PEMERINTAH KABUPATEN KULON PROGO

RUMAH SAKIT UMUM DAERAH WATES

Jl. Tentara Pelajar Km.1 No.5 Wates Kulon Progo Yogyakarta 55611
Telp. (0274) 773169 Fax.(0274) 773092

KEPUTUSAN DIREKTUR RSUD WATES KABUPATEN KULON PROGO

NOMOR : TAHUN 2015

TENTANG
KEBIJAKAN JENIS TINDAKAN KEDOKTERAN YANG HARUS
DISERTAI DENGAN PERSETUJUAN TINDAKAN KEDOKTERAN
(INFORMED CONSENT)
RUMAH SAKIT UMUM DAERAH WATES

DIREKTUR RUMAH SAKIT UMUM DAERAH WATES,

Menimbang a
:. bahwa dalam rangka untuk meningkatkan pelayanan bagi
pasien dan memberikan kepastian dan perlindungan bagi
tenaga medis dalam melakukan tindakan kedokteran di RSUD
Wates, maka dipandang perlu ditetapkan jenis tindakan
kedokteran yang harus disertai dengan persetujuan tindakan
kedokteran (Informed Consent) dalam proses pelayanan di
RSUD Wates sesuai dengan Undang-undang dan peraturan
yang berlaku;
b. bahwa kebijakan tersebut pada butir a perlu ditetapkan
dengan Surat Keputusan Direktur RSUD Wates;
Mengingat : 1. Undang-Undang Nomor 29 tahun 2004 tentang Praktik
Kedokteran;
2. Undang-Undang Nomor 36 tahun 2009 tentang Kesehatan;
3. Undang-undang Nomor 44 tahun 2009 tentang Rumah Sakit;
4. Peraturan Menteri Kesehatan Republik Indonesia
Nomor : 269/MENKES/PER/III/2008 tentang Rekam Medis;

MEMUTUSKAN
Menetapkan :
KESATU : KEPUTUSAN DIREKTUR RSUD WATES TENTANG
KEBIJAKAN JENIS TINDAKAN KEDOKTERAN YANG
HARUS DISERTAI DENGAN PERSETUJUAN TINDAKAN
KEDOKTERAN (INFORMED CONSENT) RUMAH SAKIT
UMUM DAERAH WATES;
KEDUA : Memberlakukan Kebijakan jenis tindakan kedokteran yang
 harus disertai dengan persetujuan tindakan kedokteran
(informed consent) di RSUD Wates sebagaimana tersebut
dalam lampiran surat keputusan ini;
KETIGA : Kepada seluruh staf RSUD Wates dalam memberikan
pelayanan mengacu pada kebijakan yang tersebut dalam
lampiran;
KEEMPAT : Segala biaya yang timbul akibat ditetapkannya Surat
Keputusan ini dibebankan pada Anggaran Rutin RSUD
Wates;
KELIMA : Keputusan ini berlaku mulai tanggal ditetapkan.

Ditetapkan di : Wates
Pada tanggal : 2015

DIREKTUR

dr. Lies Indriyati, Sp.A

Pembina Utama Muda, IV/c
NIP. 19620729 198812 2 001
Tembusan :
1. Direktur
2. Ketua Komite/SMF
3. Kepala Bagian /Bidang
4. Kepala Instalasi/ Unit
Paraf Koordinasi

PEMERINTAH KABUPATEN KULON PROGO

RUMAH SAKIT UMUM DAERAH WATES
Jl. Tentara Pelajar Km.1 No.5 Wates Kulon Progo Yogyakarta 55611
Telp. (0274) 773169 Fax.(0274) 773092
 LAMPIRAN
KEPUTUSAN DIREKTUR RUMAH SAKIT UMUM DAERAH WATES
NOMOR ...................... TAHUN 2015 TANGGAL ..................
TENTANG
KEBIJAKAN JENIS TINDAKAN KEDOKTERAN YANG HARUS
DISERTAI DENGAN PERSETUJUAN TINDAKAN KEDOKTERAN
(INFORMED CONSENT)
RUMAH SAKIT UMUM DAERAH WATES

KEBIJAKAN JENIS TINDAKAN KEDOKTERAN YANG HARUS DISERTAI

DENGAN PERSETUJUAN TINDAKAN KEDOKTERAN (INFORMED CONSENT)
RUMAH SAKIT UMUM DAERAH WATES

I. Pengertian
Tindakan kedokteran adalah suatu tindakan medis berupa preventif,
diagnostik, terapeutik, atau rehabilitatif yang dilakukan oleh dokter atau dokter
gigi terhadap pasien.
Jenis tindakan kedokteran yang harus disertai dengan persetujuan
tindakan kedokteran (informed consent) adalah jenis-jenis tindakan kedokteran
yang dalam pelaksanaannya wajib disertai dengan adanya bukti persetujuan
tertulis (bukti formal) yang diberikan oleh pasien atau keluarga yang
berkompeten.

II. Tujuan
1. Agar pasien dan/atau keluarga mengetahui mengenai Tindakan
Kedokteran yang akan dilakukan terhadap diri pasien.
2. Agar pasien dan/atau keluarga mendapatkan hak untuk menentukan
keputusan yang terbaik bagi pasien setelah mendapatkan penjelasan
medis.
3. Untuk mendapatkan alat bukti yang sah bagi pasien, dokter dan rumah
sakit dalam pemberian tindakan kedokteran kepada pasien.

