopsy of ureter Closed endoscopic biopsy of ureter Open biopsy of ureter Endoscopy of ileal conduit: cystoscopy, looposcopy Other diagnostic procedures on ureter Ureterectomy Ureterectomy, NOS Partial ureterectomy. Excision of lesion of ureter. Shortening o f ureter with

57 58 59 60 61 62 63 64 65 66 67 68

reimplantation. Reimplantasi ureter bilat Total ureterectomy Cutaneous uretero-ileostomy Formation of cutaneous uretero-ileostomy. Ileal conduit (Bricker) Revision of cutaneous uretero-ileostomy Other external urinary diversion Formation of other cutaneous ureterostomy. Anastomosis of ureter to skin. Ureterostomy NOS. Ureterokutaneostomi Revision of other cutaneous ureterostomy. Revision of ureterostomy stoma Other anastomosis or bypass of ureter Urinary diversion to intestine Revision of ureterointestinal anastomosis Nephrocystanastomosis, NOS

69 70 71 72 73 74 75 76 77 78 79

78

I


56.21 56.22 56.3 56.31 56.32 56.33 56.34 56.35 56.39 56.4 56.40 56.41 56.42 56.5 56.51 56.52 56.6 56.61 56.62 56.7 56.71 56.72 56.73

NO 80

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

' TINDAKAN'''' ' — Ureteroneocystostomy. Replacement of ureter with bladder flap Ureterovesical anastomosis. Reimplantasi ureter unilateral

- ^^-^-^^

Psoas Hitch/ Boari flap Transuretero-ureterostomy. Uretero-ureterostomy Other. Anastomosis end to end ureter Repair of ureter Lysis of intraluminal adhesions of ureter Suture of laceration Closure of ureterostomy Closure of other fistula of ureter Ureteropexy Removal of ligature from ureter Other repair of ureter. Tailoring ureter Other operations on ureter Dilation of uretral meatus Implantation of electronic ureteral stimulator Replacement of electronic ureteral stimulator Removal of electronic ureteral stimulator Ligation of ureter Other Removal DJ stent

56.75 56.79 56.8 56.81 56.82 56.83 56.84 56.85 56.86 56.89 56.9 56.91 56.92 56.93 56.94 56.95 56.99 97.79

OPERATIONS ON URINARY BLADDER 99 Transurethral clearance of bladder Drainage of bladder without incision Removal o f (blood clots, calculus, foreign body) from bladder without

100 101 102 103 104 105 106 107 108 109 UO 111 112 113 114 115 116 117 118 119

ICD9-C] 56.74

incision Lithotripsi batu buli Cystostomy Percutaneous aspiration of bladder Lysis of intraluminal adhesions with incision into bladder Percutaneous cystostomy Closed cystostomy, percutaneos suprapubic cystostomy Other suprapubic cystostomy. Railroading ruptur uretra Other cystostomy. Lithopalaksi. Sectio alta/ vesikolithotomi Vesicostomy Vesicostomy Revision or closure of vesicostomy Diagnostic procedures on bladder Cystoscopy through artificial stoma. Sistoskopi ODS Other cystoscopy. Transurethral cystoscopy Closed (transurethral) biopsy of bladder. TUR tumor buli Open biopsy of bladder Other diagnostic procedures on bladder Transurethral excision/destruction of bladder tissue Transurethral lysis of intraluminal adhesions Other transurethral excision/destruction of lesion/tissue of bladder Endoscopic resection of bladder lesion Other excision/destruction of bladder tissue Excision of urachus. Excision of urachal sinus of bladder

57 57.0

57.1 57.11 57.12 57.17 57.18 57.19 57.2 57.21 57.22 57.3 57.31 57.32 57.33 57.34 57.39 57.4 57.41 57.49 57.5 57.51

7 - Berita Acara PP l A U I dan PP I K A B I I

79

NO 120

TINDAKAN Open excision/destruction of other lesion/tissue of bladder Endometrectomy of bladder. Suprapubic excision of bladder lesion Diverticulectomy of bladder

121

Partial cystectomy. Excision of bladder dome, trigonectomy, wedge resection of bladder. Reduction of cystosplasty Total cystectomy. Total cystectomy with urethrectomy Radical cystectomy Radical cystectomy Other total cystectomy Other repair of urinary bladder Suture of laceration of bladder Closure of cystostomy Repair of fistula involving bladder and intestine

122 123 124 125 126 127 128

I C D 9-CM 57.59

57.6 57.7 57.71 57.79 57.8 57.81 57.82 57.83

Fistulectomy: (rectovesicovaginal, vesicosigmoidovaginal) Repair fistel enterovesika. Repair fistel vesikorektal 129

Repair of other fistula of bladder

57.84

Fistulectomy: cervicovesical, urethroperineo vesical, uterovesical, vaginovesical. Repair fistel vesikokutan 130

Cystourethroplasty and plastic repair of bladder neck

57.85

Plication of sphincter of urinary bladder Rekonsiruction/V-Y plasty of bladder neck Repair of bladder extrophy Reconstruction of urinary bladder

131 132

57.86 57.87

Anastomosis of bladder with isolated segment of ileum, augmentation of bladder, replacement of bladder with ileum/sigmoid (closed ileal bladder) 133

Other anastomosis of bladder

57.88

134 135 136 137 138 139 140 14! 142 143 144

Anastomosis of bladder to intestine NOS, cystocolic anastomosis Other repair of bladder. Neobladder Other operations on bladder Sphincterotomy of bladder. Division of bladder neck Dilation of bladder neck Control of (post operative) hemorrhage of bladder Insertion of indwelling urinary catheter Replacement of indwelling urinary catheter Implantation of electronic bladder stimulator Replacement of electronic bladder stimulator Removal of electronic bladder stimulator Other

57.89 57.9 57.91 57.92 57.93 57.94 , 57,95 57.96 57.97 57.98 57.99

OPERATIONS ON URETHRA 145 Urethrotomy

58 58.0

Excision o f urethral septum, formation o f urethrovaginal fistula, perineal 146 147 148 149

urethrostomy, removal of calculus from urethra by incision Urethral meatotomy Diagnostic procedures on urethra Perineal urethroscopy Other urethroscopy. PER (primary endoscopic realignment)

150

Uretroskopi/ uretrosistoskopi Biopsy of urethra

80

I


,

58.1 58.2 58.21 58.22 58.23

NO 151 152 153 154

155

TINDAKAN Biopsy o f periurethral tissue Other diagnostic procedures on urethra and periurethral tissue Excision/destruction of lesion or tissue of urethra Endoscopic excision/destruction of lesion or tissue of urethra Fulguration of urethral lesion Kauterisasi Other local excision/destruction of lesion or tissue of urethra

ICD 9-CM 58.24 58.29 58.3 58.3!

;!

58.39

Excision of: (congenital valve, lesion, stricture) of urethra 156 157 158 159 160 161 162 163 164

165

Urethrectomy. Divertikulum uretra. Insisi posterior urethral valve Repair of urethra Suture of laceration of urethra Closure of urethrostomy Closure of other fistula of urethra. Fistulektomi/ repair fiste! uretra Reanastomosis of urethra. Anastomosis of urethra. Reseksi-anastomosis uretra Repair of hypospadias/epipadias

58.4 58.4! 58.42 58.43 58.44

Other reconstruction of urethra. Urethral construction. Johanson Urethral meatoplasty Other repair of urethra

58.45 58.46 58.47 58.49

Benenenti rotation of bulbous urethra. Repair of old obstetric laceration of urethra. Urethra! plication. Uretroplasty Release of urethral stricture.

58.5

Cutting of urethral sphincter. Internal urethral sphincter. Urethrolysis. Uretrotomi 166

interna (Sachse) Dilation of urethra

58.6

Dilation of urethrovesical junction Passage of sound through urethra

167 168 169 170 171 172 173

Removal of calculus from urethra without incision Businasi/dilatasi uretra Other operations on urethra and periurethral tissue Incision of periurethral tissue. Drainage of bulbourethral gland Excision of periurethral tissue Implantation of artificial urinary sphincter Other Kalibrasi urethra Insertion catheter

58.9 58.91 58.92 58.93 58.99 89.29 96.48

OTHER OPERATION ON URINARY TRACT 174 Dissection of retroperitoneal tissue 175 Retroperitoneal dissection, NOS

59 59.0 59.00

176 177

Limfadeneklomi retroperitoneal/ RPLND Ureterolysis with freeing/repositioning of ureter for retroperitoneal Other lysis of perirenal/periureteral adhesions

178 179

Ureterolysis Laparoscopic lysis of perirenal/periureteral adhesions Other incision of perirenal/periureteral tissue

59.03 59.09

180 181 182

Exploration of perinephric area. Incision of perirenal abscess Incision of perivesical tissue Other lysis of perivesical adhesions Laparoscopic lysis of perivesical adhesions

59.1 59.11 59.12

fibrosis

59.01 59.02

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NO 183

TINDAKAN Other incision of perivesical tissue Exploration of perivesical tissue. Incision of hematoma of space of Retzius. Retropubic exploration Diagnostic procedures on perirenal and perivesical tissue Biopsy of perirenal or perivesical tissue Other diagnostic procedures on perirenal tissue, perivesical tissue and retroperitoneum Plication of urethrovesical junction Suprapubic sling operation. MMK7 sling uretra Retropubic urethral suspension Paraurethral suspension Other repair of urinary stress incontinence Levator muscle operation for urethrovesical suspension Injection of implant into urethra and/or bladder neck Collagen implant. Collagen implant. Endoscopic injection of implant Fat implant. Polylel implant Other Anterior urethropexy, repair o f stress incontinence NOS, tudor "rabbit ear"urethropexy Ureteral catheterization. Drainage of kidney by catheter Insertion o f ureteral stent/DJ stent. Ureterovesical orifice dilation Drainage periureter. Insersi ureter kateter for RPG Other operations on urinary system Excision of perirenal or perivesical tissue Other operations on perirenal or perivesical tissue Replacement of ureterostomy tube: Change, reinsertion Replacement of cystostomy tube Ultrasonic fragmentation of urinary stones. Shattered urinary stones Other Ureterosigmoidostomy (Coffey)

184 185 186 187 188 189 190 191 192 193

194

195

196 197 198 199 200 201 202 203

OPERATIONS ON PROSTATE AND SEMINAL VESICLES 204 Incision of prostate. Drainage of prostatic abscess. Prostatolithotomy 205 Diagnostic procedures on prostate and seminal vesicles Biopsi prostat Closed (percutaneous) (neddle) biopsy of prostate Open biopsy of prostate Closed (percutaneous) biopsy of seminal vesicles Needle biopsy of seminal vesicles Open biopsy of seminal vesicles Biopsy of periprostatic tissue Other diagnostic procedures on prostate and periprostatic tissue Other diagnostic procedures on seminal vesicles Transurethral prostatectomy Transurethral (ultrasound) guided laser induced prostatectomy (TULIP)

206 207 208 209 210 211 212 213 214

TRUS Other transurethral prostatectomy: Excision of median bar by transurethral apparoach, TEVAP, transurethral enucleative procedures, transurethral prostatectomy NOS, TURP, TUIP, B N l , TVP, TMP Suprapubic prostatectomy. Transvesical prostatectomy

215

216

82

I


I C D 9-CM 59.19

59.2 59.21 59.29 59.3 59.4 59.5 59.6 59.7 59.71 59.72

59.79

59.8

59.9 59.91 59.92 59.93 59.94 59.95 59.99 69.22 60 60.0 60.1 60.11 60.12 60.13 60.14 60.15 60.18 60.19 60.2 60.21 60.29

60.3

'

NO 217 218 219 220 221 222 223 224 225 226

TINDAKAN Retropubic prostatectomy Radical prostatectomy. Prostatovesiculectomy Other prostatectomy Local excision of lesion of prostate. Open prostatectomy Perineal Other Operations on seminal vesicles Percutaneous aspiration of seminal vesicles Incision of seminal vesicles Excision of seminal vesicles

227 228 229 230

Excision of Mullerian duct cyst, spermatocystectomy Other operations on seminal vesicles Incision/excision of periprostatic tissue Incision of periprostatic tissue. Drainage of periprostatic tissue Excision of periprostatic tissue

60.79 60.8 60.81 60.82

231 23? 233 234 235

Excision of lesion of periprostatic tissue Other operations on prostate Percutaneous aspiration of prostate Injection into prostate Repair of prostate Control of (postoperative) hemorrhage of prostate

60.9 60.91 60.92 60.93 60.94

I C D 9-C 60.4 60.5 60.6 60.61 60.62 60.69 60.7 60.71 60.72 60.73

Coagulation of prostetic bed 236 237

Cystoscopy for control of prostatic hemorrhage Transurethral balloon dilation of the prostatic urethra Transurethral destruction of prostate tissue by microwave

60.95 60.96

thermotherapy 238

Transurethral microwave thermotherapy (TUMT) of prostate Other transurethral destruction of prostate tissue by other

60.97

Thennotherapy. Radiofrequency thermotherapy 239 240

Transurethral needle ablation (TUNA) of prostate Other Masase prostate

60.99 99.94

OPERATION ON SCROTUM AND TUNICA VAGINALIS 241 Incision and drainage of scrotum and tunica vaginalis 242 Diagnostic procedures on scrotum and tunica vaginalis 243 Biopsy of scrotum or tunica vaginalis 244 Other diagnostic procedures on scrotum and tunica vaginalis 245 Excision of hydrocele (of tunica vaginalis) 246 Excision/destruction o f lesion or tissue of scrotum: fulguration of lesion. reduction of elephantiasis, partial scrotectomy 247 Repair of scrotum and tunica vaginalis 248 Suture of laceration of scrotum and tunica vaginalis 249 Repair of scrotal fistula 250 Other repair of scrotum and tunica vaginalis

61 61.0 61.1 61.11 61.19 61.2 61.3 61.4 61.41 61.42 61.49

251 252

Reconstruction with rotational or pedicle flaps. Scrotoplasty Other repair on scrotum and tunica vaginalis Percutaneous aspiration of tunica vaginalis

61.9 61.91

253 254

Aspiration of hydrocele of tunica vaginalis Excision of lesion of tunica vaginalis other than hydrocele Other

61.92 61.99

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NO TINDAKAN OPERATIONS ON TESTIS 255 Incision of testis. Eksplorasi testis (microsurgery) 256 Diagnostic procedure of testis 257 Closed {percutenous)(needle) biopsy of testis 258 Open biopsy of testis 259 Other diagnostic procedure of testis 260

Excision/destruction of testicular lesion Excision of appendix testis. Excision of cyst of Morgagni in the male Unilat orchidectomy Bilat orchidectomy. Male castration. Radical bilat orchidectomy Removal of both testis at same operative episode Bilat orchidectomy NOS. Extended orchidectomy Removal of remaining testis Removal of solitary testis. Subcapsular orchidectomy Orchidopexy (UDT, torsio testis) Repair of testis Suture of laceration of testis Other repair of testis. Testicular graft Insertion of testicular prosthesis Other operations on testis Aspiration of testis Injection of therapeutic substance into testis Other

261 262 263 264 265 266 267 268 269 270 271 272 273

OPERATION ON SPERMATIC CORD, EPIDIDYMIS, AND VAS DEFERENS 274 Diagnostic procedures on spermatic cord, epididymis, and vas deferens 275 Biopsy of spermatic cord, epididymis, and vas deferens 276 Other diagnostic procedures on spermatic cord, epididymis, and vas deferens 277 Excision of varicocele and hydrocele of spermatic cord

I C D 9-CM 62 62.0 62.1 62.11 62.12 62.19 62.2 62.3 62.4 62.41 62.42 62.5 62.6 62.61 62.69 62.7 62.9 62.91 62.92 62.99 63 63.0 63.01 63.09 63.1

High ligation o f spermatic vein. Hydrocelectomy o f canal o f Nuck. Funicocelectomy. Varicocelectomy (palomo) Excision of cyst of epididymis. Spennatocelectomy Excision of other lesion or tissue of spermatic cord and epididymis Excision of appendix epididymis Epididymectomy Repair of spermatic cord and epididymis Suture of laceration of spermatic cord and epididymis Reduction of torsion of testis or spermatic cord Transplantation of spermatic cord Other repair of spermatic cord and epididymis Vasotomy. Vasostomy. Vasovasostomy Vasectomy and ligation of vas deferens Male sterilization procedure, NOS (ligation, crushing, division) of vas deferens Ligation of spermatic cord Vasectomy Repair of vas deferens and epididymis Suture of laceration of vas deferens and epididymis Reconstruction of surgically divided vas deferens Epididymovasostomy Removal of ligature from vas deferens Removal of valve from vas deferens

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 84

I


63.2 63.3 63.4 63.5 63.51 63.52 63.53 63.59 63.6 63.7 63.70 63.71 63.72 63.73 63.8 63.81 63.82 63.83 63.84 63.85

NO 298 299 300 301 302 303 304 305

• TINDAKAN Other repair of vas deferens and epididymis Other operations on spermatic cord, epididymis and vas deferens Aspiration of spermatocele Epididymotomy Incision of spermatic cord Lysis of adhesions of spermatic cord Insertion of valve in vas deferens Other

OPERATIONS ON PENIS 306 Circumcision (male) 307 Diagnostic procedures on the penis 308 Biopsy of penis 309 Other diagnostic procedures on penis 310 Local excision/destruction of lesion of penis

I C D 9-CM 63.89 63.9 63.91 63.92 63.93 63.94 63.95 63.99 64 64.0 64.1 64.11 64.19 64.2

311 312 313 314 315 316 317

Eksisi plaque {Peyronie disease). Excisi webbed penis Amputation of penis Repair and plastic operation on penis Suture of laceration of penis Release of chordae/chordectomy Construction of penis Reconstruction of penis. Eksisi fibroma Replantation of penis. Reattachment of amputated penis

64.3 64.4 64.4! 64.42 64.43 64.44 64.45

318

Other repair of penis. Operasi priapismus (prosedur Winter)

64.49

319 320 321 322 323 324

Koreksi priapismus Other operations on male genital organs Dorsal or lateral slit of prepuce Incision of penis Division of penile adhesions Fitting of external prosthetis of penis Insertion or replacement of non-inflatable penile prosthesis

64.9 64.91 64.92 64.93 64.94 64.95

325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 34!

