Professional Documents
Culture Documents
Orthopaedi
Januari 2014
Residen wajib mengisi lembar RM 1, Lembar Verifikasi dan laporan operasi sesuai
dengan diagnosis dan tindakan yang tertera secara lengkap, setiap selesai operasi
ICD 10 Diagnosis
S52.90
14.952.975
12.485.355
ganglion
ICD 9 Prosedur
78.69 removal implant
device from the bone
Plafon
3.765.791
8.403.235
8.403.235
12.485.355
14.952.971
level
M20.0 Deformity of finger
9099.408
11.164.055
12.485.355
14.952.975
8.404.231
8.403.235
12.485.355
8.403.235
12.485.355
on hand,
kontracture
12.485.355
polidactili
Q69 polidactyli
8.403.235
8.403.235
ICD 10 Diagnosis
M84.90 disorder of continuity of
bone , unspecified
S42 fracture of shoulder and upper
arm
S.06.9 intracranial injury
S42 fracture of shoulder and upper
arm
ICD 9 Prosedur
78.69 bone graft
86.66 homograft to skin
79.30 ORIF,unspecified site
Plafon
8.403.235
7.691.543
8.403.235
Trauma (Fracture)
No
1.
Keterangan
Non union perlu bone graft
2.
Fracture clavikula
3.
3.835.376
4.
Fracture tibia/fibula
21.963.542
5.
79.36 ORIF
21.963.542
6.
Fracture femur
7.
Fracture radius
Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
12.485.355
8.
Fracture ulna
12.485.355
9. Fr antebrachii
10. Fracture humerus
12.485.355
12.485.355
12.485.355
Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
M81.65 Osteoporosis
S72.14 Intertrochanteric fracture of
femure
Hip implant :
6000.000
Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Knee implant :
6000.000
Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Hip implant :
6000.000
12.485.355
12.485.355
12.485.355
5.978.592
Klas 1: 30.748.959
Klas 2:26.353.251
Klas 3: 21.963.542
Knee replacement
3.000.000
5.978.592
Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Hip implant :
M81.65 Osteoporosis
Klas 1= 8.898.656
elsewhere classified
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Hip implant :
3000.000
21.963.542
11.164.055
25. Fracture
pedis,metacarpale,ankle
26. Fracture patella
Hip implant :
6000.000
8.855.736
21.963.542
M86 Osteomyelitis,
1.948.000
1.948.000
3481.352
Keterangan
Reposisi dan pasang gip
ekstremitas atas dengan GA
ICD 10 Diagnosis
S62.80 fracture at wrist and hand
level
ICD 9 Prosedur
79.04 closed reduction of
fracture without internal
fixation
Plafon
1.948.000
1.948.000
8.855.731
Fracture neglected
12.485.355
disease
deformities of feet,
operation of bone
Pemanjangan tulang
21.953.542
Tumor Tulang
No
1.
Keterangan
Biopsi tumor
ICD 10 Diagnosis
D21.9 other benign neoplasm and
other soft tissue
ICD 9 Prosedur
80.31 biopsy of joint
structure
plafon
2.049.737
Eksisi tumor
Amputasi tumor di atas
lutut(above knee)
12.485.355
9.099.400
12.485.355
7.
9.099.400
8.403.235
8.403.235
Keterangan
Infeksi sendi lutut,
ICD 10 Diagnosis
M17.9 Gonarthrosis , unspecified
M01.56 arthritis in other bacterial
disease lower leg
M35.4 diffuse fasciitis
ICD 9 Prosedur
81.47 other repair of knee
plafon
21.000.000
7.691.547
21.000.000
4
5
Debridement shoulder
Klas 3 = 7.691.547
Klass 2 =9226.000
Klass1: 10.768.160
6
7
9.229.852
Rupture meniscus
21.000.000
21.000.000
Klas 3= 21.963.542
Klas 2= 26.356.251
Klas 1= 30.748.959
10
11
Implant knee :
6000.000
12
13
14
Klas 1: 30.748.959
Klas 2:26.353.251
Klas 3: 21.963.542
Knee replacement
3.000.000
Klas 1: 30.748.959
Klas 2:26.353.251
Klas 3: 21.963.542
Knee replacement
3.000.000
15
Keterangan
scoliosis
ICD 10 Diagnosis
M41.55 scoliosis
S25.9 injury of unspecified blood
vessel of thorax
M43.54 vertebral subluxation
ICD 9 Prosedur
81.60 , 360 degree spinal
fusion, single incision
approach
83.74 reattachment of
muscle
77.31 other division of
scapula, clavicle,and thorax
(rib and sternum)
plafon
34.590.151
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
3.
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
HNP/canal stenosis di
thorakal/lumbal dengan implan
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
25.165.278
HNP/canal stenosis di
thorakal/lumbal tanpa implant
19.950.055
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390