III. Kebijakan
1. Setiap pasien yang akan menjalani tindakan kedokteran di RSUD Wates,
maka pasien dan atau keluarga yang berkompeten wajib diberikan
penjelasan medis terlebih dahulu oleh dokter penanggungjawab pasien
 (DPJP) atau dapat didelegasikan kepada residen yang kompeten terhadap
tindakan tersebut.
2. Pasien atau keluarga yang bertanggungawab setelah mendapatkan
penjelasan kedokteran maka diberikan waktu yang cukup untuk memahami
penjelasan tersebut, sebelum menentukan untuk memberikan persetujuan
atau menolak tindakan kedokteran yang akan diberikan kepadanya.
3. Persetujuan atau penolakan tindakan kedokteran dapat diberikan secara
tertulis maupun tidak tertulis dengan lisan atau isyarat bahasa tubuh.
4. Persetujuan atau penolakan tindakan kedokteran yang memiliki resiko
tinggi/mengancam jiwa wajib diberikan secara tertulis ;
5. Jenis-jenis tindakan kedokteran yang harus disertai dengan persetujuan
tindakan kedokteran tertulis terdapat dalam lampiran surat keputusan ini
dan jadi satu kesatuan yang tidak terpisahkan.
6. Instalasi Rekam Medik bertanggungjawab menyiapkan lembar persetujuan
atau penolakan tindakan medik.
7. Lembar persetujuan atau penolakan tindakan kedokteran setelah
ditandatangani oleh pasien dan atau keluarga dan dokter yang
memberikan penjelasan maka wajib dimasukkan dalam berkas rekam
medis.

DIREKTUR RSUD WATES

dr. Lies Indriyati, Sp.A

Pembina Utama Muda, IV/c
NIP. 19620729 198812 2 001
Lampiran Surat Keputusan Direktur Utama RSUD WATES
Nomor :
Tanggal :
Tentang : Kebijakan Jenis Tindakan Medik Yang Hams Disertai Dengan
Persetujuan Tindakan Medik (Informed Consent) di RSUD WATES

Tindakan dengan Informed Concent

Kategori Tindakan

NO JENIS TINDAKAN
1. (Aorto)coronary bypass of four or more coronary arteries
2. (Aorto)coronary bypass of three coronary arteries
3. Attachment of pedicle or flap graft to lip and mouth
4. Bilateral lung transplantation
5. Biopsy of diaphragm
6. Bronchoscopy through artificial stoma
7. Closure of salivary fistula
8. Combined heart-lung transplantation
9. Complete sialoadenectomy
10. Construction of auricle of ear
11. Division of glossopharyngeal nerve
12. Division of penile adhesions
13. Drainage of face and floor of mouth
14. Endolymphatic shunt
15. Ethmoidectomy
16. Excision of lesion of middle ear
17. Excision of lesion or tissue of gum
18. Excision of lung and bronchus
19. Excision of major lesion of eyelid, partial-thickness
20. Excision of preauricular sinus
21. Excision of tonsil tag
22. Excision or destruction of lesion of external ear
23. Excision or destruction of lesion or tissue of tongue
24. Excision or destruction of other lesion of external ear
25. Extension or deepening of buccolabial or lingual sulcus
26. Fenestration of Inner ear (initial)
27. Implantation or replacement of cochlear prosthetic device
28. Incision of chest wall and pleura
29. Incision of external auditory canal
30. Incision of lung
31. Incision of mastoid
32. Incision of mouth
33. Incision of multiple nasal sinuses
34. Incision of penis
35. Incision of salivary gland or duct
36. Includes: incidental resection of hyoid bone
37. Insertion of palatal implant
38. Insertion of removable bridge
39. Interatrial transposition of venous return
40. Labial frenectomy
41. Ligation of adrenal vessels
42. Myringoplasty
43. Noninvasive programmed electrical stimulation (NIPS)
44. Partial glossectomy
45. Partial sialoadenectomy
46. Pericardiocentesis
47. Permanent tracheostomy
48. Radical dissection of thoracic structures
49. Radical excision of lesion of external ear
50. Radical excision of periaortic lymph nodes
51. Removal of prosthesis of fallopian tube
52. Removal of tympanostomy tube
53. Repair and plastic operations on trachea
54. Repair of adrenal gland
55. Repair of cleft lip
56. Repair of endocardial cushion defect with prosthesis
57. Repair of oval and round windows
58. Repair of uvula
59. Repair of ventricular septal defect with technique prosthesis, closed
60. Replacement of laryngeal or tracheal stent
61. Revision of stapedectomy
62. Root canal therapy with apicoectomy
63. Scarification of pleura
64. Attachment of pedicle or flap graft to lip and mouth
65. Bilateral lung transplantation