Insertion of semi-rigid rod prosthesis into shaf^ of penis Removal of internal prosthesis of penis Insertion or replacement of inflatable penile prosthesis Insertion of cylinders into shaft of penis and placement of pump and reservoir Other operations on penis. Corpora cavemosa-corpus spongiosum shunt Corpora-saphenous shunt. Irrigation of corpus cavemosum Other Dissection of lymp node of inguinal Hidrokelektomi per inguinal/ligasi tinggi Incisi abses perineum Lymphadenectomy ilioinguinal Vasography Dissection of lymp node of pelvis ESWL Laparotomy exploration Operasi sistokel Insersi catheter Tenckhoff untuk CAPD Uroflowmetri Infiltrasi sitostatika intravesica Chemotherapy

64.96 64.97 64.98 64.99 40.54 69.19 86.09 40.29 87.94 54.3 98.52 54.11 40.51 54.98 89.24 96.49 99.25

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85

IKATAN D O K T E R INDONESIA PERHIMPUNAN D O K T E R S P E S I A L I S B E D A H INDONESIA

IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl, Kramat Raya 160, Jakarta Pusat 1CM30, Telp & Fax. 021 - 3916774 Website: www. ikabj,org Email; [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014

BERITA ACARA

Dewan Pertimbangan Ptof. Dr. Sjamsuhidaiat, SpB.SpB-KBD •r. Soerarso Hardjowasilo, SpB.SpBTKV

Yang bertanda tangan dibawah ini Nama : Dr Setyowidi Nugroho, SpB.SpBS Majelis Etik t Penawhal Prof. Dr Miichlis Ram!i, SpB(K)-Onk Jabatan : Ketua PERSPEBSI M
Mcnyerahkan 1 berkas naskah asli daftar kewenangan klinis profesi PERSPEBSI kepada: Nama Jabatan



Bfiodahaa Dr Barlian Sutedja, SpB Homisi Orjianisasi, LeqIslatI dan AdvoKasi Or HN Nazar, SpB Dr. Chandra Svaras. SpB

Dr Setyowidi Nugroho, SpB.SpBS

Dr. DjoniiDarmadjaja, SpB.MARS

Ketua PERSPEBSI

Sekjen IKABI

Komlal Profesi Bedah, Asuransi dan Perpjjakan Dr Nurhayal Usman, SpB KGO Dr, Erawan Wiradlsuria, SpB KBD Dr. Henry Boyke Sitompul, SpB Dr. Inzta Arfti, SpB Komlsi Globalisasi & Pagar Bebas Dr. dr. Fathema D Rachmal, SpB SpBTKV Or Hunlal Simamora, SpBP-RE Komijl Komunlkasi dan PublikasI OR. Or. Yefta Munadjal, SpB Sp6P-RE{K) Prol. DR. Dr, Sri Maliawan, SpBS (K) Dr Iskandar Budianla, SpB SpBA Komisi Hubunqan Dalam Neqerl Prof. DR. Dr. Ardi Asadul Islam, SpBS Dr. Boyke Sumanln, SpU Dr. EmirT Pasaribu SpB.Onk Homisi Pelayanan Ambulance 118 Dr ZAIsma,Spe Dr. Agi Salria, SpB KBD Komisi Trauma DR. Dr. Achmad Hidayal, SpB Dr.B Sunoko,SpB DR, Dr Tiiwahyu Mumi, SpB SpBTKV


87

:

•

1

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH SARAF INDONESIA (PERSPEBSI)

89

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS D O K T E R SPESIALIS BEDAH SARAF INDONESIA (PERSPEBSI) I C D 9-CM

NO JENIS TINDAKAN . Kongenitai Kranial 1 Koreksi (Kranioplasti) Mikrosefal (Kraniostenosis) 2 Hidrocephalus Simpel: Shunting Kompleks/malfungsi pirau: Shunting/revisi

02.06

3

KistaArahnoid: Marsupialisasi/ekstirpasi (kraniotomi konvensional/

4 5 6 7

Mikroskopik, endoscopic) MeningokelAnterior: Reseksi & Rekonstruksi kraniofasial Meningokel Posterior: Reseksi & Rekonstruksi Deformitas kranium: Koreksi dan rekonstruksi Dandy Walker Malformaion:Trepanasi

39.28 39.28 01.24 + 01.59 01.51 02.12 01.24

Spinal

10

11

Spinal Disrafisme: Koreksi struktur Anatomi, release tethered cord 78.00 + 03.93 Deformitas Atlanto-oksipital: Koreksi struktur Anatomi, stabihsasi (auto/allo bone graft, implant - spine intrumentasi) S i n d r . A r n o l d - C h i a r y / S i r i n g o m i e l i : Koreksi struktur Anatomi (decompression brain: 01.24, spinal cord: 03.09) (Oksipitoservikal decompresi, myelostomy dan duroplasty) (myelotomy spine: 03.29, percutaneous: 0 3 . 2 1 , duraplasty: 02.12)) 03.93 Spinal Deformity: Koreksi dan satbilisasi (implant - spine instrumentasi)

Infeksi 12 13 14

01.39

Abses Serebri: Mengeluarkan Abses (Reseksi, drainage) Tuberkuloma: Mengangkat Tumor Infeksi Komensal/lmunitas turun: Biopsi diagnostik

(brain: cerebral

01.13/01.14, meninges:

01.11/01.12, spinal cord: 03.32) Kelainan Parasiter 15 Cacing: Biopsi diagnostik

(brain: cerebral

01.13/01.14, meninges:

01.11/01.12, spinal cord: 03.32) 16

Jamur: Biopsi diagnostik

(brain: cerebral

01.13/01.14, meninges:

01.11/01.12, spinal cord: 03.32) 17

SpondilitisTBC: Debridemen, stabihsasi (auto/allo bonegarft, impant

18

instrumentasi) bila diperlukan Morbus Hansen: Dekompresi saraf

spme 03.4 01.24

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91

NO JENIS TINDAKAN Neoplasma Kranium 19 Granuloma Eosinofilik: Mengangkat tumor

20 21 22 23 24 25

Plasmositoma; Mengangkat tumor Osteoma: Mengangkat tumor Fibrous Displasia: Mengangkat tumor Hamartoma: Mengangkat tumor Tumor Metastase: Mengangkat tumor Neurotibrosarkom/Osteosarkom: Mengangkat tumor

I C D 9-CM

(excisi lesion brain/ cerebral: 01.59, meninges; 01.51, spinal cord: 03.4) (sama dengan atas) (sama dengan atas) (sama dengan atas) (sama dengan atas) (sama dengan atas) (sama dengan atas)

Supratentorial 26

Glioma: Mengangkat tumor Glioma simpel: Mengangkat tumor Glioma kompleks: Mengangkat tumor

27

Ependymoma: Mengangkat tumor

28

Pleksus Papiloma: Mengangkat tumor

Meningioma 29 Meningioma simpel: Mengangkat tumor 30

Meningioma kompleks: Mengangkat tumor, Radiosurgery, embolisasi (prosedur endovaskuler)

Tumor Sella 31 Kraniofaringioma: Mengangkat tumor 32 Adenoma hipofise: Mengangkat tumor, Radiosurgery 33 Tumor daerah Pineal Body: Mengangkat tumor. Radiosurgery

(sama dengan atas) chemotherapy (99.25) (sama dengan atas) chemotherapy (99.25) (sama dengan atas) chemotherapy (99.25) (sama dengan atas) chemotherapy (99.25) (sama dengan atas) chemotherapy (99.25)

+ + + +

(excisi meninges (cerebral: 0J.51, spinal: 03.4)) (excisi meninges (cerebral: 01.51, spinal: 03.4)) (embolisasi intracranial: 38.81)

(sama dengan atas) chemotherapy (99.25)

Tumor metastase 34 Tumor Metastase simpel: Mengangkat tumor

(sama dengan atas) +

35

chemotherapy (99.25) Tumor Metastase kompleks: Mengangkat tumor. Radiosurgery, embolisasi (sama dengan atas) +

36 37

(prosedur endovaskuler) chemotherapy (99.25) Angioma simpel: Mengangkat tumor Angioma kompleks: Mengangkat tumor. Radiosurgery, prosedur endovaskuler

Infratentorial: Glioma 38 Simpel: Mengangkat tumor

(sama dengan atas) + chemotherapy (99.25)

92


NO 39

JENIS TINDAKAN Kompleks: Mengangkat tumor

I C D 9-CM (sama dengan atas) + chemotherapy (99.25)

40

Akustic Neuroma: Mengangkat tumor, Radiosurgery

Meningioma 41 Meningioma simpel: Mengangkat tumor. 42

Meningioma kompleks: Mengangkat tumor. Radiosurgery

43

Medulloblastoma: Mengangkat tumor

44

Coiesteatoma: Mengangkat tumor

45

Ependymoma: Mengangkat tumor

46

Pleksus Papiloma: Mengangkat tumor

(excisi meninges (cerebral: 01.51, spinal: 03.4)) (excisi meninges (cerebral: 01.51, spinal: 03.4)) (sama dengan atas) + chemotherapy (99.25) (sama dengan atas) + chemotherapy (99.25)

Angioma 47 48

Angioma simpel: Mengangkat tumor Angioma kompleks: Mengangkat tumor, radiosurgery, prosedur endovaskuler

Tumor Spinal 49 Glioma: Mengangkat tumor 50 51

Meningioma: Mengangkat tumor, radiosurgery Ependimoma: Mengangkat tumor

52 53 54 55

Schwanoma: Mengangkat tumor, radiosurgery Angioma: Mengangkat tumor, radiosurgery, prosedur endovaskuler Tumor Saraf Tepi Schwanoma: Mengangkat tumor

(excisi spinal cord: 03.4) + chemotherapy (99.25) (sama dengan atas) (sama dengan atas) + chemotherapy (99.25) (sama dengan atas) (sama dengan atas)

Ket. Chemotherapy: C9253, J9328, J8700

Trauma Trauma Kranial 56 Depressed Fracture: Koreksi/Kranioplasti 57 Epidural Hematoma: Evakuasi Hematom 58 Subdural Hematoma Acut: Evakuasi Hematom 59 Subdural Hematoma Kronik: Evakuasi Hematom 60 Intracerebral Hematoma: Evakuasi Hematom 61 Intraventricular Hematoma: Evakuasi Hematom 62 Trauma tembus: Pengangkatan BendaAsing

63

02.06 01.24 01.31 01.31 01.39 (vein intracranial: 38.01) ( i n c i s i brain: 01.39, without incision into brain:01.24, incisi cerebral meninges: 01.31, incisi spinal: 03.01)

Bocoran likuor: Penutupan Bocoran


93

NO 64

JENIS T I N D A K A N ICD 9-CM Karotis-Kavemosus Fistul: Penutupan Fistul (Kraniotomi mikirosurgery, (01.24+21.06, ligasi ligasi a. carotis, prosedur endovaskular) intracranial: 38.81)

Trauma Medula Spinalis 65 Kompresi Medula: Dekompresi tanpa/dengan stabilisasi (auto/allo bonegraft, (decompression brain: impant spine instrumentasi) 01.24, spinal cord: 03.09) 66

Kompresi Radiks: Dekompresi tanpa/dengan stabilisasi (auto/allo bonegraft,

(decompression

impant spine instrumentasi)

01.24, spinal cord: 03.09)

Trauma Saraf Perifer 67 Lesi Saraf Tepi: Menyambung Saraf 68 Lesi Pleksus: Menyambung Pleksus Degeneratif Spinal Degenerasi diskus intervertebral 69 Lumbal: Dekompresi (laminekstomi konvensional, mikrolumbal diskektomi, endoscopic surgery), stabilisasi bila diperlukan (auto/allo bonegraft, implantspine intsrumentasi) 70 71 72

Servikal: Dekompresi (posterior foraminotomi. Anterior Cervical Diskektomy

04.79

03.09+80.51

03.09

+ Fusi; Cloward, cervical allograft atau implant;, endoscopic surgery), 78.00 + 03.93 Spondilolistesis: Stabilisasi (implant - spine instrumentasi) (decompression brain: Kanal Stenosis: Dekompresi, stabilisasi bila diperlukan (auto/allo bonegraft, 01.24, spinal cord: 03.09) implant(myelotomy spine: 03.29, spine intsrumentasi) percutaneous: 03.21, duraplasty: 02.12)) (stabilisasi: 78.00, 03.93)

Saraf Perifer 73 Entrapment syndrome: Dekompresi (bedah terbuka, endoscopic surgery)

Vaskuler Intrakranial 74 AVM Simpel: Reseksi, Embolisasi (prosedur endovaskular), radiosurgery 75 A V M Kompleks: Reseksi, Embolisasi (prosedur endovaskular), radiosurgery 76 Aneurysm: Penutupan Aneurisma (kraniotomi + clipping, Coilling/stenting prosedur endovaskuler) 77 Cavemoma; Eksisi Kavemoma, radiosurgery 78 Spontaneous ICH: Evakuasi Hematom 79 Stroke Iskemik (Stenosis/trombus: Operasi Anastomosis, Rekanalisasi dengan prosedur endovaskular /emboli intrakranial) 80 Dural AV Fistula: Penutupan fistula (microsurgery, prosedur endovaskuler) 81 Trombosis vena intrakranial: Microsurgery, prosedur endovaskuler Spinal 82 AVM: Reseksi, Embolisasi (prosedur endovaskular), radiosurgery 83 AV fistula: Menutup Fistul (Microsurgery, Prosedur endovaskular) 84 Aneurysma: Microsurgery, prosedur endovaskuler

94

brain:

I


(decompression brain: 01.24, spinal cord: 03.09)

38.31,38.80 38.31.38.80 01.24 + 39.51/39.7

75.91

39.53

39.53 39.51/39.52, 39.7

NO Fungsiona! 85 Movement disorders

86

87 88 89

JENIS TINDAKAN

I C D 9-CM

Movement Disorder simpel: Memperbaiki Fungsi (prosedur stereotaktik ;

03.93

ablasi. Implant Deep Brain Stimulation) Movement Disorder kompleks: Memperbaiki Fungsi (prosedur stereotaktik; ablasi, Implant Deep Brain Stimulation) Pain Pain Surgery simpel: Menghilangkan Nyeri (Therapeutic nerve block - pulse radioirequency, thermal ablation) epidural steroid injection,, intrathecal drug delivery, neurolytic Blockade) Pain Surgery kompleks: Menghilangkan Nyeri (Therapeutic nerve block (pulse radiofrequency, thermal ablation), epidural steroid injection,, intrathecal drug delivery, neurolytic Blockade), Dorsal Rhizotomy, Myelotomy, Thalamothomy, Deep Brain Stimulaion, Dorsal Collum Stimulation Epilepsi; Menghilangkan Kejang (Microsurgery, Implant Deep Brain Stimulation, Ablasi, Radiosurgery) Intracranial compression syndr: Dekompresi (Microvascular Decompresi), Ablasi (chemical agent. Radiosurgery, radiofrequency) Psichosis: Memperbaiki Fungsi - Psikosurgery (Microsurgery, Implant Deep Brain Stimulation)

Tekanan Tinggi Intrakranial 90 Bendungan Cairan Otak: Pemasangan Pirau, External-Ventriculo Drainage (EVD) 91 Pembengkakan jaringan otak: Dekompresi, Intracranial Pressure Monitoring (ICP Monitoring) 92 Diagnosa Penyakit Kranial dan Spinal: Prosedur Digital Substraksi Angiografi (DSA) kranial dan Spinal 93 Insisi dan eksisi pada Skull, Brain dan Meninges 94 95 96

Pungsi Cranial Pungsi sistema. Tapping sistema Pungsi ventrikel melalui implant kateter

01.24

01.24 88.40 01 01.0 01.01 01.02

Pungsi melalui tube ventrikel shunt 97

Pungsi cranial yang lain. Ruang subdural. Aspirasi cranial

01.09

98 99 100 101 102 103 104 105

Pungsi melalui fontanella anterior Prosedur diagnostic pada Skull, Brain dan Meninges Biopsi skull Craniotomy dan craniectomy Insisi dan drainase sinus cranialis Reopening tempat craniotomy Debridemen kepala Rekonstruksi tulang kepala Insisi pada brain dan cerebral menings

106

Lobotomy dan tractotomy. Jaringan otak. Traktus serebri

01.32

107 108 109 110

Pcrkutaneus singulotomy Operasi pada thalamus dan globus pallidus Thalamus. Chemothalamectomy. Thalamotomy Globus Pallidus. Pallidoansectomy. Pallidotomy Eksisi atau Destruksi jaringan otak dan meninges

01.4 01.41 01.42 01.5

OI.l 01.15 01.2 01.21 01.23 01.25 01.3


95

NO 111 tI2 113 114 115 116

JENIS TINDAKAN Hemisferektomy Lobeklomy Tindakan lain pada Skull, Brain dan Meninges Cranioplasty Membuka sutura cranial. Linear craniectomy. Strip craniectomy Elevasi fragmen tulang kepala yang patah

I C D 9-CM 01.52 01.53 02 02.0 02.01 02.02

Debridemen fraktur tulang kepala 117 118 119

Dekompresi fraktur tulang kepala Cranial bone flap Bone graft. Autograf cranioplasty Pemasangan implant skull defek. Cranioplasty acrylic

02.03 02.04 02.05

120 121 122 123 124

Cranioplasty titanium mesh Pengangkatan implant skull defek Rekonstruksi cerebral menings Penjahitan primer duramater Ligasi menings. Sinus sagitalis. Arteri meningea media Choroid plexectomy kauterisasi pleksus koroid

02.07 02.1 02.11 02.13 02.14

125

Ventriculostomy. Cervical dan rongga subarachnoid. Sistema magna. Insersi

02.2

126 127

Holter Valve. Endoscopy Third Ventriculostomy Ekstrakranial ventricular shunt Ventrikel shunt dihubungkan dengan struktur pada kepala dan leher

02.3 02.31

Ventricular - nasofarings shunt. Ventricular mastoid anastomose. Ventricular-

131 132

sistema shunt Ventricular shunt dengan system sirkulasi Ventriculo-atrial anastomosis. Ventriculo-atrial shunt Ventricular shunt dengan cavum thorasic Ventriculo-pleural shunt Ventricular shunt dengan cavum abdomen dan organs Ventriculo-peritoneostomy Revisi, removal dan irrigasi dari ventricular shunt Irrigasi dan eksplorasi ventricular shunt

133

Penggantian ventricular shunt. Penggantian ventricular kateter. Revisi VP

02.42

134 135 136 137 138 139 140 141 142 143 144

shunt pada sisi yang sama Pengangkatan ventricular kateter Operasi Spinal cord dan Struktur kanalis spinalis Eksplorasi dan dekompresi struktur canalis spinalis Reopening laminectomy Intraspinal nerve root. Rhizotomy Chordotomy. Perkutaneus chordotomy. Tractotomy Prosedur diagnostik untuk spinal cord dan struktur canalis spinalis Tapping spinal. Lumbal pungsi Plastic operation pada struktur spinal cord Repair meningocele Repair spinal myelomeningocele

02.43 0303.0 03.02 03.1 03.2 03.3 03.31 03.5 03.51 03.52

145

Repair fraktur vertebra. Elevasi fragmen tulang. Pengangkatan serpihan

03.53

146 147 148 149 150

tulang Repair Spina bifida. Spinal meninges. Spinal cords. Defect arkus vertebra Lisis dari adhesi spinal cord dan nerve root , Spinal theca shunt Spinal subarachnoid-peritoneal shunt. Lumbo-peritoneal shunt Spinal subarachnoid-ureteral shunt

03.59 03.6 03.7 03.72 03.72

128 129 130

96

I


02.32 02.33 02.34 02.4 02.41

I C D 9-CM 03.79

NO 151

JENIS TINDAKAN Yang lain: Pleurothecal anastomosis, Lumbal-subarachnoid shunt, Syringo-

152

subdural shunt Injeksi agen destruksi ke dalam canalis spinalis

03.92

153

Percutaneus epidurolisis Prosedur operasi spine yang lain.

