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