NO JENIS TINDAKAN
66. Sphenoidectomy
67. Stapedectomy
68. Suture of laceration of external ear
69. Suture of laceration of gum
70. Thyroid tissue reimplantation
71. Tracheoscopy through artificial stoma
72. Type III tympanoplasty
73. Umbilical vein catheterization
74. Unilateral adrenalectomy
75. Unilateral lung transplantation
76. (Aorto)coronary bypass of one coronary artery
77. (Aorto)coronary bypass of two coronary arteries
78. 06.01 Aspiration of thyroid field
79. 06.02 Reopening of wound of thyroid field
80. 06.11 Closed [percutaneous] [needle] biopsy of thyroid gland
81. 06.12 Open biopsy of thyroid gland
82. 06.13 Biopsy of parathyroid gland
83. 06.19 Other diagnostic procedures on thyroid and parathyroid glands
84. Abdominal - coronary artery bypass
85. abdominal artery to coronary artery
86. Abdominal proctopexy
87. abdominal wall
88. Abdominoperineal resection of rectum
89. abscess
90. acetabular and femoral components (total)
91. acetabular component only
92. acetabular liner
93. acetabular liner and/or femoral head only
94. Adenoidectomy without tonsillectomy
95. adjuct vascular system procedure
96. adrenal gland
97. Adrenalotomy (with drainage)
98. Allotransplantation of cells of Islets of Langerhans
99. Alveoloplasty
100. alveolus, alveolar bone
101. Amputation of cervix
102. Amputation of penis
103. Anal cerclage
104. Anal fistulotomyOAnal fistulectomy
105. Anastomosis of gallbladder to hepatic ducts
106. Anastomosis of gallbladder to intestine
107. Anastomosis of gallbladder to pancreas
108. Anastomosis of gallbladder to stomach
109. Anastomosis of hepatic duct to gastrointestinal tract
110. Anastomosis of kidney
111. Anastomosis of pancreas
112. Anastomosis of small intestine to rectal stump
113. Anastomosis to anus
114. Angioplasty or atherectomy of other non-coronary vessel(s)
115. ankle (total)
116. Annuloplasty
117. antecubital fossa
118. Anterior resection of rectum with synchronous colostomy
119. Antestemal esophageal anastomosis with interposition of colon
120. Antestemal esophageal anastomosis with interposition of small bowel
121. Antestemal esophagoesophagostomy
122. Antestemal esophagogastrostomy
123. anus NEC
124. Aorta-iliac-femoral bypass
125. Aorta-renal bypass
126. Aorta-subclavian-carotid bypass
127. aortic
128. aortic
129. aortic branches to heart muscle
130. Aortocoronary bypass for heart revascularization
131. Apicoectomy
132. Appendectomy
133. Appendicostomy
134. appendix
135. appendix
136. Application of orthodontic appliance
137. Arterial catheterization

NO JENIS TINDAKAN
143 Arteriovenostomy for renal dialysis
144 artery
145 artery
146 artificial
147 Artificial pneumothorax for collapse of lung
148 Artificial rupture of membranes
149 Aspiration and lavage of nasal sinus
150 Aspiration biopsy of ovary
151 Aspiration biopsy of thyroid
152 Aspiration of fallopian tube
153 Aspiration of ovary
154 Aspiration of spermatocele
155 Aspiration of testis
156 aspiration of the thyroid field
157 Aspiration or lavage of nasal sinus through natural ostium
158 atrium (heart)
159 auditory canal or meatus, external
160 Augmentation rhinoplasty
161 auricle
162 Autotransplantation of adrenal tissue
163 Autotransplantation of cells of Islets of Langerhans
164 Autotransplantation of parathyroid tissue
165 Autotransplantation of thyroid tissue
166 Auxiliary liver transplant
167 auxiliary ventricle
168 axilla
169 baffle, atrial or interatrial
170 Bartholin's gland or cyst
171 Bilateral adrenalectomy
172 Bilateral exploration of adrenal field
173 Bilateral inguinal hernia repair with graft or prosthesis
174 Bilateral nephrectomy
175 Bilateral orchiectomy
176 Bilateral repair of direct inguinal hernia
177 Bilateral repair of direct inguinal hernia with graft or prosthesis
178 Bilateral repair of femoral hernia with graft or prosthesis
179 Bilateral repair of indirect inguinal hernia
180 Bilateral repair of indirect inguinal hernia with graft or prosthesis
181 Bilateral repair of inguinal hernia, not otherwise specified
182 Bilateral repair of inguinal hernia, one direct and one indirect
183 Bilateral repair of inguinal hernia, one direct and one indirect
184 Bilateral salpingo-oophorectomy
185 Bilateral vulvectomy
186 bile duct
187 biliary fistulous tract into stomach or intestine
188 Biopsy of abdominal wall or umbilicus
189 Biopsy of alveolus
190 Biopsy of blood vessel
191 Biopsy of bony palate
192 Biopsy of chest wall
193 Biopsy of conjunctiva
194 Biopsy of cul-de-sac
195 Biopsy of eyelid
196 Biopsy of gum
197 Biopsy of heart
198 Biopsy of lacrimal gland
199 Biopsy of lacrimal sac
200 Biopsy of lip
201 Biopsy of lymphatic structure
202 Biopsy of mouth
203 Biopsy of penis
204 Biopsy of pericardium
205 Biopsy of periprostatic tissue
206 Biopsy of perirectal tissue
207 Biopsy of perirenal or perivesical tissue
208 Biopsy of peritoneum
209 Biopsy of periurethral tissue
210 Biopsy of pineal gland
211 Biopsy of pituitary gland, transfrontal approach
212 Biopsy of pituitary gland, transsphenoidal approach
213 Biopsy of pituitary gland, unspecified approach
214 biopsy of skull