03.98

154 155 156 157 158 159

Pengangkatan spinal theca shunt Operasi pada saraf cranial dan saraf tepi Insisi, divisi dan eksisi nervus cranial dan nervus perifer Eksisi akustik neuroma Bagian dari nervus trigeminal. Retrogasserian neurotomy Prosedur diagnostic dari system nervus perifer Closed percutaneous biopsy nervus cranial atau nervus perifer atau

04 04.0 04.01 04.02 04.1 04.11

160 161 162 163

ganglion Open biopsy nervus cranial atau nervus perifer atau ganglion Destruksi nervus cranial atau nervus perifer Penjahitan nervus cranialis dan nervus perifer Penghancuran dari adhesi dan dekompresi nervus cranial dan nervus

04.12 04.2 04.3 04.4

164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181

perifer Dekompresi nevus trigeminal Dekompresi nervus yang lain Release carpal tunnel Release tarsal tunnel Neurolisis nerve perifer Graft Nervus cranial atau nervus perifer Transposisi Nervus cranial atau nervus perifer Transplantasi nervus Injeksi ke dalam nervus perifer Injeksi nervus perifer Injeksi anestesi ke nervus perifer Injeksi agen lain selain neurolisis Neurectasis Operasi saraf simpatis atau ganglia Prosedur diagnostic saraf simpatis atau ganglion Biopsi Simpatektomy Injeksi ke dalam saraf simpatis atau ganglion

04.41 04.42 04.43 04.44 04.49 04.5 04.6 04.6 04.8 04.80 04.81 04.89 04.91 05.0 05.1 05.11 05.2 05.3

8 - Berita Acara PP PERSPEBSI dan PP I K A B I

I

IKATAN D O K T E R INDONESIA PERHIMPUNAN D O K T E R S P E S I A L I S BEDAH INDONESIA

IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Kramat Raya 160. Jakarta Pusal 10430, Telp & Fax. 021 - 3916774 Website: wwwikabi.org Email: [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014 Dtwtn Pwtlmbaninn Prof. Dr. Sjamsuhidaial. SpB.SpS-KBD Dr. Soerarso Hardjowasito, SpB.SpBTKV HalelHEtlkAPenMthal Prot Dr. Muchlis Ramli, SpB|K]-Onk Ketui PrMidiutn Prof. DR. Dr Paul Tahalele, SpB.SpBTKV

BERITA ACARA Yang bertanda tangan dibawah ini Nama : Dr Poerwadi, SpB.SpBA Jabatan

: Ketua PERBANI Periode 2012-2014

Wakll Kilua/Ketua Terpillh Dr. R. Suhanono. SpBKBV Prof OR. Or. Sunaryo Hardjowkljolo. SpB SpU Prof. DR. Dr. Suwandi Sugandi. SpB SpU KitUi MKIBI Prof Dr. Errol U. Nutagalung, SpB SpOT Priildlum Dr, Urip Mjrtedjo, SpB PGD Pal Med. ECU Dr. Rizal Pohan, SpB SpOT Dr Sonar Soni Panigoro, SpB K Onk Dr Patnol Muslim, SpU Dr Poenradi. SpB Sp8A Dr R Suhartono. SpBKBV Dr. Setyowidi Nugrofio, SpB SpBS Dr Nutliayat Usmar. SpB KBD Dr Maral Anwar. SpBTKV Or Istiandono Dachlan, Msc, SpB, SpBP-RE|K) Sekfatirl* Jenderal Or. Djoni Darmadjaja. SpB UARS

Menyerahkan I berkas naskah asli daftar kewenangan klinis profesi PERBANI kepada: Nama Jabatan



Dr. Agung Prasmono, SpB SpBTKV.MARS

BiDdibin Dr Barlian Sutedga, SpB Komisi Organisasi. LtgislasI dan Advokaii Dr HN Nazar, SpB Dr Chandra Svaras, SpB

'oerwadi, SpB.SpBA Ketua PERBANI

Dr. Djoni Dbrmadjaja. SpB.MARS Sekjen IKABI

Komisi Profe«l Bedah. Aauransi dan Ptfpâkan Dr hlurtiayat Usman. SpB KBD Dr Erawan Wiradisuna. SpB KBD Dr Henry Boyke Silompul, SpB Dr inzlaAibi. SpB Komlai Globalliail t PaMf Btbw Dr. dr Fathema 0 Rachmat, SpB SpBTKV Df. Huntal Simamora, SpBP-RE Komisi Komunlliasi dan Publlkasi DR Dr Yefta Mjrad|at, SpB SpBP-RE(K| Prof, DR. Dr Sn Maliawan, SpSS (K) Dr Iskandar Budianta, Sp8 SpBA Komlii Hubungm Oalam Megirl Pfof DR Dr. Andi Asadul Islam. SpBS Or Boyke Suinanln, SpU Dr Emif T Pasanbo SpB Onk Komlil Pelayanan Ambulance 118 Dr. ZA Isma, SpB Dr Agi Satria, SpB KBD KomtiilHuma

DR. Di. Aciimad Mklayat, SpB Or B. Sunoko, SpB DR. Dr. Tiiwahyu Mumi, SpB SpBTKV


I

99

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH ANAK (PERBANI)

101

DAFTAR KOMPETENSI DAN KEWENANGAN K L I N I S D O K T E R SPESIALIS BEDAH ANAK (PERBANI) NO. NAMA TINDAKAN 1 Abdominoperineal Pull Through (Malformasi Anorectal) 2 Abdominorectal Pull Through (Swenson Procedure) 3 Amputasi eksisi kista bronchiogenik 4 Appendiktomi 5 Bedah laparoskopi diagnostik anak 6 Billroth I & II/ reseksi gaster parsial 7 Biopsi rectum "Full thickness" 8 9 10 11

ICD-9 C M 48.49 48.49 39.09, 32.01 (endoscopic) 47.0 54.21 43.6/43.7 48.25

(open),

48.24

(brush/

endoscopic) 86.11 (skin & subcutaneous tisuue) 86.19 (skin & subcutaneous tisuue) 54.23 Biopsi ganglion (04.11,04.12), excisi

Biopsi eksisional dalam narkose Biopsi insisional dalam narkose Biopsi perlaparotomi Biopsi/eksisi KGB,lipoma,ateroma,ganglion

ganglion (82.21), excisi KGB (40.29). 40.11, 86.2 (biopsy/excisi skin & 12 13

subcutaneous tisuue) 64.42 (release chordae) 51.32 (anastomosis gallbladder to

Chordektomi Cystojejenostomi

intestine) Tergantung iokasi/regio 62.5 45.91 83.39 86.3 (excisi/destruction lession of skin & subcutaneous tissue) 39.99 (other operation on vessels) 39.99 (other operation on vessels) 39.99 (other operation on vessels)

14 15 16 17 18

Debulking tumor ganas Detorsi testis + orchidopexy Duodenoduodenostomi/duodenojejunostomi Eksisi Baker cyst Eksisi granuloma umbilical

19 20 21 22 23 24 25

Eksisi hemangioma besar/ multiple Eksisi hemangioma dengan skin graft STSG/FTSG Eksisi hemangioma kecil Eksisi higroma colli/ limfangioma simple Eksisi higroma colli/ axilla pada neonatus Eksisi kelenjar getah bening Eksisi kelenjar liur submandibula

26 27 28 29 30

Eksisi kista branchial Eksisi kista duktus tiroglosus Eksisi kista salura empedu Eksisi kista urachus Eksisi neuroblastoma

31 32

Eksisi teratoma retroperitoneal Eksisi teratoma sacrococcygeal

33

Eksisi tumor jaringan lunak ukuran kecil (marginal margin

34 35 36 37 38

eksisi) Ekstirpasi tumor jinak kulit < 3 cm Ekstirpasi tumor jinak kulit > 3 cm Endorectal pull through (Soave- BoUey Procedure) Esofagomyotomi (operasi heller) Esofagostomi+ gastrostomi (atresia esophagus)

40.29 40.29 40.29 26.30, 26.31 (partial), 26.32 (total/ radikal) 29.2 (branchial cleft cyst) 06.7 51.69, 51.64 (endoscopic) 57.51 (bladder), 54.3 (abd. wall) 04.07 ( e x c i s i nerve c r a n i a l / peripheral) 54.4 04.07

(excisi

nerve

cranial/

peripheral) 83.39 86.3 86.3 48.41 42.7 42.10 + 43.1

9 - Berita Acara PP PERBANI dan PP I K A B I

I

NAMA T I N D A K A N Esophagus replacement procedure Fistulektomi pada fistula perianal Fundoplikasi gaster Gastrotomy anak Gastrotomy neonates Genitoplasty (clitoroplasty,vaginoplasty,phalioplasty) Glosektomi totalis Hemiglosektomi Hemimandibulektomi Hemiotomi Ligasi Tinggi (Unilat) Hemiotomi bilat Ligasi Tinggi Hemiotomi pada hernia Inguinal strangulate Hemiotomi residif Hemiotomi umbilikalis Hemiotomi+ laparotomy+ reseksi+ anastomosis

IC0-9 C M 42.89 49.12 44.66 43.0 43.0 70.61/70.62, 64.43/64.44 25.3 25.2 76.31 53.01 (direct), 53.02 (indirect) 53.11 (direct), 53.12 (indirect) 46.03 53.9 53.4 (53.49, 53.41) 53.9+ 54.11+45.79 ( L I ) / 4 5 . 6 2 (SI)+45.94 (L-L)/45.93 (L-S). 45.94 (S-S)

54

Ileostomi

46.21 (temporary), 46.22 (permanent), 46.01 (loop)

55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73

Insisi abses perianal Insisi drainase/ debridement abses Insisi tongue tie Koreksi/rekonstruksi/amputasi Polydactyly kaki atau tangan Koreksi constriction ring kaki/tangan single Separasi syndactyly (multiple) Separasi syndactyly (single) Repair Kelainan umbilicus Kolesistektomi Kolostomi anak Kolostomi naonatus Prosedur Ladd Laparoskopik appendiktomi Laparoskopik diagnostic/ biopsi Laparoskopik gastrektomi Laparoskopik kolektomi Laparotomi + appendiktomi pada app perforasi Laparotomi + milking/ reseksi pada invaginasi Laparotomi'+ reseki anastomose

74 75 76 77 78 79 80 81 82 83 84 85

Laparotomi + reseksi usus halus/ kolon Laparotomi adhesiolisis Laparotomi eksplorasi/ biopsy Laparotomi pada perforasi usus Laparotomi pada trauma abdomen Laparotomi pada peritonitis neonates Limpoma, atheroma, excisi/extirpasi Lobektomi subtotalis (tiroid) Marsupialisasi dengan ranula Minimal/ limited PSARP Near total tiroidektomi Nefrektomi parsial

86

Nefrourektomi tumor Wilms

NO. 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53

104

I

49.01 86.04 25.91 Amputasi jari (84.01), jempol (84.02) 86.2 86.85 86.85 53.4 (repair hernia umbilikalis) 51.22, 51.23 (laparoscopic) 46.10 46.10 54.95 47.01 54.24 (biopsi intraabdominal) 43.99 (gastrectomy) 45.7/45.8 54.1+47.0 54.11+46.80+45.62 (SI)/45.79 (LI) 54.11+45.62 (SI)/45.79 (LI) + 45.94 (L-L)/45.93 (L-S), 45.94 (S-S) 54.11 + 45.62 (SI)/45.79 (LI) 54.11+54.59 54.11 54.11 54.11 54.11 86.2 06.39 26.21 ^n-j 49.79 06.39 (subtotal), 06.4 (total) 55.4 55.51

'•


NO. 87 88 89 90 91 92 93 94 95

NAMA TINDAKAN Orchidektomi unilat Orchidektomi bilat Orchidektomi subkapsuler Parotidektomi radikal Parotidektomi superficial Parotidektomi totalis Pasang akses port ceisite Pasang PEG Pemasangan double lumen kateter dengan local anastesi;

ICD-9 C M 62.3 62.41 i 62.42 26.32 26.31 26.32 86.07 78.05 89.62 (pemasangan CVP) Insersi catheter vein (38.95), artery (38.91)

96 Plikasi diaftâgma 97 Polipektomi 98 Polipektomi rectum 99 Portoenteroskopi (operasi Kasai) 100 Postero sagital anorectoplasty/PSARP 101 Postero sagital anorectovaginourethroplasty/ PSARVUP 102 Potong stump 103 Proedur Tiersch pada prolap rekti 104 PSARP+laparotomi 105 Pyeloplasty 106 Pyoloromyotomy (operasi Fredet Ramstedt) 107 Release sinekia vulva 108 Repair bladder extrophy 109 Repair cloacal extrophy 110 Repair defek dinding perut (omphalocele/ gastroschizis) 111 Repair defek hernia umbilikalis 112 Repair fistel rectovaginal 113 Repair Diafi-agma pada CDH 114 Repair rupture perineum lama

53.81 86.3 48.36 51.37 49.79 49.79 48.35 48.76 49.79+54.11 55.87 43.3 71.8 57.86 70.91 53.49/54.71 53.4 70.73 53.7/53.8 Pria

(71.79/71.71),

wanita

(86.89/86.59) 115 116 117

Repair vesika urinaria Reseksi+ anastomosis esophagus Reseksi anastomosis pada atresia usus, duplikasi

118 119 120

Reseksi esophagus & rekonstruksi Reseksi gaster Reseksi hepar (tumor, trauma)

121 122 123 124 125 126 127 128 129 130 131 132

Reseksi sigmoid Reseksi urachus Retrorectal pull through(Duhamel procedure) Salpingo oophorektomi bilat Sirkumsisi (narkose) Sistostomi Skleroterapi dengan anastesi Sphincterotomy Splenectomy pada trauma Spelenectomy ec hipertensi portal/ kelainan hematologi lain Suntik scleroting agent malformasi vaskuler Thoracotomy +anastomosis esophagus

57.89 42.41/42.42+42.59 Reseksi usus: L I (45.79/45.8), SI (45.62/45.63). anastomosis: 45.94 (LL)/45.93 (L-S), 45.94 (S-S) 42.41/42.42+42.59 43.5, 43.6, 43.7, 43.8, 43.9 50.22 (partial), 50.3 (lobus total), 50.4 (total) 45.76 57.51 48.65 65.61 Pria (64.0), wanita (71.4) 57.17/57.18 39.92 49.51,49.52, 49.59 (anal sphincter) 41.43 (partial), 41.5 (total) 41.43 (partial), 41.5 (total) 39.92 34.00 + 42.59


I

NO. 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184

106

NAMA TINDAKAN Tiroidektomi subtotalis Total gastrektomi dan rekonstruksi Tracheostomy (temporary) Transanal mucosektomy Uretero neosistostomi Ureteroplasty(hipospadia) Vena seksi dan pasang akses vaskuler Yeyunostomi Operations on thyroid and parathyroid glands Unilat thyroid lobectomy Substernal thyroidectomy Excision of lingual thyroid Partial parathyroidectomy Complete parathyroidectomy Other operations on thyroid and parathyroid glands Operations on other endocrine glands Exploration of adrenal glands Partial adrenalectomy Bilat adrenalectomy Other operations on adrenal glands Thymectomy Transplantation of thymus Other operations on endocrine glands Operation on tongue Exicision or destruction of lesion of tongue Radical glossectomy Operations on salivary glands and ducts Incision of salivary glands and ducts Exicision of lesion of salivary gland Other exicision of salivary gland Repair of salivary gland or duct Other operations on salivary glands and duct Other operations on mouth and face Drainage of face or floor of mouth Incision of palate Exicision of branchial cleft vestiges Other operations on larynx and trachea Injection into larynx ' Permanent tracheostomy Other incision of larynx or trachea Local exicision or destruction of trachea Operations on chest wall, pleura, mediastinum and diaphragm Incision of chest wall and pleura Incision of mediastinum Excision or destruction of mediastinal lesion Excision or destruction of chest wall lesion Repair of chest wall Operations on diaphragm Operations on lymphatic system Incision on lymphatic system Simple excision of lymphatic structure Regional lymph node exicision

I


ICD-9 C M 06.39 43.9 + 44.69 31.1 49.3 56.74 56.89 38.00 46.41 06 06.2 06.5 06.6 06.8 06.81 06.9 07 07.0 07.2 07.3 07.4 07.8 07.9 07 25 25.1 25.4 26 26.0 26.2 26.29 26.49 26.9 27 27.0 27.1 31 31.0 31.2 31.3 31.5 34 34.01 34.1 34.3 34.4 34.7 34.8 40 40.0 40.2 40.3

NO. 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 ' 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236