NO JENIS TINDAKAN
215 Biopsy of spermatic cord, epididymis, or vas deferens
216 Biopsy of thymus
217 Biopsy of urethra
218 Biopsy of uvula and soft palate
219 Biopsy of vulva
220 bipolar endoprosthesis (femoral head)
221 bladder sphincter,artificial(inflatable)
222 Blepharorrhaphy
223 Blood Transfusion
224 blood vessels to' myocardium
225 breast (for augmentation) (bilateral)
226 Breech extraction
227 Bronchial dilation
228 Burying of fimbriae in uterine wall
229 Cannulation of pancreatic duct
230 Cannulation of thoracic duct
231 Canthorrhaphy
232 Canthotomy
233 cardiac support device (CSD)
234 cardiac support device (CSD)
235 cardiomyostimulation system
236 Cardioplegia
237 Cardiotomy
238 cardioverter/defibrillator (automatic)
239 carpocarpal, carpometacarpal
240 Catheter based invasive electrophysiologic testing
241 Cauterization of hemorrhoids
242 Caval-pulmonary artery anastomosis
243 Cecectomy
244 Cervical esophagostomy
245 Cesarean section and removal of fetus
246 chemoterapi
247 chemothalamectomy
248 Cholecystectomy
249 Choledochoenterostomy
250 Choledochoplasty
251 Circumcision
252 cisternal pucture
253 Clipping of aneurysm
254 Closed [aspiration] [needle] [percutaneous] biopsy of pancreas
255 Closed [endoscopic] biopsy of bronchus
256 Closed [endoscopic] biopsy of esophagus-
257 Closed [endoscopic] biopsy of larynx
258 Closed [endoscopic] biopsy of small intes
259 Closed [endoscopic] biopsy of trachea
260 Closed [needle] biopsy of salivary gland or duct
261 Closed [needle] biopsy of tongue
262 Closed [percutaneous] [needle] biopsy of adrenal gland
263 Closed [percutaneous] [needle] biopsy of lung
264 Closed [percutaneous] [needle] biopsy of lung
265 Closed [percutaneous] [needle] biopsy of mediastinum
266 Closed [percutaneous] [needle] biopsy of prostate
267 Closed [percutaneous] [needle] biopsy of testis
268 Closed [percutaneous] biopsy of seminal vesicles
269 Closed [transurethral] biopsy of bladder
270 Closed biopsy of uterine ligaments
271 Closed biopsy of uterus
272 Closed endoscopic biopsy of lung
273 Closed endoscopic biopsy of lung
274 Closed endoscopic biopsy of ureter
275 Closed heart valvotomy, aortic valve
276 Closed heart valvotomy, mitral valve
277 closed heart valvotomy, pulmonary valve
278 Closed heart valvotomy, tricuspid valve
279 Closed heart valvotomy, unspecified valve
280 closed percutaneous biopsy of brain
281 Closed percutaneous biopsy of ureter
282 closed precutneus biopsy of cerebral mennges
283 Closed reduction of nasal fracture
284 Closure of anal fistula
285 Closure of appendiceal fistula
286 Closure of branchial cleft fistula
287 Closure of bronchial fistula
288 Closure of cholecystostomy
289 Closure of cystostomy
290 Closure of esophagostomy
291 Closure of external fistula of trachea
292 Closure of fistula of diaphragm
293 Closure of fistula of duodenum
294 Closure of fistula of large intestine
295 Closure of fistula of larynx
296 Closure of fistula of mouth
297 Closure of fistula of small intestine
298 Closure of fistula of thoracic duct
299 Closure of fistula of uterus
300 Closure of gastrostomy
301 Closure of laceration of liver
302 Closure of laceration of lung
303 Closure of nasal fistula
304 Closure of nasal sinus fistula
305 Closure of nephrostomy and pyelostomy
306 Closure of other fistula of kidney
307 Closure of other fistula of pharynx
308 Closure of other fistula of thorax
309 Closure of other fistula of ureter
310 Closure of other fistula of urethra
311 Closure of other gastric fistula
312 Closure of other rectal fistula
313 Closure of proctostomy
314 Closure of stoma of large intestine
315 Closure of stoma of small intestine
316 Closure of thoracostomy
317 Closure of ureterostomy
318 Closure of urethrostomy
319 Colostomy
320 Combined right and left heart cardiac
321 Common duct exploration for relief of other
322 Common duct exploration for removal of calculus
323 Complete glossectomy
324 Complete laryngectomy
325 Complete parathyroidectomy
326 Complete pneumonectomy
327 Complete removal of one lobe of thyroid (with or
328 Complete substernal thyroidectomy
329 Complete thyroidectomy
330 Conization of cervix
331 Conjunctivocystorhinostomy
332 Conjunctivorhinostomy with insertion of tube or
333 Construction of penis
334 Continent ileostomy
335 control of (postoperative) hemorrhage
336 Control of (postoperative) hemorrhage of an
337 Control of (postoperative) hemorrhage of bladder
338 Control of (postoperative) hemorrhage of prostate
339 Control of hemorrhage after tonsillectomy and
340 Control of hemorrhage following vascular surgery
341 cornea
342 Correction of cleft palate
343 Correction of everted punctum
344 Correction of eyelid ptosis NOS
345 Correction of lid retraction
346 Correction of ureteropelvic junction
347 Creation of conduit between atrium and
348 Creation of conduit between left ventricle and
349 Creation of conduit between right ventricle and
350 Creation of pleuroperitoneal shunt
351 Creation of septal defect in heart
352 Cricopharyngeal myotomy
353 Cryosurgical epilation of eyelid
354 Culdocentesis
355 Culdotomy
356 custodis eye
357 Cystourethropiasty and plastic repair of bladder
358 Dacryocystorhinostomy [DCR]

NO JENIS TINDAKAN
359 Decapsulation of kidney
360 Decortication of lung
361 Delayed opening of colostomy
362 Delayed opening of ileostomy
363 dental (endosseous) (prosthetic)
364 Destruction of hemorrhoids by cryotherapy
365 Destruction of hemorrhoids by cryotherapy
366 Destruction of lesion of cervix by cauterization
367 Destruction of lesion of cervix by cryosurgery
368 Destruction of lesion of conjunctiva
369 Destruction of lesion of eyelid
370 Destruction of phrenic nerve for collapse of lung
371 Destruction of rectal lesion or tissue by cryosurgery
372 Destruction of rectal lesion or tissue by laser
373 diaphragmatic pacemaker
374 Dilation and curettage following delivery or abortion
375 Dilation and curettage for termination of pregnancy
376 Dilation and curettage of uterus
377 Dilation of bladder neck
378 Dilation of cervical canal
379 Dilation of esophagus
380 Dilation of fallopian tube
381 Dilation of pharynx
382 Dilation of pylorus by incision
383 Dilation of sphincter of Oddi
384 Dilation of ureteral meatus
385 Dilation of urethra
386 Distal pancreatectomy
387 Division of endometrial synechiae
388 Division of laryngeal nerve
389 Division of nerves to adrenal glands
390 Division of thyroid isthmus
391 Dorsal or lateral slit of prepuce
392 Double internal mammary-coronary artery bypass
393 drainage by incision (06.09)
394 Drainage of hematoma by incision
395 Drainage of pancreatic cyst by catheter
396 Drainage of thyroglossal tract by incision
397 Duhamel resection of rectum
398 elbow (total)
399 Electrosurgical epilation of eyelid
400 Endarterectomy
401 Endocervical biopsy
402 Endometrial ablation
403 endoprosthesis
404 Endoscopic control of gastric or duodenal bleeding
405 Endoscopic dilation of pylorus
406 Endoscopic excision or destruction of lesion or tissue of
407 Endoscopic excision or destruction of lesion or tissue of lung
408 Endoscopic excision or destruction of lesion or tissue of stomach
409 Endoscopic excision or destruction of lesion or tissue of urethra
410 Endoscopic insertion of other bronchial device or substances Li
411 Endoscopic Insertion of stent (tube) into pancreatic duct
412 Endoscopic insertion or replacement of bronchial valve(s
413 Endoscopic insertion, replacement and removal of therapeutic device or
414 Endoscopic removal of bronchial device(s) or substances
415 Endoscopic removal of stone(s) from pancreatic duct
416 Endoscopic retrograde pancreatography fERP]
417 Endoscopic transmyocardial revascularization
418 Endoscopy (cystoscopy) (looposcoov)of ileal conduit
419 Endoscopy of small intestine through artificial stoma
420 endosseous (dental)
421 Endovascular implantation of graft in abdominal aorta
422 Endovascular implantation of graft in thoracic aorta
423 Endovascular removal of obstruction from head and neck
424 Endovascular repair of vessel
425 Endovascular repair or occlusion of head and neck vessels
426 Enlargement of existing atrial septal defect
427 epicardiai support device
428 Epididymectomy
429 Epididymotomy
430 Epididymovasostomy

NO JENIS TINDAKAN
431 epidural pegs
432 Epiglottidectomy
433 epikeratoprosthesis
434 Episiotomy
435 ercutaneous insertion of other precerebral (extracranial) artery stent
436 Esophagectomy, not otherwise specified
437 Esophagogastroplasty
438 Esophagoscopy through artificial stoma
439 Esophagectomy, not otherwise specified
440 estradiol (pellet)
441 Ethmoidotomy
442 Evacuation of thrombosed hemorrhoids
443 Excision involving one-fourth or more of lid margin, full-thickness
444 Excision involving one-fourth or more of lid margin, partial-thickness
445 Excision of ampulla of Vater (with reimplantation of common duct)
446 Excision of aneurysm of heart
447 Excision of anus
448 Excision of axillary lymph node
449 Excision of branchial cleft cyst or vestige
450 Excision of chalazion
451 Excision of cyst of epididymis
452 Excision of cystic duct remnant
453 Excision of deep cervical lymph node
454 Excision of dental lesion of jaw
455 Excision of hemorrhoids
456 Excision of hydrocele (of tunica vaginalis)
457 Excision of Inguinal lymph node
458 Excision of
459 nternal mammary lymph node
460 Excision of
461 acrimal gland, not otherwise specified
462 Excision of
463 acrimal sac and passage
464 Excision of
465 esion of adrenal gland
466 Excision of
467 esion of lacrimal gland
468 Excision of
469 esion of maxillary sinus with Caldwell-Luc approach
470 Excision of
471 esion of thyroid
472 Excision of
473 esion of tonsil and adenoid
474 Excision of
475 lesion of tunica vaginalis other than hydrocele
476 Excision of
477 esion or tissue of conjunctiva
478 Excision of
479 esion or tissue of diaphragm
480 Excision of
481 ingual thyroid
482 Excision of lingual tonsil
483 Excision of major lesion of eyelid, full-thickness
484 Excision of other lesion or tissue of spermatic cord and epididymis
485 Excision of other minor lesion of eyelid
486 Excision of perianal skin tags
487 Excision of periprostatic tissue
488 Excision of perirectal tissue
489 Excision of periurethral tissue
490 Excision of seminal vesicle
491 Excision of thyroglossal duct or tract
492 Excision of urachus
493 Excision of uvula
494 Excision of varicocele and hydrocele of spermatic cord
495 Excision of: verucca
496 Excision ofcwart
497 Excision or destruction of lesion of chest wall
498 Excision or destruction of lesion of cui-de- sac
499 Excision or destruction of lesion of nose, not otherwise specified
500 Excision or destruction of lesion of vagina
501 Excision or destruction of lesion or tissue of larynx
502 Excision or destruction of lesion or tissue of mediastinum