N A M A TINDAKAN'"'^^^^^^^ Radical exicision of cervical lymph nodes Other radical excision of lymph nodes Operation on thoraric duct Other operations on lymphatic structures , ' , . Operations on esophagus Esophagotomy u;.'^..; Esophagostomy Local Exicision or destruction of lesion of esophagus Exicision of esophagus (with end to end anastomosis) Anastomosis of esphogus (intrathoracic) Antestemal anastomosis of esophagus Other repair of esophagus Manipulation within esophagus Other operations on esophagus Incision and exicision of stomach Gastrotomy Temporary Gastrotomy Permanent gastrostomy Exicision or destruction of lesion of stomach Partial gastrectomy with anastomosis to esophagus Partial gastrectomy with anastomosis to duodenum Partial gastrectomy with anastomosis to jejunum Other partial gastrectomy Other operations on stomach Vagatomy . ..^ . , Pyloroplasty Gastroenterostomy (without gastrectomy) Suture of gastric or duodenal ulcer site Revision of gastric anastomosis Other Repair of stomach Other operations on stomach ^^SJ^'! Incision, exicision and anastomosis of intestine Enterotomy Exicision or destruction of lesion of small intestine Exicision or destruction of lesion of large intestine Isolation of intestinal segment Other exicision of small intestine Exicision of large intestine, partial Total colectomy Anastomosis, small to small intestine Anastomosis, small to large intestine Anastomosis, large to large intestine Other operations on intestine Exteriorization of intestine Other enterostomy Repair of intestinal stoma Closure of intestinal stoma Fixation of intestine Other repair of intestine Intra-abdominal manipulation of intestine Other operations on intestine Operations on appendix

• •

ICD-9 C M 40.4 40.5 40.6 40.9 42 42.0 42.0 42.3 42.4 42.5 42.6 42.8 42.89 42.9 43 43.6 43.1 43.1 43.4 43.5 43.6 43.7 43.8 44 44.0 44.2 44.3 44.4 44.5 44.6 44.9 45 45.0 45.3 45.4 45.5 45.6 45.7 45.8 45.91 45.93 45.94 46 46.0 46.3 46.4 46.5 46.6 46.7 46.8 46.9 47


- ^ ^* '''

"-

I

NO. 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 26! 262 263 264 265

NAMA TINDAKAN Drainage of appendix abscess Other Operations on appendix Operations on rectum Proctotomy Proctostomy Local exicision or destruction of rectum Pull-through exicision of rectum Abdominoperineal exicision of rectum Other exicision of rectum Repair of rectum Incision or excision of perirectal tissue Other operations on rectum and perirectal tissue Operations on anus Incision or excision of perianal tissue Incision or excision of anal fistula Other local excisionor destruction of anus Hemorrhoidectomy Division of anal sphincter Other exicision of anus Repair of anus Other operations on anus Operations on liver Hepatotomy Liver transplant Repair of liver Other operations on liver Operations on gallbladder and biliary tract Anastomosis of gallbladder or bile duct Incision of bile ducts, for relief of obtruction for calculus,

ICD-9 C M 47.2 47.9 48 48.0 48.1 48.3 48.4 48.5 48.6 48.7 48.8 48.9 49 49.0 49.1 49.3 49.4 49.5 49.6 49.7 49.9 50 50.0 50.5 50.6 50.9 51 51.3

266

stricture or tumor Other Incision o f bile ducts for drainage,

267 268 269 270 27! 272 273 274 275 276 277 278 279 280

exploration,radiography Local excision or destruction of bile ducts repair of bile ducts Removal of prosthetic appliance from hi le duct Operation on sphincter of oddi Other operations on billiary tract Operations on pancreas Pancreatotomy Partial pancreatectomy Local exicision or destruction of pancreas Marsupialization of pancreatic cyst . Internal drainage of pancreatic cyst Total pancreatectomy Radical pancreaticoduodenectomy Anastomosis o f Pancreatic duct anastomosis to stomach,

51.5 51.6 51.7 51.95 51.8 51.9 52 52.0 52.5 52.2 52.3 52.4 52.6 52.7

281 282 283

jejunum or ileum implant of tube Transplant of pancreas Other operations on pancreas Repairofhemia

52.96 52.8 52.9 53

284 285

Repair of femoral hernia Repair of inguinofemoral hernia with graft or prosthesis

108

I

*

51.4 endoscopy,

o u^,


.;

^"

53.2 53.03

r'-

NO. 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329

NAMATINDAKAN " - - - - - - - - - - - - - - - - =

ICD-9 C M

Bilat repair of femoral hernia Bilat repair of inguinofemoral hernia with graft or prosthesis Repair of other hernia of anterior abdominal wall Repair of other hernia of anterior abdominal wall with graft or

53.3 53.15 53.5

prosthesis Other operations in abdominal region Incision of abdominal parietes Exicision or destruction of abdominal wall and umbilicus Exicision or destruction of peritoneum Division of peritoneal adhesions Suture of abdominal wall and peritoneum Other repair of abdominal wall and peritoneum Other operations in abdominal region Nephrotomy and nephrostomy Pyelotomy and pyelostomy Local exicision or destruction of kidney Total nephrectomy Cystotomy Cystostomy Reconstruction of urinary bladder Urethral meatotomy Repair of urethra Dissection of retroperitoneal tissue Incision of scrotum and tunica vaginalis drainage Excision o f hydrocele ( o f tunica vaginalis) repair o f hydrocele Exicision of varicocele and hydrocele of spermatic cord Unilat oophorectomy Unilat salpingo-oophorectomy Bilat oophorectomy Reconstruction of muscle and tendon Local exicision of lesion of breast Complete mastectomy Other Operation on breast Mastotomy Incision of pilonidal sinus Surgical toilet of wound or infected tissue removal of slough Cytotoxic drug therapy Other arterial injection of cytotoxic drug Pleural instillation of cytotoxic drug Peritoneal instillation of cytotoxic drug Bladder instillation of cytotoxic drug Superficial application of cytotoxic drug Other cytotoxic drug therapy Sclerosing of hemangioma Other sclerosing injection

53.6 54 54.0 54.3 54.4 54.5 54.6 54.7 54.9 55.0 55.1 55.3 55.5 57.1 57.1 57.87 58.1 58.4 59.0 61.0

^

'

61.2 63.1 65.3 65.4 65.5 83.7 85.22 85.44 85.9 85.0 86.03 86.27

39.92 39.92


I

109

IKATAN D O K T E R INDONESIA PERHIMPUNAN D O K T E R S P E S I A L I S BEDAH INDONESIA

IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl Kramat Raya 160, Jakarta Pusat 10430. Telp & Fax. 021 - 3916774 Website: www.ikabi.org Email: [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014 Dewan Parti mbarôan Prol Dr. Sjamsjtiidaiat, SpB SpB-KBD Dr Soerarso Hardjowasito, SpB.SpBTKV MaialHEIIk&Panasahat Prof. Dr Mgclilis Ramli, SpB(K)-Orl( Hslua Prasidium Prof. DR. Dr Paul Tahalele, SpB.SpBTKV


: Dr Maizul Anwar, SpBTKV : Ketua HBTKVI Periode 2012-2014

WlhilKetua/KetuaTflrpilih Dr R. Suhartono, SpBKBV

tIMMia Prof. DR. Dr. Sjnaryo Hardjowidjoto, SpB SpU Kalua Purna Prof. DR. Dr. Sjwandi Sugardi, SpB SpU KsIuaMIBI

Menyerahkan I berkas naskah asli daftar kewenangan klinis profesi H B T K V I kepada: Nama Jabatan


Prof, Dr. Errol U. Hutagaljng, SpB SpOT Pwldlum Dr Urip Muitedjo. SpB PGD Pal Med, ECU Dr. Rizal Pohan. SpB SpOT Dr. Sonar Soni Panigoro, SpB K Onk Df Patriot Muslim, SpU Dr Poerwadi, SpB SpBA Dr R Suhartono, SpBKBV Dr Setyowidi Nugroho, SpB SpBS Dr Nurhayat Usman, SpB KBD Dr. Maizul Anwar, SpB TKV Dr. Isfiandono Dachlan. Msc, SpB, SpBP-RE(K} S^kraljirit Jand^ral Dr. Djoni Darmadjaja, SpB MARS Or Agung Prasmono, SpB SpBTKV.MARS

Untuk dikompilasi menjadi Buku Kompetensi Kewenangan Klinis Dokter Spesialis Bedah Indonesia. Jakarta, I I Februari 2013

pendahara Dr. Barlian Sutedta, SpB KoiP|8i OfaanisaBi. Ugislasi dan Advokasi Dr. HN Nazar, SpB Dr. Chandra Svaras, SpB

Dr MaiitjhAnwar, SpBTKV Ketua HBTKVI

Dr. DjoniiDarmadjaja, SpB.MARS Sekjen I K k B I

Kgml*' Pro(i«l Badah. Aguransi dan PBrp^jakan Dr. Nurhayat Usman. SpB KBD Dr Erawan Wiradisuria. SpB KBD Dr. Henry Boylô Silompul, SpB Dr. InztaArbi, SpB Uprplai Globaiisaaj ft Pâar Baliag Dr dr Fathema D Raciimat, SpB SpBTKV Dr. Huntal Simamora, SpBP-RE Komi»t Komunlkasi dan Pubilkaai DR, Dr. Yefta Munadjal. SpB SpBP-RE[K) Prof. DR. Dr Sri Maliawan, SpBS (K) Dr. Iskandar Budianta, SpB SpBA Komisi Hubungan Dalam Nagiri Prol. DR, Dr Andi Asadul Islam, SpBS Dr. Boyke Sumantri, SpU Dr. Emir T Pasaribu SpB.Onii Komlal Pitavanan Ambulanca 11B Dr ZAIsma, Sp8 DrAgi Satria, SpB KBD OR. Dr Achmad Hidayat, SpB Dr B. Sunoiio, SpB DR. Dr. Triwahyu Mumi, SpB SpBTKV

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia B

111

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH THORAKS KARDIAK DAN VASKULAR (HBTKVI)

113

DAFTAR K O M P E T E N S I DAN K E W E N A N G A N K L I N I S D O K T E R SPESIALIS B E D A H T H O R A K S K A R D I A K DAN V A S K U L A R NO JENIS TINDAKAN EXCISION OF LARYNX 1 Excision or destruction of lesion or tissue of larynx 2 Marsupialization of laryngeal cyst

I C D 9-CM 30 30.0 30.01 î-

3

Other excision or destruction of lesion or tissue of larynx, Stripping of

30.09

4 5 6 7 8

vocal cords Hemilaryngectomy Other partial laryngectomy Epiglottidectomy Vocal cordectomy. Excision of vocal cords Other partial laryngectomy. Excision of laryngeal cartilage

30.1 30.2 30.21 30.22 30.29

9

Complete laryngectomy, Block dissection of larynx (with thyroidectomy)

30.3

(with synchronous tracheostomy), Laryngopharyngectomy 10

Radical laryngectomy. Complete [total] laryngectomy with radical neck

30.4

dissection (with thyroidectomy) (with synchronous tracheostomy) OPERASI PADATRAKEA 11 Trakeostomi temporer, temporary percutaneus dilatational trakeostomy

31.1

12 13 14 15 16

(PDT) Trakeostomi permanen Trakeostomi trakea mediastinum PDT permanen Insisi pada laring dan trakea (Iain - lain) Prosedur diagnostik pada larings dan trakea (laringoskopik/

31.2 31.21 31.29 31.3 31.4

17 18 19 20 21 22 23 24 25 26 27

trakeoskopik) Trakeoskopi melalui stoma artifisial . Laringoskopi atau Trakeoskopi lain - lain Biopsi larings (endoskopik) Biopsi trakea (endoskopik) Biopsi terbuka trakea/larings Prosedur diagnostik yg lain pd laring Prosedur diagnostik yg lain pd trakea Eksisi/destruksi lesi trakea Repair laring Sutur(jahit) laserasi larings Penutupan tistula laring. mis.: Laryngotracheal fistulektomy. Take-down

31.41 31.42 31.43 31.44 31.45 31.48 31.49 31.5 31.6 31.61 31.62

28 29 30

of laringostomi Revisi laringostomi Repair fraktur laring Repair laring yang lain: Aritenoidopeksi, Grat^ laring, Transposisi korda

31.63 31.64 31.69

31 32 33 34 35 36

vokalis Repair & operasi plastik pada trakea Sutur(jahit) laserasi trakea Tutup trakeostomi/fistula trakea Tutup fistula trakeo-esofagus (fistulektomi) Revisi trakeostomi Rekonstruksi trakea dan konstruksi laring artifisial. mis: Trakeoplasti

31.7 31.71 31.72 31.73 31.74 31.75

37 38

dengan laring artifisial Repair dan operasi plastik lain - lain pada trakea Operasi lain pada laring & trakea

31.79 31.9

10 - Berita Acara PP H B T K V i dan PP I K A B I I

115

NO 39 40 41 42 43 44

JENIS TINDAKAN Pemisahan nervus laringeal Adesiolisis pada trakea dan laring Penggantian stent laring atau trakea Injeksi bahan terapetik yg bekerja lokal pada trakea Fistulisasi tracheoesophageal Operasi yang lain pada laring.

I C D 9-CM 31.91 31.92 31.93 31.94 31.95 31.98

mis.: dilatasi laring, Pemisahan web kongenitaipadalaring, Pengangkatan stent laring. 45 Operasi yang lain pada trakea EKSISI PARU DAN BRONKHUS 46 Eksisi/destruksi lokal (simpel) lesi pada bronkhus 47 Endoskopik eksisi atau destruksi lesi atau jaringan pada bronkus 48 Lokal eksisi atau destruksi lesi atau jaringan pada baronkus (Iain-lain) 49 Reseksi bronkhus 50 Lokal eksisi/destruksi lesi/jaringan di paru 51 Eksisi lesi/jaringan paru terbatas (wedge) melalui torakoskopik (VATS) 52 Plikasi jaringan emfisematosa .' 53 Operasi reduksi volume paru 54 Ablasi lesi paru terbuka 55 Ablasi perkutaneus pada lesi atau jaringan paru 56 Ablasi lesi paru dengan torakoskopik/VATS 57 Ablasi Iain-Iain pada lesi atau jaringan paru (unspecified) 58 Termoplasty bronkial bronkoskopik, ablasi pada otot polos saluran nafas Endoskopik eksisi atau destruksi pada lesi atau jaringan paru Reseksi baji (wedge resection) paru Reseksi segmental paru, lobektomi parsial Reseksi segmental paru dengan torakoskopik/VATS Reseksi paru segmental lain - lain (unspecified) Lobektomi paru, bilobektomi Lobektomi dengan torakoskopik/VATS Lobektomi paru (Iain-lain) Pneumonektomi komplit Pneumonektomi dengan torakoskopik Pneumoektomi lain - lain (unspecified) Diseksi radikal struktur toraks Eksisi paru (Iain-lain) Insisi bronkhus Insisi paru Prosedur diagnostik pada paru dan bronkhus Biopsi paru dengan torakoskopik/VATS Bronkoskopi melalui stoma artifisial Bronkoskopi Bronkoskopi Iain-lain "' Biopsi tertutup (endoskopik) pada bronkus ^ Biopsi bronkhus terbuka . , Biopsi paru per kutan (FNA, TTNB) '^'^ ' Biopsi tertutup (endoskopik) pada paru Biopsi paru terbuka Prosedur diagnostik yang lain pada paru dan bronkus

59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84

116

I


31.99 32.0 32.01 32.09 32.1 32.2 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.3 32.30 32.39 32.4 32.41 32.49 32.5 32.50 32.59 32,6 32.9 33.0 33.1 33.2 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29

NO JENIS TINDAKAN OPERASI LAIN PADA PARU 85 Operasi untuk paru kolaps 86 Destruksi nervus frenikus untuk paru kolaps 87 AirPlumbage 88 Pneumoperitoneum untuk paru kolaps 89 Torakoplasti 90 Muscle plumbage, operasi kolaps paru lainnya 91 Jahit laserasi bronkhus 92 Tutup fistula bronkhus (fistulectomy), tutup bronkostomi 93 Repair laserasi paru 94 Repair dan operasi plastik yang Iain pada bronkus 95 Repair dan operasi plastik yang Iain pada paru 96 Transplantasi paru 97 Transplantasi paru (not otherwise specified) 98 Transplantasi paru unilat 99 Transplantasi paru bilat 100 Transpalantasi paru-jantung 101 Prosedur endoskopik iain-lain pada bronkus dan paru lb2 Insersi atau penggantian katup bronkial endoskopik, satu lobus 103 Pengukuran aliran udara di paru secara endoskopik 104 Insersi atau penggantian katup bronkial endoskopik, multi lobus 105 Pelepasan alat atau bahan pada bronkial secara endoskopik 106 Insersi alat atau bahan pada bronkial lainnya secara endoskopik 107 Operasi lainnya pada paru dan bronkus 108 Dilatasi bronkus 109 Ligasi bronkus 110 Puncture/penusukan paru 111 Operasi lainnya pada bronkus 112 Operasi lainnya pada paru OPERASI PADA DINDING DADA, PLEURA, MEDIASTINUM DAN DIAFRAGMA 113 Insisi pada dinding dada dan pleura 114 Insisi dinding dada, drainase ekstrapleura dinding dada 115 Torakotomi Eksplorasi 116 Redo Torakotomi 117 Pemasangan drainase toraks (WSD, kateter) 118 Shunt pleuro-peritoneal 119 Drainase empiema/ efusi dengan torakoskopik/VATS 120 Prosedur Open Window, Eloeser Flap 121 Prosedur Diagnotik Pada Dinding Dada, Pleura, Mediastinum, dan 122 123 124 125 126 127 128 129 130

Diafiâgma Diagnostik pada Timus Biopsi timus Diagnostik lain pada timus Timektomi Eksisi timus parsial terbuka Eksisi timus total terbuka Operasi lain pada timus Eksplorasi timus Insisi pada timus

I C D 9-CM 33.3 33.31 33.32 33.33 33.34 33.39 33.41 33.42 33.43 33.48 33.49 33.5 33.50 33.51 33.52 33.6 33.7 33.71 33.72 33.73 33.78 33.79 33.9 33.91 33.92 33.93 33.98 33.99

34.0 34.01 34.02 34.03 34.04 34.05 34.06 34.09 34.2 07.1 07.16 07.19 07.80 07.81 07.82 07.9 07.91 07.92