NO JENIS TINDAKAN
503 Exploratory thoracotom
504 Exposure of tooth
505 Exteriorization of esophageal pouch
506 Exteriorization of large intestine
507 Exteriorization of small intestine
508 Extracorporeal circulation auxiliary to open heart surgery
509 Extracorporeal hepatic assistance
510 Extracorporeal membrane oxygenation [ECMO]
511 Extracranial-intracranial (EC-IC) vascular bypass
512 Extraction of deciduous tooth
513 extraperitoneal
514 extremity (bioelectric) (cineplastic) (kineplastic)
515 eye (Iowa type)
516 facial bone, synthetic (alloplastic)
517 fallopian tube (Mulligan hood) (silastic tube) (stent)
518 fascial sling
519 femoral (bipolar endoprosthesis)
522 femoral component only
525 femoral head (bipolar)
526 femoral head only and/or
527 femoral head only and/or acetabular liner
529 Fiber-optic bronchoscopy
530 finger
531 fistula
532 Fistulization of thoracic duct
533 Fitting of external prosthesis of penis
534 Fixation of large intestine to abdominal wall
535 Fixation of small intestine to abdominal w
536 for hallux valgus repair
537 Forceps application to aftercoming head
538 Forceps rotation of fetal he
539 Formation of cutaneous uretero-ileostomy
540 Formation of other cutaneous ureterostomy
541 Freeing of vessel
542 Frontal sinusectomy
543 Frontal sinusotomy
544 Full-thickness skin graft to lip and mouth
545 gastroepipolic artery to coronary artery
546 Gastropexy
547 Gingivoplasty
548 Gracilis muscle transplant for anal incontinence
549 half-heart
550 hand (metacarpophalangeal) (interphalangeal)
551 hearing device, electromagnetic
552 heart
553 Heart revascularization by arterial implant
554 Heart transplantation
555 Hemilaryngectomy
556 Hemithyroidectomy
557 Hemodialysis
558 Hepatotomy
559 Heterotransplant of pancreas
560 High forceps operation
561 High gastric byp
562 Highly selective vagotomy
563 hip (partial) 81.52
564 Home-transplant of pancreas
565 Hymenectomy
566 Hymenorrhaphy
568 Hypothermia (systemic) incidental to open heart surgery
569 Hysterotomy
570 ICCE (intracapsular cataract extraction)
571 lleocecostomy
572 lleocolectomy
573 lleocolostomy
574 lleocolotomy
575 lleocystoplasty
576 lleoduodenotomy
577 lleoectomy (partial)
578 lleoesophagostomy
579 lleoileostomy
580 I leopancreatostomy

NO JENIS TINDAKAN
581 lleopexy
582 I leo proctostomy
583 lleorectostomy
584 lleorrhaphy
585 I leoscopy
586 lleosigmoidostomy
587 Ileostomy
588 Ileostomy, not otherwise specified
589 lleotomy
590 I leotransversostomy
591 lleoureterostomy (Bricker's) (ileal bladder)
592 impantation or replacement of cardiac resynchronization defibriltion pulse
593 impantation or replacement of cardiac resynchronization pacemaker pulse
594 Implant of external heart assist system
595 Implant of pulsation balloon
596 Implant, implantation
597 implantation cardiac resynchronization pacemacker without mention of
598 Implantation of artificial urinary sphincter [AUS]
599 Implantation of automatic cardioverter/defibrillator lead(s)
600 Implantation of automatic cardioverter/defibrillator pulse
601 implantation of cardiac resynchronization defibrilation, total system (CRT-D)
602 Implantation of cardiomyostimulation system
603 Implantation of diaphragmatic pacemaker
604 Implantation of electromagnetic hearing device
605 Implantation of electronic bladder stimulator
606 Implantation of electronic ureteral stimulator
607 Implantation of prosthetic cardiac support device around the heart
608 implantation of replacement of transvenous lead (electrode) into left ventricular
609 Implantation of total replacement heart system
610 Implantation or replacement of cochlear prosthetic device,
611 Implantation or replacement of mechanical kidney
612 Implantation or replacement of prosthesis of fallopian tube
613 Implantation or revision of artificial anal sphincter
614 implntation or replacement of subcutaneous device for intracardiac hemodinamic
615 Incision (and drainage)
616 incision and drainage of cranial sinus
617 Incision and drainage of tonsil and peritonsillar structures
618 Incision of adrenal gland
619 Incision of anal septum
620 Incision of Bartholin's gland (cyst)
621 Incision of bronchus
622 incision of cerebral meninges
623 Incision of cervix to assist delivery
624 Incision of chest wall
625 Incision of cornea
626 Incision of duo
627 Incision of esophageal web
628 Incision of external ear
629 Incision of gum or alveolar bone
630 Incision of intestine
631 Incision of lacrimal canaliculi
632 Incision of lacrimal gland
633 Incision of lacrimal punctum
634 Incision of lacrimal sac
635 Incision of large intestine
636 Incision of lid margin
637 Incision of mediastinum
638 Incision of middle ear
639 Incision of other bile ducts for relief of obstruction
640 Incision of palate
641 Incision of perianal abscess
642 Incision of periprostatic tissue
643 Incision of perirectal tissue
644 Incision of periurethral tissue
645 Incision of petrous pyramid air cells
646 Incision of pineal gland
647 Incision of prostate
648 Incision of seminal vesicle
649 Incision of spermatic cord
650 Incision of testis
651 Incision of thyroid field
652 Incision of uvula
 NO JENIS TINDAKAN
653 Incision of vessel
654 Incision or excision of congenital septum of uterus
655 Incisional hernia repair
656 Incisional hernia repair with prosthesis
657 inert material
658 Infundibulectomy
659 Inguinal herniorrhaphy NOS
660 Injection into inner ear
661 Injection into prostate test link
662 Injection into thoracic cavity
663 Injection of hemorrhoids
664 Injection of implant into urethra and/or bladder neck
665 Injection of locally-acting therapeutic substance into trachea
666 Injection of sclerosing agent into vein
667 Injection of therapeutic substance into testis
668 Injection of tympanum
669 insertion of catheter into canial cavity or tissue
670 Insertion of choledochohepatic tube for decompression
671 Insertion of drug-eluting coronary artery stent(s)
672 insertion of drug-eluting peripheral vessel stent
673 Insertion of fixed bridge
674 Insertion of gastric bubble (balloon)
675 insertion of implantable heart assist system
676 Insertion of indwelling urinary catheter
677 Insertion of intercostal catheter for drainag
678 Insertion of intrauterine contraceptive device
679 Insertion of non-drug-eluting coronary artery stent(s)
680 Insertion of non-implantable heart assist system
681 Insertion of percutaneous external heart assist device
682 Insertion of permanent tube into esophagus
683 Insertion of subcutaneous electrical anal stimulator
684 Insertion of temporary transvenous pacemaker system
685 Insertion of valve in vas deferens
686 Insertion of vessel-to-vessel cannula
687 insertion or replacement of implantable pressure sensor (lead) for intracardiac
688 Insertion or replacement of inflatable penile prosthesis
689 Insertion or replacement of non-inflatable penile prosthesis
690 Insertion, replacement, removal, and revision of pacemaker device
691 Insertion, revision, replacement, and removal of leads; insertion of
692 Insufflation of fallopian tube
693 Insufflation of therapeutic agent into fallopian tubes
694 interbody spinal fusion device
695 Internal and combined version and extraction
696 Internal drainage of pancreatic cyst
697 interphalangeal
698 interposition operation
699 Interruption of the vena cava
700 Intestinal anastomosis,
701 into uterus
702 Intra-abdominal venous shunt
703 Intra-amniotic injection for abortion
704 intracardiac hemodynamic monitor, subcutaneous
705 Intracoronary artery thrombolytic infusion
706 Intraoperative cardiac pacemaker
707 Intraoperative manipulation of stomach
708 Intrathoracic esophageal anastomosis with interposition of colon
709 Intrathoracic esophageal anastomosis with interposition of small bowel
710 Intrathoracic esophagoesophagostomy
711 Intrathoracic esophagogastrostomy
712 Intrauterine transfusion
713 intravascular imaging of blood vessel
714 Intubation of nasolacrimal duct
715 ischiorectal
716 Isthmectomy
717 joint (prosthesis) (silastic) (Swanson type)
718 kidney, mechanical
719 knee (partial) (total)
720 Labial frenotomy
721 laparoscopic
722 Laparoscopic ablation of liver lesion or tissue
723 Laparoscopic ablation of renal lesion or tissu
724 Laparoscopic appendectomy

NO JENIS TINDAKAN
725 Laparoscopic biopsy of ovary
726 Laparoscopic cholecystectomy
727 Laparoscopic gastric restrictive procedure
728 Laparoscopic gastroenter
729 Laparoscopic gastroplasty
730 Laparoscopic incidental appendectomy
731 Laparoscopic lysis of adhesions of ovary and fallopian tube
732 Laparoscopic lysis of perirenal or periureteral adhesions
733 Laparoscopic lysis of perivesical adhesions
734 Laparoscopic marsupialization of ovarian cyst
735 Laparoscopic oophorotomy
736 Laparoscopic partial cholecystectomy
737 Laparoscopic procedures for creation of esophagogastric sphincteric
738 Laparoscopic radical abdominal hysterectomy
739 Laparoscopic radical vaginal hysterectomy
740 Laparoscopic reimplantation of ovary
741 Laparoscopic removal of both ovaries at same operative episod
742 Laparoscopic removal of gastric restrictive device(s)
743 Laparoscopic removal of remaining ovary
744 Laparoscopic revision of gastric restrictive procedure
745 Laparoscopic salpingo-oophoroplasty
746 Laparoscopic simple suture of ovary
747 Laparoscopic supracervical hysterectomy
748 Laparoscopic total abdominal hysterectomy
749 Laparoscopic unilateral oophorectomy
750 Laparoscopic unilateral salpingo-oophorectomy
751 Laparoscopic wedge resection of ovary
752 Laparoscopically assisted vaginal hysterectomy
753 Lap-Band
754 Large-to-large intestinal anastomosis
755 larynx
756 larynx
757 Left heart cardiac catheterization
758 Left hemicolectomy
759 Left lateral anal sphincterotomy
760 leoentectropy
761 Levator muscle operation for urethrovesical suspension
762 Ligation and stripping of varicose veins
763 Ligation of bronchus
764 Ligation of esophageal varices
765 Ligation of gastric varices
766 Ligation of spermatic cord
767 Ligation of thoracic duct
768 Ligation of thyroid vessels
769 Ligation of ureter
770 Ligation of vas deferens
771 Limited rhinoplasty
772 Linear repair of laceration of eyelid or eyebrow
773 Lingual frenectomy
774 Lingual frenotomv
775 HP
776 Lobectomy of liver
777 Lobectomy of lung
778 lobotomy and tractotomy
779 Local excision of esophageal diverticulum
780 Local excision of lesion of prostate
781 Local excision of other lesion or tissue of esophagus
782 Local excision of other lesion or tissue of stomach
783 Local excision or destruction of intranasal lesion
784 Local excision or destruction of lesion of penis
785 Local excision or destruction of lesion or tissue of bony palate
786 Local excision or destruction of lesion or tissue of bronchus
787 Local excision or destruction of lesion or tissue of trachea
788 Local perfusion of kidney
789 Local perfusion of large intestine
790 Local perfusion of small intestine
791 Localized perfusion of liver
792 Low forceps operation
793 Low forceps operation with episiotomy
794 lower
795 Lower eyelid rhytidectomy
796 Lung transplantation, not otherwise specified