10 - Berita Acara PP H B T K V I dan PP I K A B I I

117

NO 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168

JENIS TINDAKAN Repair timus Transplantasi timus Lain - lain (timopeksi) Biopsi pleura dengan torakoskopik/VATS Torakoskopik transpleura Mediastinoskopi Biopsi dinding dada Biopsi pleura lainnya Biopsi mediastinum per kutan Biopsi mediastinum terbuka Biopsi diatragma Prosedur diagnostik lainnya pada dinding dada, pleura dan diafragma Prosedur diagnostik lainnya pada mediastinum Operasi Pada Dinding Dada Dan Pleura Eksisi/destruksi lesi/jaringan di mediastinum Eksisi/destruksi lesi/jaringan di dinding dada Pleurektomi Dekortikasi Dekortikasi dengan torakoskopik/VATS . Eksisi lesi pada pleura Pleurodesis (terbuka) Repair dinding dada Repair (jahit) laserasi dinding dada Tutup torakostomi Tutup /repair fistula dinding dada (bronko-pleura-kutan) Repair Pektus Karinatum/'Ekskavatum Repair kelainan dindidng dada lainnya Operasi pada Diafiâgma Eksisi lesi/jaringan pada diafi'agma Repair laserasi diafi'agma Repair fistula diafi'agma Plikasi diafi'agma, repair lain diafi-agma Impiantasi pace maker diafi'agma Operasi diafi'agma lainnya Operasi lainnya pada toraks Torakosistesis Pleurodesis Repair pleura Lainnya*

169

Operations on valves and septa of heart. Includes: stemotomy (median)

170 171 172 173 174 175

(transverse) as operative approach thoracotomy as operative approach Closed heart valvotomy Closed heart valvotomy, unspecified valve Closed heart valvotomy, aortic valve Closed heart valvotomy, mitral valve Closed heart valvotomy, pulmonary valve Closed heart valvotomy, tricuspid valve

35.0 35.00 35.01 35.02 35.03 35.04

176

Open heart valvuloplasty without replacement. Includes: open heart

35.1

177 178 179

valvotomy Open heart valvuloplasty without replacement, unspecified valve Open heart valvuloplasty of aortic valve without replacement Open heart valvuloplasty of mitral valve without replacement

35.10 35.11 35.12

118

I


I C D 9-CM 07.93 07.94 07.99 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.3 34.4 34.5 34.51 34.52 34.59 34.6 34.7 34.71 34.72 34.73 34.74 34.79 34.8 34.81 34.82 34.83 34.84 34.85 34.89 34.9 34.91 34.92 34.93 34.99 35

NO 180 181 182 183 184

185

JENIS TINDAKAN Open heart valvuloplasty of pulmonary valve without replacement Open heart valvuloplasty of tricuspid valve without replacement Replacement of heart valve. Includes: excision of heart valve with replacement Replacement of unspecified heart valve, Repair of unspecified heart valve with tissue graft or prosthetic implant Replacement of aortic valve with tissue graft Repair o f aortic valve w i t h tissue graft ( a u t o g r a f t ) (heterograft)(homograft) Other replacement of aortic valve

I C D 9-CM 35.13 35.14 35.2 35.20 35.21

35.22

Repair of aortic valve with replacement: NOS, prosthetic (partial) (synthetic) (total) 186

Replacement of mitral valve with tissue graft Repair

of

mitral

valve

with

tissue

35.23 graft

(autograft)

(heterograft)(homograft) 187

Other replacement of mitral valve

35.24

Repair o f mitral valve with replacement: NOS, prosthetic (partial) (synthetic) (total) 188

Replacement of pulmonary valve with tissue graft

35.25

Repair of pulmonary valve with tissue graft (autograft) (heterograft) 189

190

191

192 193

(homograft) Other replacement of pulmonary valve Repair of pulmonary valve with replacement: NOS, prosthetic (partial) (synthetic) (total) Replacement of tricuspid valve with tissue graft Repair o f tricuspid valve w i t h tissue graft (autograft) (heterograft)(homograft) Other replacement of tricuspid valve Repair of tricuspid valve with replacement: NOS, prosthetic (partial) (synthetic) (total) Operations on structures adjacent to heart valves Operations on papillary muscle, Division o f papillary muscle, Reattachment of papillary muscle Repair of papillary muscle

35.26

35.27

35.28

35.3 35.31

194

Operations on chordae tendineae, Division of chordae tendineae. Repair

35.32

195 196 197

of chordae tendineae Annuloplasty, Plication of annulus Infundibulectomy, Right ventricular infundibulectomy Operations on trabeculae cameae cordis, Division of trabeculae cameae

35.33 35.34 35.35

cordis. Excision o f trabeculae carneae cordis, Excision of aortic subvalvular ring 198

Operations on other strucfiares adjacent to valves of heart. Repair of sinus

35.39

199 200

of Valsalva (aneurysm) Production of septal defect in heart Enlargement o f existing atrial septal defect. Septostomy (atrial)

35.4 35.41

201 202

(balloon)Rashkind procedure Creation of septal defect in heart, Blalock-Hanlon operation Repair of atrial and ventricular septa with prosthesis,

35.42 35.5

Includes: repair of septa with synthetic implant or patch


119

NO 203 204

JENIS TINDAKAN Repair of unspecified septal defect of heart with prosthesis Repair o f atrial septal defect with prosthesis, open technique. Atrioseptoplasty with prosthesis Correction of atrial septal defect with prosthesis. Repair: foramen ovale (patent) with prosthesis ostium secundum defect with prosthesis

205

Repair of atrial septal defect with prosthesis, closed technique Insertion of atrial septal umbrella [King-Mills]

206

Repair of ventricular septal defect with prosthesis, open technique. Correction o f ventricular septal defect with prosthesis. Repair of supracristal defect with prosthesis

207

Repair of endocardial cushion defect with prosthesis Repair: atrioventricular canal with prosthesis (grafted to septa), ostium primum defect with prosthesis (grafted to septa), valvular defect associated with atrial and ventricular septal defects with prosthesis (grafted to septa) Repair of ventricular septal defect with prosthesis, closed technique Repair of atrial and ventricular septa with tissue graft Repair of unspecified septal defect of heart with tissue graft Repair of atrial septal defect with tissue graft, Atrioseptoplasty with

208 209 210 211

tissue graft Correction of atrial septal defect with tissue graft Repair: foramen ovale (patent) with tissue graft, ostium secundum defect with tissue graft 212

Repair of ventricular septal defect with tissue graft. Correction o f ventricular septal defect with tissue graft. Repair of supracristal defect with tissue graft

213

Repair of endocardial cushion defect with tissue graft Repair of: atrioventricular canal with tissue graft, ostium primum defect with tissue graft, valvular defect associated with atrial and ventricular septal defects with tissue graft Other and unspecified repair of atrial and ventricular septa Other and unspecified repair of unspecified septal defect of heart. Repair of septal defect NOS Other and unspecified repair of atrial septal defect Repair NOS: atrial septum, foramen ovale (patent), ostium secundum defect Other and unspecified repair of ventricular septal defect Repair NOS: supracristal defect, ventricular septum Other and unspecified repair of endocardial cushion defect. Repair NOS: atrioventricular canal, ostium primum defect, valvular defect associated with atrial and ventricular septal defects Total repair of certain congenital cardiac anomalies

214

215

216 217

218

Note: For partial repair of defect [e.g. repair of atrial septal defect in tetralogy of Fallot] ~ code to specific procedure

120

I


m 219

JENIS TINDAKAN

' ..mmwm^w^':

Total repair of tetralogy of Fallot

ICD9-CM 35.81

One-stage total correction o f tetralogy o f Fallot with or without: commissurotomy of pulmonary valve. Infundibulectomy, outflow tract prosthesis, patch graft of outflow tract, prosthetic tube for pulmonary artery, repair of ventricular septal defect (with prosthesis), take-down of previous systemic-pulmonary artery anastomosis 220

Total repair of total anomalous pulmonary venous connection

35.82

One-stage total correction o f total anomalous pulmonary venous connection with or without: anastomosis between (horizontal) common pulmonary trunk and posterior wall of left atrium (side-to-side) enlargement of foramen ovale incision [excision] of common wall between posterior left atrium and coronary sinus and roofing of resultant defect with patch graft (synthetic) ligation o f venous connection (descending anomalous vein) (to left innominate vein) (to superior vena cava), repair of atrial septal defect (with prosthesis) 221

Total repair of truncus arteriosus

35.83

One-stage total correction o f truncus arteriosus with or without: construction (with aortic homograft) (with prosthesis) of a pulmonary artery placed from right ventricle to arteries supplying the lung ligation of connections between aorta and pulmonary artery repair of ventricular septal defect (with prosthesis) 222

Total correction o f transposition o f great vessels, not elsewhere

35.84

Classified Arterial switch operation [Jatene] Total correction of transposition of great arteries at the arterial level by switching the great arteries, including the left or both coronary 223 224

arteries, implanted in the wall of the pulmonary artery Other operations on valves and septa of heart Interatrial transposition of venous return; Bangkatle: Atrial, Interatrial;

35.9 35.91

Mustard's operation Resection o f atrial septum and insertion of patch to direct systemic venous return to tricuspid valve and pulmonary venousretum to mitral valve 225

Creation o f conduit between right ventricle and pulmonary artery;

35.92

Creation of shunt between right ventricle and (distal) pulmonary artery; Creation of conduit between left ventricle and aorta

226 227

Creation of apicoaortic shunt; Shunt between apex of left ventricle and aorta Prosedur Shunt Ventrikel Kiri-Aorta Creation of conduit between atrium and pulmonary artery; Fontan

35.93 35.94

procedure 228

Revision of corrective procedure on heart; Replacement of prosthetic

35.95

heart valve poppet Resuture of prosthesis of: Septum, Valve


121

NO 229 230 231 232

JENIS TINDAKAN Percutaneous valvuloplasty; Percutaneous balloon valvuloplasty Other operations on septa of heart Other operations on valves of heart Operations on vessels of heart. Includes: stemotomy (median) (transverse) as operative approach thoracotomy as operative approach Removal of coronary artery obstruction and insertion of stent(s) Open chest coronary artery angioplasty; Coronary (artery): endarterectomy (with patch graft) thromboendarterectomy (with patch graft), Open surgery for direct relief of coronary artery obstruction Intracoronary artery thrombolytic infusion That by direct coronary artery injection, infusion, or catheterization, enzyme infusion. Platelet inhibitor Insertion of non-drug-eluting coronary artery stent(s); Bare stent(s); Bonded stent(s); Drug-coated stent(s), i.e. heparin coated; Endograft(s); Endovascular graft(s); Stent grafts

233 234

235

236

237

239

Insertion o f drug-eluting coronary artery stent(s); Endograft(s); Endovascular graft(s); Stent graft(s) Other removal of coronary artery obstruction; Coronary angioplasty NOS Bypass anastomosis for heart revascularization; CABG

240

Aortocoronary bypass for heart revascularization, not otherwise

238

Specified Direct revascularization: cardiac with catheter stent, prosthesis, or vein graft coronary with catheter stent, prosthesis, or vein graft heart muscle with catheter stent, prosthesis, or vein graft myocardial with catheter stent, prosthesis, or vein graft; Heart revascularization NOS (Aorto)coronary bypass of one coronary artery (Aorto)coronary bypass of two coronary arteries (Aorto)coronary bypass of three coronary arteries (Aorto)coronary bypass of four or more coronary arteries Single internal mammary-coronary artery bypass

241 242 243 244 245

Anastomosis (single): mammary artery to coronary artery, thoracic artery

248

to coronary artery Double internal mammary-coronary artery bypass Anastomosis, double: mammary artery to coronary artery; thoracic artery to coronary artery Abdominal - coronary artery bypass; Anastomosis: Gastroepiploic coronary artery; Other bypass anastomosis for heart revascularization

249

Heart revascularization by arterial implant

246

247

Implantation of: aortic branches [ascending aortic branches] into heart muscle, blood vessels into myocardium, internal mammary artery [internal thoracic artery] into: heart muscle, Myocardium, Ventricle, ventricular wall; Indirect heart revascularization NOS Other heart revascularization Open chest transmyocardial revascularization

250 251

122

I


NO 252 253

JENIS TINDAKAN Other transmyocardial revascularization Endoscopic transmyocardial revascularization; Robot-assisted

I C D 9-CM 36.32 36.33

transmyocardial revascularization Thoracoscopic transmyocardial revascularization 254

Percutaneous transmyocardial revascularization; Endovascular

255

Other heart revascularization, Abrasion o f epicardium, Cardio-

36.34

transmyocardial revascularization 36.39

omentopexy, Intrapericardial poudrage, Myocardial graft: mediastinal 256 257 258

fat, omentum, pectoral muscles Other operations on vessels of heart Repair of aneurysm of coronary vessel Other operations on vessels of heart, Exploration of coronary artery,

36.9 36.91 36.99

Incision of coronary artery Ligation of coronary artery. Repair of arteriovenous fistula Other operations on heart and pericardium Pericardiocentesis Cardiotomy and pericardiotomy Incision of heart, not otherwise specified, Cardiolysis NOS Cardiotomy, Incision of: Atrium, Endocardium, Myocardium, Ventricle

37 37.0 37.1 37.10 37.11

264

Pericardiotomy, Pericardial window operation, Pericardiolysis,

37.12

265 266 267

Pericardiotomy Biopsy of pericardium Biopsy of heart Pericardiectomy and excision of lesion of heart

37.24 37.25 37.3

268

Pericardiectomy, Excision of: adhesions of pericardium constricting scar

37.31

269 270

of: Epicardium, Pericardium Excision of aneurysm of heart. Repair of aneurysm of heart Excision or destruction of other lesion or tissue of heart,open approach.

37.32 37.33

259 260 261 262 263

Ablation of heart tissue (cryoablation) (electrocurrent) (laser) (microwave) (radiofrequency) (resection), open chest approach. Cox-maze procedure. Maze procedure. Modified maze procedure, trans-thoracic approach 271

Excision or destruction of other lesion or tissue of heart,other approach.

37.34

Ablation of heart tissue (cryoablation) (electrocurrentXlaser) (microwave) (radiofrequency) (resection), via peripherally inserted catheter. Modified maze procedure, endovascular approach 272

Partial ventriculectomy. Ventricular reduction surgery. Ventricular

37.35

273 274

remodeling Repair of heart and pericardium Implantation of prosthetic cardiac support device around the heart.

37.4 37.41

Cardiac support device (CSD) Epicardial support device. Fabric (textile) (mesh) device. Ventricular 275 276 277 278

support device on surface of heart Other repair of heart and pericardium Heart replacement procedures Heart transplantation Implantation o f total replacement heart system. Artificial heart.

37.49 37.5 37.51 37.52

Implantation o f fully implantable total replacement heart system, including ventriculectomy 279

Replacement or repair o f thoracic unit o f total replacement heart

37.53

system 10 ~ Benta Acara PP H B T K V I dan PP I K A B I I

123

NO 280

JENIS TINDAKAN Replacement or repair o f other implantable component o f total replacement heart system Implantable battery. Implantable controller. Transcutaneous energy transfer [TET] device Implantation of heart and circulatory assist system Implant of pulsation balloon. Pemasangan lABP Insertion of non-implantable heart assist system. Insertion of heart assist

281 282 283

system, NOS Insertion of heart pump 284

Repair of heart assist system. Replacement o f parts of an existing

285 286

ventricular assist device (VAD) Removal of heart assist system Implant of external heart assist system Note: Device (outside the body but connected to heart) with external circulation and pump. Includes open chest (stemotomy) procedure for cannulae attachments

287

Insertion of implantable heart assist system. Axial flow heart assist system. Diagonal pump heart assist system. Left ventricular assist device (LVAD). Pulsatile heart assist system. Right ventricular assist device (RVAD). Rotary pump heart assist system. Transportable, implantable heart assist system. Ventricular assist device (VAD) not otherwise specified. Note: Device directly connected to the heart and implanted in the upper left quadrant of peritoneal cavity. This device can be used for either destination therapy (DT) or bridgeto-transplant (BTT)

288

Implantation of cardiomyostimulation system. Note: Two-step open procedure consisting of transfer of one end of the latissimus dorsi muscle; wrapping it around the heart; rib resection; implantation of epicardial cardiac pacing leads into the right ventricle; tunneling and pocket creation for the cardiomyostimulator.

289

Insertion o f percutaneous external heart assist device. Includes percutaneous [femoral] insertion of cannulae attachments. Circulatory assist device. Extrinsic heart assist device VAD. Percutaneous heart assist device

290

Insertion, revision, replacement, and removal of leads; insertion o f temporary pacemaker system; or revision of cardiac device pocket

291

Initial insertion of lead [electrode], not otherwise specified

292 293

Pemasangan Pacemaker Temporer Initial insertion of transvenous lead [electrode] into ventricle Initial insertion of transvenous leads [electrodes] into atrium and

294 295

ventricle Initial insertion of transvenous lead [electrode] into atrium Insertion or replacement of epicardial lead [electrode] into Epicardium. Insertion or replacement of epicardial by: Stemotomy, Thoracotomy

124

I


NO 296

JENIS TINDAKAN Revision of lead [electrode]. Repair of electrode [removal with re-

I C D 9-CM 37.75

insertion]. Repositioning of lead(s) (AICD) (cardiac device) (CRT-D) (CRT-P). (defibrillator) (pacemaker) (pacing) (sensing) [electrode]. Revision of lead NOS 297

Replacement of transvenous atrial and/or ventricular lead(s) [electrode].

37.76

Removal or abandonment of existing transvenous or epicardial lead(s) with transvenous lead(s) replacement 298

Removal of lead(s) [electrode] without replacement. Removal: epicardial

37.77

lead (transthoracic approach) transvenous lead(s) 299

Revision or relocation of pacemaker pocket. Debridement and reforming

37.79

pocket (skin and subcutaneous tissue). Insertion o f loop recorder. Relocation of pocket [creation of new pocket] pacemaker or CRT-P. Removal of cardiac device/pulse generator without replacement. Removal of the implantable hemodynamic presssure sensor (lead) and monitor device. Removal without replacement of cardiac resynchronization defibrillator device. Repositioning of implantable hemodynamic pressure sensor (lead) and monitor device. Repositioning o f pulse generator. Revision of cardioverter/defibrillator (automatic) pocket. Revision of pocket for intracardiac hemodynamic monitoring. Revision or relocation of CRT-D pocket. Revision or relocation of pacemaker, defibrillator, or other implanted cardiac device pocket 300

Insertion, replacement, removal, and revision of pacemaker device

37.8

Note: Device testing during procedure - omit code 301

Insertion of permanent pacemaker, initial or replacement, type of device

37.80

not specified 302

Initial insertion o f single-chamber device, not specified as rate

37.81

responsive 303

Initial insertion of single-chamber device, rate responsive.

37.82

Rate responsive to physiologic stimuli other than atrial rate 304

Initial insertion of dual-chamber device. Atrial ventricular sequential

37.83

device 305

Replacement of any type pacemaker device with single-chamber

37.85

device, not specified as rate responsive 306

Replacement of any type of pacemaker device with singlechamber

37.86

device, rate responsive . Rate responsive to physiologic stimuli other than atrial rate 307

Replacement of any type pacemaker device with dual-chamber device.

37.87

Atrial ventricular sequential device 308

Revision or removal of pacemaker device

37.89

Removal without replacement of cardiac resynchronization pacemaker 309 310

device [CRT-P] Other operations on heart and pericardium Insertion of left atrial appendage device. Left atrial fiher. Left atrial

37.9 37.90

311 312

occluder. Transsepta! catheter technique Open chest cardiac massage Injection of therapeutic substance into heart

37.91 37.92

10 - Berita Acara PP H B T K V i dan PP I K A B I I

125

NO 313 314

JENIS TINDAKAN Injection of therapeutic substance into pericardium Implantation or replacement of automatic cardioverter/ defibrillator, total

I C D 9-CM 37.93 37.94

system [AICD] Implantation of defibrillator with leads (epicardial patches), formation of pocket (abdominal fascia) (subcutaneous), any transvenous leads, intraoperative procedures for evaluation of lead signals, and obtaining defibrillator threshold measurements Techniques: lateral thoracotomy, medial sternotomy, subxiphoid procedure Implantation of automatic cardioverter/defibrillator lead(s) only Implantation of automatic cardioverter/defibrillator pulse generator only

315 316 317

Replacement of automatic cardioverter/defibrillator lead(s) only Replacement of automatic cardioverter/defibrillator pulse generator only Other Incision, excision, and occlusion of vessels Incision of vessel: Embolectomy, Thrombectomy Endarterectomy. Endarterectomy with: Embolectomy, patch graft temporary bypass during procedure. Thrombectomy

318 319 320 321

37.95 37.96 37.97 37.98 37.99 38 38.0 38.1

322 323 324 325 326 327 328

Diagnostic procedures on blood vessels Biopsy of blood vessel Percutaneous angioscopy Spektroskopi intra vaskular* Imaging koroner intra vaskular dengan optikal koherens tomografi* Imaging non koroner intra vaskular dengan optikalkoherens tomografi* Insersi sensor tekanan implantabel tanpa lead untukmonitoring hemodinamik intra kardiak dan pembuluh darah besar*

38.2 38.21 38.22 38.23 38.24 38.25 38.26

329 330

Other diagnostic procedures on blood vessels Resection of vessel with anastomosis. Angiectomy Excision of: aneurysm (arteriovenous) with anastomosis blood vessel (lesion) with anastomosis

38.29 38.3

Resection of vessel with replacement. Angiectomy. Excision of:

38.4

331

aneurysm (arteriovenous) or blood vessel (lesion) with replacement. Partial resection with replacement Ligation and stripping of varicose veins Other excision of vessel. Excision of blood vessel (lesion) NOS Interruption of the vena cava. Insertion of implant or sieve in vena cava. Ligation of vena cava (inferior) (superior). Plication of vena cava Other surgical occlusion of vessels. Clamping of blood vessel. Division of blood vessel. Ligation of blood vessel. Occlusion of blood vessel

332 333 334 335 336 337 338 339 340 341

126

Puncture of vessel Arterial catheterization Umbilical vein catheterization Venous catheterization, not elsewhere classified Venous cutdown Kateterisasi vena untuk dialisa ginjal

I


38.5 38.6 38.7 38.8 38.9 38.91 38.92 38.93 38.94 38.95

NO 342 343 344 345 346

JENIS TINDAKAN Pemasangan kateter vena sentral dengan tuntunan: EKG, fluoroskopi, ultrasound Penusukan arteri lainnya Flebotomi Other operations on vessels Systemic to pulmonary artery shunt. Descending aorta-pulmonary artery anastomosis (graft)

Left to right anastomosis (graft). Subclavian-pulmonary anastomosis (graft) 347 Shunt Vena Intra Abdominal (portocavaJ, mesocaval, portal ~- vena cava inferior) 348 Other shunt or vascular bypass 349 Caval-pulmonary artery anastomosis 350 Aorta-subclavian-carotid bypass. Bypass (arterial): aorta to carotid and

I C D 9-CM 38.97 38.98 38.99 39 39.0

39.1 39.2 39.21 39.22

brachial, aorta to subclavian and carotid, carotid to subclavian 351 352 353 354

355

356 357

Other intrathoracic vascular shunt or bypass. Intrathoracic (arterial) bypass graft NOS Aorta-renal bypass Aorta-iliac-femoral bypass. Bypass: Aortofemoral, Aortoiliac, aortoihac to popliteal, Aortopopliteal, iliofemoral [iliac-femoral] Other intra-abdominal vascular shunt or bypass. Bypass: Aortoceliac, aortic-superior mesenteric common hepatic-common iliac-renal. Intra-abdominal arterial bypass graft NOS Arteriovenostomy for renal dialysis. Anastomosis for renal dialysis, Formation of (peripheral) arteriovenous fistula for renal [kidney] dialysis Extracranial-intracranial (EC-IC) vascular bypass Other (peripheral) vascular shunt or bypass. Bypass (graft): axillary-

39.23 39.24 39.25 39.26

39.27

39.28 39.29

brachial, axillary-femoral [axiliofemoral] (superficial), Brachial, femoralfemoral, Femoroperoneal, femoropopliteal (arteries), femorotibial 358 359 360 361 362 363 364

(anterior) (posterior), Popliteal, vascular NOS Suture of vessel. Repair of laceration of blood vessel Suture of unspecified blood vessel Suture of artery Suture of vein Revision of vascular procedure Control of hemorrhage following vascular surgery Revision of arteriovenous shunt for renal dialysis. Conversion of renal

39.3 39.30 39.31 39.32 39.4 39.41 39.42

dialysis: end-to-end anastomosis to end-to-side, end-to-side anastomosis to end-to-end, vessel-to-vessel cannula to arteriovenous shunt. Removal 365 366

of old arteriovenous shunt and creation of new shunt Removal of arteriovenous shunt for renal dialysis Other revision of vascular procedure. Declotting (graft). Revision of:

39.43 39.49

anastomosis of blood vessel 367

vascular procedure (previous) Other repair of vessels

39.5

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127

NO 368

JENIS TINDAKAN Angioplasty or atherectomy of other non-coronary vessel(s). Percutaneous transluminal angioplasty (PTA) of non-coronary vessels: Lower extremity vessels, Mesenteric artery. Renal artery. Upper extremity vessels. Code also any: injection or infusion of thrombolytic agent (99.10), Insertion of non-coronary stent(s) or stent grafts(s) (39.90), percutaneous insertion of carotid artery stent(s) (00.63), number of vascular stents inserted (00.45-00.48), number of vessels treated (00.40-00.43), procedure on vessel bifurcation (00.44) Clipping of aneurysm Other repair o f aneurysm. Repair o f aneurysm by: Coagulation,

369 370

Electrocoagulation, Filipuncture, methyl methacrylate. Suture, Wiring, Wrapping 371

Repair of arteriovenous fistula. Embolization of carotid cavernous fistula. Repair of arteriovenous fistula by: Clipping, Coagulation, ligation and division

372

Re-entry operation (aorta). Fenestration o f dissecting aneurysm of

373 374 375 376 377

thoracic aorta Reimplantation of aberrant renal vessel Repair of blood vessel with tissue patch graft Repair of blood vessel with synthetic patch grai^ Repair of blood vessel with unspecified type of patch graft Other repair of vessel. Aorticopulmonary window operation. Arterioplasty NOS. Construction of venous valves (peripheral). Plication of vein

378 379

(peripheral). Reimplantation of artery Extracorporeal circulation and procedures auxiliary to heart surgery Extracorporeal circulation auxiliary to open heart surgery. Artificial heart

380 381 382

and lung. Cardiopulmonary bypass. Pump oxygenator Hypothermia (systemic) incidental to open heart surgery Cardioplegia. Arrest: Anoxic, Circulatory Intraoperative cardiac pacemaker. Temporary pacemaker used during and immediately following cardiac

383 384 385

surgery Extracorporeal membrane oxygenation [ECMO] Percutaneous cardiopulmonary bypass. Closed chest Endovascular repair of vessel. Endoluminal repair

386

Endovascular implantation of graft in abdominal aorta. Endovascular repair of abdominal aortic aneurysm with graft. Stent graft(s)

387

Endovascular repair or occlusion of head and neck vessels. Coil embolization or occlusion Endograft(s). Endovascular graft(s). Liquid tissue adhesive (glue) embolization or occlusion Other implant or substance for repair, embolization or occlusion that for repair of aneurysm, arteriovenous malformation[AVM] or fistula

388

Endovascular implantation of graft in thoracic aorta. Endograft(s). Endovascular graft(s). Endovascular repair of defect of thoracic aorta with graft(s) or device(s). Stent graft(s) or device(s) that for repair of aneurysm, dissection, or injury

128

I


NO 389

JENIS TINDAKAN Endovascular removal of obstruction from head and neck vessel(s).

I C D 9-CM 39.74

Endovascular embolectomy Endovascular thrombectomy of pre-cerebral and cerebral vessels. Mechanical embolectomy or thrombectomy 390

Other endovascular repair ( o f aneurysm) o f other vessels. Coil

39.79

embolization or occlusion. Endograft(s), Endovascular graft(s). Liquid tissue adhesive (glue) embolization or occlusion. Other implant or substance for repair, embolization or occlusion 391

Operations on carotid body and other vascular bodies. Chemodectomy.

39.8

Denervation of: aortic body, carotid body, Glomectomy, carotid. Implantation into carotid body: electronic stimulator. 392 393

Pacemaker Other operations on vessels Insertion of non-drug-eluting peripheral vessel stent(s). Bare stent(s),

39.9 39.90

Bonded stent(s). Drug-coated stent(s), i.e., heparin coated, Endograft(s), Endovascular graft(s). Endovascular recanalization techniques. Stent graft(s) 394

Freeing of vessel. Dissection and freeing of adherent tissue: artery-vein-

39.91

395 396

nerve bundle, vascular bundle Injection of sclerosing agent into vein Insertion of vessel-to-vessel cannula. Formation of: arteriovenous: fistula

39.92 39.93

by external cannula, 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414

shunt by external cannula. Code also any renal dialysis (39.95) Replacement of vessel-to-vessel cannula. Revision of vessel-to-vessel cannula Hemodialysis. Artificial kidney. Hemodiafiltration. Hemofiltration. Renal dialysis Total body perfusion. Code also substance perfused (99.21 -99.29) Other perfusion. Perfusion NOS. Perfiision, local [regional] of: carotid artery, coronary artery. Head, lower limb, Neck, upper limb Control of hemorrhage, not otherwise specified. Angiotripsy. Control of postoperative hemorrhage NOS. Venotripsy Other operations on vessels Operations on lymphatic system Incision of lymphatic structures Diagnostic procedures on lymphatic structures Biopsy of lymphatic structure Other diagnostic procedures on lymphatic structures Simple excision of lymphatic structure Excision of deep cervical lymph node Excision of internal mammary lymph node • Eksisi limf node aksiler Eksisi limf node inguinal Simple excision of other lymphatic structure. Excision of: cystic hygroma, lymphangioma. Simple lymphadenectomy Regional lymph node excision. Extended regional lymph node excision. Regional lymph node excision with excision of lymphatic drainage area including skin, subcutaneous tissue, and fat

39.94 39.95 39.96 39.97 39.98 39.99 40 40.0 40.1 40/11 40.19 40.2 40.21 40.22 40.23 40.24 40.29 40.3

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NO 415

JENIS TINDAKAN Eksisi radikal limf node leher*. Reseksi limf node servikal hingga otot

I C D 9-CM 40.4

416 417 418 419 420

dan fasia dalam Diseksi leher radikal Diseksi leher radikal, unilat Diseksi leher radikal, bilat Radical excision of other lymph nodes Radical excision of lymph nodes, not otherwise specified. Radical

40.40 40.41 40.42 40.5 40.50

421 422 423 424 425 426 427 428 429 430 431 432

(lymph) node dissection NOS Radical excision of axillary lymph nodes Radical excision of periaortic lymph nodes Radical excision of iliac lymph nodes Radical groin dissection Radical excision of other lymph nodes Operations on thoracic duct Carmulation of thoracic duct Fistulization of thoracic duct Closure of fistula of thoracic duct Ligation of thoracic duct Other operations on thoracic duct Other operations on lymphatic structures. Anastomosis o f peripheral

40.51 40.52 40.53 40.54 40.59 40.6 40.61 40.62 40.63 40.64 40.69 40.9

lymphatics. Dilation of peripheral lymphatics. Ligation of peripheral lymphatics. Obliteration of peripheral lymphatics Reconstruction of peripheral lymphatics. Repair of peripheral lymphatics. Transplantation of peripheral lymphatics. Correction of lymphedema of 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447

limb, NOS Operations on bone marrow and spleen Operasi Pada Esofagus (Servikal dan Torakal) Esofagotomi Insisi Web esofagus Insisi lain - lain pada esofagus (Unclasified) Esofagostomi Esofagostomi (unclasified) Esofagostomi Servikal Eksteriorasi kantong esofagus Esofagostomi Torakal Prosedur diagnostik pada esofagus Esofagoskopi operatif melalui insisi Esofagoskopi melalui stoma artifisial Esofagoskopi lain - lain Biopsi tertutup esofagus (endoskopik)

448 449 450 451 452

pada esofagus Biopsi esofagus terbuka Prosedur diagnostik lain pada esofagus Eksisi lokal/destruksi lesi pada esofagus Eksisi divertikulum esofagus Eksisi lokal pada lesi atau jaringan lain pada esofagus

41 42 42.0 42.01 42.09 42.1 42.10 42.11 42.12 42.19 42.2 42.21 42.22 42.23 42.24

Sikatan atau cuci spesimen, esofagoskopi dengan biopsi, biopsi hisapan

130

I


42.25 42.29 42.3 42.31 42.32

. j.

NO 453

JENIS TINDAKAN Eksisi atau destruksi pada lesi atau jaringan pada esofagus secara

I C D 9-CM 42.33

endoskopik Pendekatan endoskopik pada: ablasi neoplasma esofagus, kontrol

-^f-

perdarahan esofagus, polipektomi esofagus, varisesesofagus, injeksi 454 455 456 457 458 459 460 461 462 463 464 465 466

varises esofagus Destruksi lesi atau jaringan lain - lain pada esofagus Esofagektomi Parsial Esofagektomi Total Rekonstruksi (anastomosis) esofagus intratorakal Rekonstruksi (anastomosis) esofagus antesternal Esofagomiotomi Insersi Tube Permanen Esofagus Repair laserasi esofagus Tutup esofagostomi Repair fistula esofagus Repair striktur esofagus Repair hernia diafragma trans torasik Repair hernia diafragma melalui torakotomi, repair hernia diafragma

467 468 469 470 471 472 473 474 475 476 477 478

torako abdominal Plikasi difragma Repair hernia para sternal Repair hernia diafragma laparoskopik, approach toraks Repair terbuka lainnya pada hernia diafragma melalui toraks Amputasi ekstemitas atas, Amputasi ekstemitas bawah Ganglion simpatektomi Lumbal Simpatektomi Peri arterial Simpatektomi Torakal simpatektomi Injeksi bahan neurolitik pada nervus simpatikus Lain - lain Ultrasound Terapetik

479

Ultrasound Terapetik untuk pembuluh darah kepala & leher. Ultrasound

42.39 42.41 42.42 42.5 42.6 42.7 42.81 42.82 42.83 42.84 42.85 53.8 53.80 53.81 53.82 53.83 53.84 84.0, 84.1 05.2 05.23 05.25 05.29 05.32 00.0 00.01

anti restenotik. Ultrasound intra vaskular nonablatif 480 481 482 483 484 485 486 487 488

Ultrasound Terapetik untuk jantung. Ultrasound anti restenotik. Ultrasound intra vaskular non ablatif Ultrasound Terapetik untuk pembuluh darah perifer. Ultrasound anti restenotik. Ultrasound intra vaskular non ablatif Obat-obatan* Pemberian Nitric Oxide Inhalasi Injeksi atau infus antibiotik kelas oksazolidinon (Linezolid) Terapi bertekanan pada graft bypass dengan bahan farmokologis Pemberian obat - obat vasopresor Imaging Pembuluh darah intra vaskular. USG endo vaskular. USG intra vaskular. Imaging pembuluh darah intra vaskular dengan USG Imaging intra vaskular pembuluh darah cerebral ekstra kranial, Pembuluh darah karotis komunis dan cabangnya. USG intra vaskular, pembuluh darah cerebral ekstra kranial

00.02 00.03 00.1 00.12 00.14 00.16 00.17 00.2 00.21


131

NO 489

JENIS TINDAKAN Imaging intra vaskular pembuluh darah intra toraks, aorta dan arkus aorta. USG intra vaskular, pembuluh darahintra toraks, vena kava superior dan inferior

490

Imaging intra vaskular pembuluh darah perifer. Imaging pembuluh darah tangan, kaki. USG intra vaskular pembuluh darah perifer Imaging intra vaskular pembuluh darah koroner. USG intra vaskular, pembuluh darah koroner Imaging intra vaskular pembuluh darah renal. U S G intra vaskular, pembuluh darah renal, arteri renalis Imaging intra vaskular pembuluh darah, spesifikasi lain Imaging intra vaskular pembuluh darah, tidak terspesifikasi Pembedahan dengan bantuan komputer Prosedur sistem vaskular (selain koroner) Prosedur pada satu pembuluh darah Prosedur pada dua pembuluh darah Prosedur pada tiga pembuluh darah Prosedur pada empat atau lebih pembuluh darah Prosedur pada pembuluh darah bifurkasio Insersi satu sten vaskular Insersi dua sten vaskular Insersi tiga sten vaskular Insersi empat atau lebih sten vaskular Prosedur kardiovaskular lainnya Impiantasi pacemaker resinkronisasi jantung tanpa defibrilasi,total sistem (CRT-P). Pacemaker biventrikuier. Pacing biventrikuler tanpa delibrilator jantung internal Impiantasi defibrilator jantung. resinkronisasi, total sistem (CRTD). BiV defibrilator Biventrikuler defibrilator. Pacing biventrikuler dengan defibrilator jantung internal, BiV ICD, BiV pacemaker dengan defibrilator Impiantasi atau penggantian elektroda transvenus ke dalamsistem vena koroner ventrikel kiri Impiantasi atau penggantian pacemaker Resinkronisasi jantung, hanya perangkat generator (CRT-P). Impiantasi perangkat CRT-P dengan pengangkatan perangkat pacemaker CRT-P lainnya.

491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507

508

509 510

511

Impiantasi atau penggantian defibrilator resinkronisasi jantung, hanya perangkat generator (CRT-D). Impiantasi perangkat CRT-D dengan pengangkatan perangkatpacemaker CRT-D lainnya

512

Insersi drug eluting stent pada pembuluh darah perifer Endograft, graft endovaskular, stent Graft Insersi atau penggantian sensor tekanan implantable untuk monitoringhemodinamik intra kardiak

513 514

Impiantasi atau penggantian perangkat subkutan untuk monitoring hemodinamik intra kardiak

515

Impiantasi alat monitoring dengan bentukan kantung subkutan dan koneksinya dengan sensor tekanan intra kardiak Prosedur pada pembuluh darah

516

Angioplasti perkutan atau atherektomi pembuluh darah precerebral (ekstra kranial)Basilar, Carotid, Vertebral

132

I


NO 517

JENIS TINDAKAN Insersi sten arteri karotis perkutan. Termasuk perangkat proteksi emboli,

I C D 9-CM 00.63

perangkat proteksi distal, filter atau sistem pemasangan sten, non drug eluting sten 518

Insersi perkutan sten arteri precerebral (ekstra kranial) lainnya.

00.64

Termasuk perangkat proteksi emboli, perangkat proteksi distal, filter atau 519 520 521

sistem pemasangan sten, non drug eluting sten pada basilar, vertebral USG Diagnostik USG diagnostik pada jantung. Ekokardiografi, TEE USG diagnostik pada tempat lain pada Toraks. USG arkus aorta, USG

88.7 88.72 88.73

522 523 524 525 526

paru USG sistem vaskular perifer. USGDVT, Mapping varises Injeksi atau inflis bahan terapetik dan profilaksis lain Injeksi antibiotik Injeksi anti infektifyang lain Insersi Chemoport (Port A Catheter)

88.77 99.2 99.21 99.22 3B.93

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133

IKATAN D O K T E R INDONESIA PERHIMPUNAN D O K T E R S P E S I A L I S B E D A H INDONESIA

IKABI Sekretariat: Gedung Wisma Bhakti Mulya-lantai 4 - 401-C Jl. Kramat Raya 160. Jakarta Pjsat 1O430. Telp & Fax, 021 - 3916774 Website: www.ikabi.org Email: [email protected]

Susunan Pengurus PP. IKABI Periode 2012-2014 Pfwan PgrtimtMnflan Prof. Dr Sjamsuhidajal. SpB SpB-KBD Dr. Soerarso Hardjowasito, SpB SpBTKV Itajelis Etik t Pwawhal Prol. Dr. Muchlis Ramli. SpB(K)-Onk Ketua Prwidium Prol. DR. Dr. Paul Tahalele, SpB.SpBTKV


: Dr Asrofi S. Surachman, SpBP-RE, MARS : Ketua PERAPI Periode 2012-2015

WakilKeluafltetuaTBrpilih Dr. R. Sjhartono, SpBKBV

Menyerahkan 1 berkas naskah asii daftar kewenangan klinis profesi PERAPI Prof DR Or. Sunaryo Hardjo*idjolo, Spfl SpU Ketua Pum« Prof. DR. Dr. Siwandi Sugandi, SpQ SpU

KibitJKIBI Prol. Dr. Errol U. Hulagalur)g. SpB SpOT Preiidium Dr Unp Murledio. SpB PGD Pal Med. ECU Dr. Rizal Pohan, SpB SpOT Or Sonar Soni Panigoro, SpB K.Onk Dr Patriot Muslim, SpU Dr. Poerwadi, SpB SpBA Dr. R Suhartono. SpBKBV Dr. Setyowidi Nugroho, SpB SpBS Dr Nurhayat Usman, SpB KBD Dr Maizjl Anwar SpB TKV Dr. bhandono Dachlan. Msc. SpB, 5p6P-RE(K) Sekretarii Jenderal Dr. Drm Dannadiaja. SpB MARS

kepada: Nama Jabatan



tm^m Dr, Agung Prasmono. SpB SpBTKV.MARS Bfioilitiaca

Dr Balian Sutedja. SpB Komlel OrflanlMti. Leîslasi dan Advokwl Dr HN Nazar. SpB Dr Cnandra Svaras. SpB

Dr Asrofi S. Surachman, SpBP-RE, MARS Ketua PERAPI

Dr. DjoniiDarmadjaja, SpB.MARS KAI Sekjen IKABI

Komtol Pfofeel Bedah. Aiuntwi dan PtrMJaKan Dr Nurhayat Usman, SpB KBD Dr Era*an Wiradisuna, SpB K8D Dr Henry Boyke Sitompul, SpB Dr InztaArbi, SpB Komlil Gtobalitati A Pa»ar Beba» Or dr Fathema D Rachmat. SpB SpBTKV Or Hunlal Simamora. SpBP-RE KomitI KomjnIkatI dan Pul>ll>tati DR. Dr Yefta Munadjai. SpB SpBP-RE(K) Prof. DR. Dr. Sn Maliawan, SpBS (K) Dr. Iskandar Budianta. SpB SpBA KomitI Hubjngan Dalam Meêfi Prof. DR. Dr AndiAsadul Islam, SpBS Dr BoyVe Sumantri, SpU Dr Emir T Pasaribu SpB Onk Komlel Paiayanan Ambulance 118 Dr. ZA Isma. SpB Or Agi Satna, SpB KBD KomttI Trauma DR Dr Achmad Hidayat. SpB DrB Sunoko. SpB DR. Dr Triwahyu Mumi, SpB SpBTKV


135

DAFTAR KOMPETENSI DAN KEWENANGAN KLINIS DOKTER SPESIALIS BEDAH PLASTIK REKONSTRUKSI DAN E S T E T I K (PERAPI)

137

DAFTAR KOMPETENSI DAN KEWENANGAN K L I N I S D O K T E R SPESIALIS BEDAH P L A S T I K REKONSTRUKSI DAN E S T E T I K I PERAPI ] I C D 9-CM NO PROSEDUR PEMBEKALAN TINDAKAN DASAR 86.71 1 Preparasi Luka Fascia (83.65), hand (82.46), skin (86.59) 2 Menjahit Luka- — 3 Photograpy 4 Membaca Imaging Radiologi 89.52 5 EKG 31.1 6 Trakeostomi 83.14, 86.22 7 Fasciotomi/Escharotomi 8 Eksisi Lesi/Tumor 9 Anestesi Ringan, Anestesi Local (Blok,lnfiltrasi Tumescent 10 Tindakan Emergency dan ATLS 11 Pembedahan Minor 12 Skleroterapi-Kemoterapi 13 Injeksi Kortikosteroid 14 Biopsi Jaringan GRAFTING/TANDUR JARINGAN 15 Split -Thickness Skin Grafting 16 Full-Thickness Skin Grafting 17 Composite Graft 18

^ :^

39.92, 99.25 '

Graft (Kulit, Fat, Fascia, Tendon, Saraf, Otot, Kartilago, 86.69, 86.89, 83.82, 83.81, 04.5, 83.82, 78.00 Tulang)

KULIT DAN JARINGAN LUNAK 19 Eksisi Parut 20 Release Contracture 21 W-plasty 22 Z-Plasty 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

86.69 86.63

Penanganan parut non Bedah Mengelola Luka Bakar Fase Akut Mengelola Luka Bakar Fase Sub Akut Mengelola Luka Bakar Fase lanjut Mengelola Trauma Inhalasi FlapAcak Flap axial Flap Bebas Tes vitalitas Jaringan Mengelola Avulsi /Degloving Debridement/Eksisi Tangantial (ET) Wound Management (Luka Akut dan Kronik) Penanganan Trauma Jaringan Lunak Penanganan Infeksi Jaringan Lunak Pengelolaan Ulcus Decubitus Penanganan Operatif/ Non Operatif Congenital/Naevi

86.3 (skin) 86.84 86.89 With excision (86,3),without excision (86.84) Debridement + skin graft (86.28+86.6) Debridement + skin graft (86.28+86.6) Debridement + skin graft (86.28+86.6)

t l - PERAPI I

139

NO PROSEDUR I C D 9-CM LESI JINAK DAN LESI GANAS KULIT & MUKOSA DAN JARINGAN LUNAK 39 Ekstirpasi, Eksisi Wide Eksisi 86.3 40 Rekonstruksi pasca Ablasi Tumor 86.89 41 Deseksi Kelenjar (Inguinal. Aksila, Leher) KELAINAN KONGENITAL PEMBULUH DARAH HEMANGIOMA DAN MALFORMASI VASKULER 42 Terapi Non Bedah,Eksisi dan Rekonstruksi

Non bedah: sclerotherapy

(39.92),

embolisasi (38.82). Bedah: 86.3/86.89 KRANIOFACIAL 43 Debridement dan Rekonstruksi Trauma jaringan lunak 44 Reposisi dan Fiksasi Temporo Mandibular Joint Reposisi dan Fiksasi (Wiring Arch bar,Mini Plate and 45 Screw) Fraktur Mandibula Reposisi Bone Graft dan Fiksasi Wiring,Arch bar,Mini 46 Plate and Screw (Fraktur Maksila) Reposisi dan Fiksasi Nasal (Splinting,Mini Plate and 47 Screw,Tampon) Fraktur Nasal 48 Penanganan non Bedah Fraktur Zygoma 49 Reposisi Bone Graft dan Fiksasi Wiring,Arch bar,Mini Plate and Screw (Fraktur Zygoma) 50 Reposisi Bone Graft dan Fiksasi (Wiring, Arch bar. Mini Plate, and Screw) Fraktur Naso-Orbito-Etmoidalis (NOE) 51

86.28 + 86.89 76.5 76.75 (closed), 76.76 (open) 76.73 (closed), 76.74 (open) 21.71 (closed), 21.72 (open) 76.71 (closed) 76.72 (open)

76.78 (closed), 76.79 (open)

Reposisi Bone-Cartilage Graft. Mesh Plate, Polyctilene, Nylon Sheet dan Fikasasi (Wiring, Mini Plate, and Screw) Fraktur Dasar Orbita Reposisi Fiksasi Fraktur Procesus Alveolaris Reposisi Fiksasi Fraktur Nasofrontal Rekonstruksi Fraktur Lama Kranioplasti Reposisi Fiksasi Fraktur Sinus Frontalis Reposisi Fiksasi Fraktur Orbita Osteotomi Fronto-Orbita Distraksi Osteogenesis Pembedahan Kraniosinostosis dan Disostosis Cranial Vault Remodelling Pembedahan Orthognatik Koreksi Hipertelorisme Orbita Koreksi Meningoensefalokel Pembedahan TM Joint Pembedahan Trauma Kraniomaksilofasial Rekonstruksi Telinga Rekonstruksi Kelopak Mata, Socket, Nasolakrimal Pembedahan Nyeri Kepala Migraine

52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69

76.78 (closed), 76.79 (open)

02.0

76.5

Duktus

KELAINAN KRANIOFACIAL KONGENITAL 70 Rekonstruksi Bertahap Kraniosynostosis

02.06, with flap (02.03), with graft (02.04)

71

140

Rekonstruksi Ensefalokel Frontalis dan Nasofrontalis

I


NO 72

PROSEDUR Rekonstruksi Hemifacial Microsomia

I C D 9-CM Excisi skin tag (18.29) Commisuroplasty (35.10) Mandibular distraksi () Bone graft (78.00) Free flap untuk augmentasi soft tissue () Osteotomy maxilla LF 1 (76.65)

Rekonstruksi Makrostomia dan Microstomia Rekonstruksi Craniofacial Cleft Pembedahan Organik Retrognatia, Prognatia, Macrognatia, dan Micrognatia Labioplasty Palatoplasty Alveolar Bone Graft Pharingoplasty

27.54 27.6 78.00 (With Silastic Implant; 29.4. For Cleft palate: 27.62)

Revisi Labioplasti Labiorhinoplasty Tutup Fistel Palatoplasty Osteotomi Le Fort 1,11, III Pembedahan Hemifasial Mikrosomia Rekonstruksi Kraniofasial Cleft 86 87 88 89 90 91 92 MATA 93 94 95

Eksisi & Rekonstruksi Tumor Tumor Tulang Wajah Tumor Perlu Rekonstruksi Maxilektomi Reseksi Mandibula, Mandibulektomi Condilektomi dan Coronoidektomi Salivary Gland Disorder

76.65

76.39 76.31 (partial), 76.42 (total) 77.8

Eksisi dan Jahit Primer/ Flap Xanlelasma Pembebasan Ektropion dan Skin Graft /Flap Koreksi Palpebra Superior dengan Skin Graft atau Flap pada Lagoftalmus

08.69

96 Koreksi Ptosis Palpebra HIDUNG 97 Koreksi Deformitas dan Rekonstruksi Hidung Akibat Trauma. Pasca Ablasi Tumor dan Kelainan Kongenitai TELINGA 98 Eksplorasi dan Fistulektomi Preauricular Synus and Cyst

21.83

(Eksplorasi

middle

ear:

20.23)

(Fistulectomy middle ear: 19.9. drum: 99

19.4) Rekonstruksi Congenital and Acquired Absence o f (external auricle: 18.71. external auditory Earlobe canal/meatus: 18.6. ossicles: 19.3.

100 101 102

prominent/protruding: 18.5) Eksisi dan Jahit Primer Tragus Ascsorius Rekonstruksi Makrotia dan Microtia/Anotia Rekonstruksi/Otoplasty Stahl's Ears. Prominent Ear. Otoplasty: external (18.79). auditory canal or meatus (18.6). auricles (18.9). cartilage Constricted Ear.

103

Labuloplasty Labuloskizis

(18.79). prominent or protruding (18.5).

11 - PERAPI I

141

NO PROSEDUR 104 Replantasi Amputasi Telinga Traumatic PAYUDARA/BREAST SURGERY 105 Reduksi Pay udara Gigantomastia 106 Rekonstruksi Amasia dan Pembuatan Puling Atelia 107 Koreksi Ginekomastia 108 Bedah Onkoplastik 109 Congenital and Breast Disorder 110 Pembedahan Asimetrik & Profilaktik Payudara 111 Rekonstruksi Payudara 112 Eksisi Mammae Abberans dan Politelia GENITALIA EKSTERNA 113 Release Chordee Hipospadia 114 Urethroplasty Hipospadia 115 Rekonstruksi Urethra Epispadia 116 Rekonstruksi Short Urethra. Buried Penis. Genitalia Ambigu 117 Revaskularisasi dan Replantasi Amputasi Penis Traumatik 118 Vaginoplasty Atresia Vaginalis 119 Sirkumsisi 120 Rekonstruksi Genetalia EKSTREMITAS

I C D 9-CM 18.72 Unilateral (85.31). bilateral (85.32). Breast-total (85.7), repair nipple (85.87) 85.31 (unilateral), 85.32 (bilateral)

Breast-total (85.7), repair nipple (85.87) 85.24 64.42 58.49 58.46 58.46, 64.44 Replantasi penis (64.45) 70.79 Laki-laki (64.0). wanita (71.4). 64.43 (penis), 70.61 (vagina)

Revakularisasi, replantasi. Rekonstruksi dan Repair Stump Replantasi extremity (84.29). ankle (84.27). arm (84.24). finger (84.22). thumb/leg Amputasi Ekstremitas (84.21). foot (84.26) forcearm/hand/wrist (84.23). thigh (84.28). toe (84.25) Excisi (40.29) Penanganan non Operatif Limfedema Penanganan Paronikia dan Nailplasty Ingrowing Nail Amputasi 84.07 (above elbow), 84.17 (above knee), 84.15 (below knee) Bone Graft 78.00 Rekonstruksi Lesi Pleksus Brakhialis Traumatika/

121

122 123 124 125 126

Obstetrikal 127 Rekonstruksi Kaki, Ankle, Kruris, 128 Rekonstruksi Extremitas Atas 129 Rekonstruksi Pasca ablasi tumor 130 Pembedahan Crush Injury dan Traumatic Amputasi BEDAH TANGAN 131 Repair Tendon Fleksor 132 Repair Tendon Ekstensor 133 Penanganan non Bedah Fraktur dan Dislokasi Falang .

81.47 (knee)

82.86 82.86 Casting (for immobilization) (93.53)

Metakarpal dan MCP 134

Percutaneous Wires Fraktur/ Dislokasi Falang. Metacarpal

135

dan MCP ORIF Fraktur/ Dislokasi Falang Metakarpal dan MCP

Phalang: foot (79.18.79.08/79.38.79. 28)

Hand(79.04.79.14./79.24.79.34).

metacarpal (79..03.79.13/79.23.79.33). MCP (79.09.79.19/79.29.79.39

142

I

Kewenangan Tindak Medik Dokler Slsesialis Bedah Indonesia

NO 136

137

PROSEDUR Release Otot Intrinsic. Fleksor synovectomy. Lateral band Release otot (82.11). synovectomy (80.74) arthroplasty (81.72). with prostetik transfer. Artoplasty. antrodesis implant (81.71) arthrodesis finger (81.28) interphalangeal finger (81.28). MCC (81.26). MCP (81.27) 82.11 Synovectomy. Dynamic splinting. Pemendekatan ventral slip,tenotomy ekstensor,Reposisi lateral Band.Arthroplasty.

138 139 140 141

Arthrodesis boutonnierre deformity. Penanganan operatif dan Non Operatif Malet Finger Revaskularisasi atau Replantasi Amputasi Jari dan Tangan

84.22, Thumb (84.21)

Traumatik 04.79 Reparasi Saraf Perifer Penanganan Operatif dan Non Operatif Carpal Tunnel Release otot (82.11), synovectomy Syndrome, Trigger Finger.De Quervain's Syndrome (80.74) Arthroplasty (81.72), with prostetik implan (81.71) Arthrodesis finger (81.28), interphalangeal finger (81.28), MCC (81.26), MCP

142 143 144 145 146 147 148 149 150 151

Rekonstruksi Finger Tip Injury Rekonstruksi Blast Injury Tangan Separasi Jari Syndactily Rekonstruksi (Ligasi/Amputasi) Polydactily Reseksi (Debulking) Macrodactily Penanganan Operatif dan Non OperatifCampodactily Rekonstruksi Jari Clinodactily Rekonstruksi Jari Thumb Hipoplasia Release Constrintion Band Penanganan Operatif dan Non Operatif Radial Club Hand, Ulnar Club Hand, Median Claw Hand, Ulnar Claw Hand 152 Penanganan Operatif dan Non Operatif Ganglion Reposisi Fiksasi Fraktur Tangan 153 154 Artroplasty, Artrodesis Tangan 155 Repair Tendon 156 Tendon Transfer 157 Rekonstruksi Kelainan Kongenitai Tangan 158 Pembedahan Trauma Tangan 159 Transfer Jari 160 Infeksi Tangan 161 Nailplasty/Roserplasty ESTETIK 162 Blepharoplasty 163 Rhinoplasty 164 Genioplasty 165 Fat Grafting 166 Face Lifting 167 Thread Lifting, Filler, Botox, Laser 168 Mammaplasty 169 Liposuction 170 Abdominoplasty

(81.27) Rhinoplasty tip (21.86) Repair Hand (82.89) 86.85 Amputasi finger (84.01). thumb (84.02) 82.83 Osteotomy + pinning (77.34 + 78.54) 82.69

81.72 83.88 83.75

82.61,82.81 (thumb)

08.70, 08.44 21.85 76.68 86.89

85.89 Repair abdominal wall (54.72)

I I - PERAPI I

143

NO 171

I C D 9-CM Breast: unilateral (85.53), bilateral

PROSEDUR Augmentasi/implantasi Silikon

(85.54) Skin for augmentation (86.89) Penanganan Operatif dan Non Operatif Hiperhidrosis Eyebrow/eyelid (08.63), scalp (86.64) Hair Transplant Vaginoplasty, Labiaplasty, Clitoroplasty, Hymenoplasty, Vaginoplasty (70.79) Labiaplasty (27.54) Release/Separasi Labia, Sinekia Vagina Clitoroplasty (71.4) Hymenoplasty (70.76) Repair Labia/Vulva (71.7) Repair Vagina (70.5) 64.5 175 Transexual 176 Eksisi, Reduksi Granuloma Silikon 177 Estetik Craniofacial 178 Penggunaan Biomaterial dan Rekayasa Jaringan 179 Pemasangan Implan dan Tissue Expander 180 Bedah Endoplastik 21.85 181 Rhinoplasti 182 Forehead Reju Venation 183 Periorbital Rejuvenation 76.68 184 Genioplasty 185 Malarplasty 186 Neck Rejuvenation 85.50 187 Breast Augmentation 85.32 (bilateral), 85.31 (unilateral) 188 Breast Reduction 189 Body Countering, Lipoplasty, Liposculture, Liposuction 190 Autologus Fat Graft 191 Penyesuaian Kelamin BEDAH MIKRO 192 Flaps Surgery 193 Bedah Mikrovaskular, Mikroneural, Flap Bebas 194 Replantasi 195 Transplantasi (Jaringan dan Organ) 76.43 196 Rekonstruksi Mandibula 197 Rekonstruksi Maksila-Midface 198 Rekonstruksi Hipopharing 27.59 (mouth) 199 Rekonstruksi Bibir dan Mulut 21.83 200 Rekonstruksi Hidung 16.89 201 Rekonstruksi O r b i t a , Kelopak Mata, Duktus 172 173 174

Nasolakrimalis Rekonstruksi Kalvaria dan Scalp Rekonstruksi Skull Base Rekonstruksi Prostetik Flap Omentum Flap Jejunum Reaminasi Wajah Fasial Paralisis Rekonstruksi Endoplastik Deseksi Kelenjar (inguinal, aksila, leher) Rekonstruksi lidah dan mulut Rekonstruksi esoftiagus Rekonstruksi Anal-Perianal

202 203 204 205 206 207 208 209 210 211 212

144

I

- ^


;

25.59 + 27.59 42.89 49.79

Lampiran 1

PROFIL PP IKABI VISI, MISI, NILAI, AZAS DAN TUJUAN IKABI Visi IKABI IKABI menjadi organisasi profesi kedokteran Indonesia yang terdepan & terkemuka baik di tingkat Nasional maupun Intemasional tahun 2014. Misi IKABI: 1. Mewujudkan tercapainya kesetaraan hasil pendidikan pelatihan dan penelitian Dokter Spesialis Bedah Indonesia yang memenuhi standar dan dapat bersaing di dalam kancah intemasional. 2. Mewujudkan pelayanan bedah paripuma demi kesejahteraan rakyat Indonesia dan anggota IKABI. 3. Mewujudkan eksistensi profesi dokter spesialis bedah berdasarkan kompetensi masing-masing dan membangun komunikasi efektif antar anggota IKABI serta kerjasama dengan institusi terkait. Nilai Budaya Organisasi Dokter Spesialis Bedah Indonesia memiliki nilai budaya: Kolegialitas untuk kesejahteraan, Profesionalisme, Pengabdi sepenuh hati, menjunjung Kejujuran, Etis bermoral dan sebagai Teladan (1967, Prof. R. Moenadjat Wiralmadja: Sutiksna Husada Sudharma Marga, Buku Sejarah Ilmu Bedah Indonesia 2004, modifikasi) Azas IKABI Berazaskan Pancasila Tujuan I K A B I : 1. Memelihara, memupuk, meningkatkan dan mendorong perkembangan Ilmu Bedah dalam arti seluas-luasnya untuk diamalkkan demi meningkatkan derajat kesehatan masyarakat. 2.

Meningkatkan kebersamaan dan pemberdayaan anggota.

12 - Lampiran I

145

Lampiran 2

CONTOH SURAT PENUGASAN KESEPAKATAN K L I N I K ( C L I N I C A L APPOINTMENT) No

/SMF 1. Bedah/RS

Yang bertanda tangan di bawah ini Direktur RS Nama

:

NIR

:

I.J

/2013 :

setelah melakukan evaluasi bersama Komite Medis RS , atas usul Ketua SMF Ilmu Bedah RS yang telah diverifikasi oleh panitia kredensial, maka diputuskan kepada Staf Medis yang tersebut di bawah ini: Nama

:

NIR

:

diberi kewenangan klinis untuk melakukan tindak medik sesuai dengan ketetapan Organisasi Profesi Kedokteran. (contoh IKABDI) berdasarkan substansi kajian dan tingkat kompetensi Nasional Pendidikan Dokter Spesialis Bedah yang dikeluarkan oleh Kolegium Ilmu Bedah Indonesia tahun 2012 dan Katalog Pendidikan Ilmu Bedah Digestif yang dikeluarkan oleh Kolegium Ilmu Bedah Digestif Indonesia tahun 2012. Dokter yang bersangkutan telah mempunyai pengetahuan dan ketrampilan dalam bidang Ilmu Bedah dan Konsultan Bedah Digestif seperti dalam daftar terlampir. Demikian, Surat Pemyataan ini dibuat untuk dilaksanakan secara bertanggungjawab dan berlaku dari tgl-bln-thn s.d tgl-bln-thn serta di .. (poliklinik, UGD, kamar operasi, dll). Apabila terdapat kekeliruan dalam penetapan jenis tindak medik ini, akan diperbaiki dikemudian hari. Surabaya, Maret 2013 Yang membuat kesepakatan Klinik {Clinical Appointment)

Direktur RS

Dokter yang bersangkutan

12 - Lampiran I

147

Contoh

KESEPAKATAN KEWENANGAN TINDAK M E D I K D O K T E R SPESIALIS BEDAH - KONSULTAN BEDAH DIGESTIF

I.

Menangani penderita dengan kelainan bedah pada Gastro intestinal Tract a. Mengegakkan diagnosis penderita dengan cara: - Melakukan anamnesa dan pemeriksaan fisik yang terarah b. c.

Meminta dan menginterpretasi pemeriksaan penunjang (laboratorium, pencitraan, dan biopsi) Memberikan terapi, termasuk merencanakan terapi penunjang Melakukan perawatan pre-operatif dan post-operatif

d. e.

Mendeteksi komplikasi post-operatif dan menanganinya Melakukan follow-up penderita dan KIE pada penderita/keluarga

I I . Melakukan operasi penderita dengan kelainan bedah pada Gastro-intestinal Tract III. Jenis kasus/kelainan penderita bedah Gastro-intestinal Tract seperti dalam label berikut: B E D A H UMUM

148

I

No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Jenis Tindalt Medik : Proktoskopi dan Rekloskopi : Appendektomi terbuka : Fistulotomi dan fislulectomi \ Hemoroidektomi ! Hemiotomi : Splenektomi dan splenorapi pada trauma lien ! Reseksi dan anastomosis usus : Eksterioriasi \ Sigmoidostomi i Kolostomi ; Penutupan perforasi usus 1 Penanggulangan cedera hepar I Drainase pankreatitis i Pankreateklomi distal 1 Laparotomi dan torako-laparotomi 1 Repair Hernia Diafragmatika ; Gastrostomi : Gastrostomi Parsial ; Gastroenterostomi Pinlas (by Pass) i Divertikulektomi Meckel's ! Hemikoleklomi : Reseksi Anterior, sigmoidektomi. Low Reseseki

23 24 25 26 27 28

Anterior i By pass entera-enterostomi \ Reposisi (milking) pada invaginasi saluran pencemaan : Ileostomi 1 Penutupan stoma (tutup kolostomi/ileostomi) 1 Appendektomi laparoskopi 1 Drainase abses apendik


Yang disepal(ati

^

^ ?

^ ^ ^

^

•

29 30 31 32 33

1 Abdomino-perineal resection Operasi Miles ^ Operasi Hartmann 1 Kolesistektomi terbuka \ Kolesistektomi laparoskopik Eksisi luas tumor dinding abdomen pada tumor Demois

34 35 36

i & dinding abdomen ; Adhesiolisis 1 Repair burst abdomen i Repair burst abdomen

^

KONSULTAN BEDAH DIGESTIF No

Jenis Tindak Medik

Yang isepakati

UPPER GASTROINTESTINAL 1

1 Oesophageal Surgery : Oesophagectomy,gastric interposition : Oesophagectomy, colonic interposition ; Oesophagectomy, free jejunal graft ; Heller procedur (Oesophageal myotomy)

1 1 1 1

1 Oesophageal (Reflux/motility) : Fundoplication \ Para-oesophageal Hemia Repair

^

\ Epiphrenic diverticulectomy ; Oesophageal myotomy + fiindoplasty

1 1 1

: Zenker's diverticulectomy (Open) 2

\ Gastric Surgery Total Gastrectomy (DI node dissection) Total Gastrectomy (D2 node dissection) : Distal Gastrectomy (DI node dissection) Distal Gastrectomy (D2 node dissection) ; Proximal Gastrectomy {D\ node dissection) \ Proximal Gastrectomy ; (D2 node dissection) \ Gastric tumour, Local excision

3

1 Laparoscopy 1 Oesophagectomy \ Gastrectomy \ Fundoplication \ Oesophageal myotomy + ftindoplasty

4

: Endoscopy Diagnostic Upper GI endoscopy i Endoscopy with biopsy

1

Therapeutic Upper GI endoscopy

12 - Lampiran I

149

5

i Bariatric Surgery and Other i Gastric Band (Laparoscopic)

1

! Gastric Band (Removal)

^

\ Gastric Band (Revision) \ Tube Gastrectomy

>/

T'

\ (Laparoscopic or Open) 1 Roux en Y Gastric Bypass (laparoscopic) i Roux en Y Gastric Bypass (open)

1 A/'

\ Roux en Y Gastric Bypass (revisional)

1

\ Splenectomy

^

•

i Jejunostomy/Gastrostrostomy 6

1 Adjunctive Thoracic Operations ; Thoracoscopy : Thoracotomy for gut interposition \ Conventional right thoracotomy

T

COLORECTAL (lanjutan) 7

\ Colonoscopy/flexible sigmoidoscopy : Diagnostic colonoscopy i Colonoscopy and Sigmoidoscopy i Polypectomy Colonoscopic decompression of volvulus i or pseudobstruction i Colonoscopic dilatation and/or metal

A/

i Stent insertion 1 Colonoscopic endomucosal resection of ! Tumour 8

1 Segmental colonic or ileo-colic resection i Ileocolic resection i Right hemi colectomy ; Transverse colectomy i Wedge colon resection i Left hemi colectomy i Sigmoid colectomy i Hartmann's resection

9

i Anterior Resection : Anterior resection of rectum for benign i and neoplastic disease 1 Rectal resection as part of abdominoi perineal resection of rectum

150

I


1

'

; ^sîi/ii'/ { K V . I H »t

Lampiran 3.

I ,L!;t:'3:o

CONTOH (MODIFIKASI) RINCIAN KEWENANGAN K L I N I S RINCIAN KEWENANGAN KLINIS (CLINICAL PRIVILEGE) SMF: RUMAH SAKIT Spesialisasi:

Nama Dokter:

Tanda Tangan

Saya menyatakan bahwa saya kompeten untuk menangani kasus-kasus yang saya minta di bidang spesialisasi saya, termasuk melayani konsultasi dari dokter- dokter lain. Saya juga menyatakan kompeten untuk melakukan tindakan medik seperti yang tercantum di bawah ini yang merupakan kewenangan klinis (Clinical Privilege) berdasarkan status kesehatan saya saat ini, pendidikan dan atau pelatihan yang telah saya jalani, serta penâlaman yang saya miliki.

Sertifikasi Sertifikat/ljazah :

Tanggal dikeluarkan :

Instansi (tempat ijasah spesialisasi dikeluarkan):

No. Ijasah Spesialisasi: Surat Rekomendasi Kolegium

Tanggal:

Kolegium

Tanggal

Institusi

No: Pelatihan (3 tahun lerakhir) 2010 - 2012

Surat Tanda Registrasi Konsil Kedokteran Indonesia Spesialisasi :

Berlaku Hingga Tanggal

Petunjuk: Untuk Mitra Bestari:

Untuk Dokter:

Tulisan kode untuk dokter menurut permintaan sejawat Mohon melakukan telaah pada setiap kategori dan sesuai daftar - " Kode untuk Dokter " yang tersedia. Setiap Kewenangan Klinis yang diminta oleh setiap dokter sesuai kategori yang ada dan atau Kewenangan Klinis yang dengan kode yang tersedia. Cantumkan persetujuan yang diminta harus tercantum kodenya. Pengisian harus lengkap tersedia. Persetujuan Mitra Bestari kepada Komite Medik untuk seluruh Kewenangan Klinis yang tercantum. Tanda untuk pemberian penugasan klinis (Clinical Appoinment) dari tangan dicantumkan pada akhir bagian 1 (Kewenangan Direktur Rumah Sakit Bubuhkan tanda Klinis). Jika terdapat revisi atau perbaikan. setelah daflar tangan Mitra Bestari pada akhir bagian 11 (rekomendasi Mitra Kewenangan Klinis ini disetujui, maka harus mengisi Bestari) kembali formulir yang baru.

Kode Untuk Dokter

Kode untuk Mitra Bestari

1.

Kompetensi sepenuhnya

1.

Disetujui berwenang penuh

2.

Memerlukan supervisi

2.

Disetujui di bawah supervisi

3.

Tidak dimintakan kewenangannya, karena diluar kompetensinya Tidak dimintakan kewenangannya, karena fasilitas tidak tersedia

3.

Tidak disetujui, karena bukan kompetensinya

4.

Tidak disetujui, karena fasilitas tidak tersedia

4.

Tanggal:

Mengetahui

Ketua SMF

Ketua Peer Group SMF

Tanda Tangan & Nama Terang NIP.

Tanda Tanjjan & Nama Terang NIP

12 - Lampiran I

1

Bagian I. Kewenangan Klinis (Clinical Privilege )

Kategori Kewenangan Kewenangan Klinis diberikan untuk memberikan pelayanan pengelolaan bidang Bedah

Diminta (yang bersangkutan)

Jenis Pelayanan

Rekomendasi disetujui oleh peer group Disetujui/Disetujui dengan Catatan/Tidak Disetujui

Kewenangan Tindak Medik

Bagian 11. Rekomendasi Mitra Bestari Disetujui:

Disetujui dengan Catalan

Tidak disetujui

Tanggal: Catalan:

Daftar Mitra Bestari No

Nama

Spesialisasi

Tanda Tangan

Bagian I I I . Komite Medlli/Sub Komite Kredensial Disetujui

Disetujui dengan Catatan

Tidak Disetujui

Tanggal ;

1

Catatan:

Ketua Komite Medik

Ketua Sub-Komite Kredensial

Tanda tangan & Nama Terang

Tanda tangan & Nama Terang

NIP

152

I


NIP

Lampiran 4

CONTOH FORMULIR SARAN, K E L U H A N & LAPORAN PENGADUAN K E L A L A I A N TINDAK M E D I K

Kepada Ytii. Pengurus Pusat i K A B I Gedung Wisma Bhalcti Mulya - lantai 4 - 4 0 1 - C Jl. Kramat Raya 160 Jakarta Pusat 10430 Telp & Fax. 021 -3916774 Website: www.ikabi.org Email, [email protected], [email protected]

(Ketua), [email protected] (Sekjen),

[email protected] (Ketua Komisi Legislasi & Advokasi) Dengan hormat, Bersama ini saya sampaikan Saran : Keluhan Laporan pengaduan kelalaian tindak medik:

Data pendukung (bisa dilampirkan secara lengkap):

Data yang mengajukan Saran, Keluhan & Laporan Pengaduan Kelalaian Tindak Medik Nama : Alamat pos Telp HP Fax

: : : :

Email : Kedudukan sebagai: pasien/keluarga pasien/dokter/paramedis/

Kola

, (tgl^ln/thn)

Materai 6000

Tanda Tangan & Nama Terang 12 - Lampiran I

153

Kewenangan Tindak Medik Dokter Spesialis Bedah Indonesia

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