NO JENIS TINDAKAN
797 Lung volume reduction surgery
798 Lysis of adhesions of conjunctiva and eyelid
799 Lysis of adhesions of nose
800 Lysis of adhesions of spermatic cord
801 Lysis of adhesions of tongue
802 Lysis of adhesions of trachea or larynx
803 Lysis of intraluminal adhesions of ureter
804 Lysis of intraluminal adhesions of vagina
805 Lysis of intraluminal adhesions with incision into bladder
806 Lysis of pharyngeal adhesions
807 Lysis of vulvar adhesions
808 Magnetic removal of embedded foreign body from cornea
809 Male sterilization procedure,
810 mammary to ventricular wall (Vineberg)
811 Manipulation of lacrimal passage
812 Manual rupture of ovarian cyst
813 Marsupialization of Bartholin's gland (cyst)
814 Marsupialization of cervical cyst
815 Marsupialization of kidney lesion
816 Marsupialization of laryngeal cyst
817 Marsupialization of lesion of liver
818 Marsupialization of ovarian cyst
819 Marsupialization of pancreatic cyst
820 Marsupialization of salivary gland cyst
821 Mediastinal tracheostomy
822 Mediastinoscopy
823 Medical induction of labor
824 metacarpophalangeal
825 Mid forceps operation
826 mitral
827 mitral
828 multiple channel
829 Multiple segmental resection of large intestine
830 Multiple segmental resection of small intestine
831 muscle or aponeurosis
832 Myotomy of other parts of colon
833 Myotomy of sigmoid colon
834 Myringotomy with insertion of tube
835 neck by incision
836 Nephrectomy of remaining kidney
837 Nephrocystanastomosis
838 Nephropexy
839 Nephropexy
840 Nephrostomy
841 Nephrotomy
842 Nephroureterectomy
843 nose
844 Obliteration and total excision of vagina
845 Obliteration of lacrimal punctum
846 Obliteration of vaginal vault
847 omental
848 Open ablation of liver lesion or tissue
849 Open ablation of lung lesion ortissuen
850 Open ablation of renal lesion or tissue
851 Open biopsy of adrenal gland
852 Open biopsy of bladder
853 open biopsy of brain
854 Open biopsy of bronchus
855 open biopsy of cerebral meninges
856 Open biopsy of esophag
857 Open biopsy of kidney
858 Open biopsy of larynx or trachea
859 Open biopsy of lung
860 Open biopsy of lung
861 Open biopsy of pancreas
862 Open biopsy of prostate
863 Open biopsy of salivary gland or duct
864 Open biopsy of seminal vesicles
865 Open biopsy of small intestine
866 Open biopsy of testis
867 Open biopsy of tongue
868 Open biopsy of ureter

NO JENIS TINDAKAN
869 Open biopsy of uterine ligaments
870 Open biopsy of uterus
871 Open chest coronary artery angioplasty
872 Open chest transmyocardial revascularization
873 Open excision or destruction of other lesion or tissue of bladder
874 Open heart valvuloplasty of aortic valve without replacement
875 Open heart valvuloplasty of mitral valve without replacement
876 Open heart valvuloplasty of pulmonary valve without replacement
877 Open heart valvuloplasty of tricuspid valve without replacement
878 Open heart valvuloplasty without replacement, unspecified valve
879 Open mediastinal biopsy
880 Open reduction of nasal fracture
881 Operations for sex transformation,
882 Operations on carotid body and other vascular bodies
883 Operations on chordae tendineae
884 Operations on clitoris
885 Operations on Eustachian tube
886 Operations on external ear
887 Operations on papillary muscle
888 Operations on thyroid and parathyroid glands
889 Operations on trabeculae carneae cordis
890 Operations on valves and septa of heart
891 Operations on vessels of heart
892 Operative esophagoscopy by incision
893 opration of the endokrin system
894 opration of the nervous system
895 Orbicularis oculi muscle sling for correction of blepharoptosis
896 orbit (eye socket)
897 Orchiopexy
898 other cardiovascular procedure
899 Other destructive procedures on conjunctiva
900 Other diagnostic procedures on adrenal glands, pituitary gland,
901 Other diagnostic procedures on eyelid
902 Other diagnostic procedures on lacrimal system
903 Other epilation of eyelid
904 Other eyelid repair
905 Other incision of eyelid
906 Other incision of lacrimal passages
907 Other incision of thyroid field
908 Other operations on parathyroid glands
909 Other operations on pineal gland
910 Other operations on thyroid glands
911 Other parathyroidectomy
912 Other partial adrenalectomy
913 Other partial dacryoadenectomy
914 Other partial dacryoadenectomy
915 Other reconstruction of eyelid, full-thickness
916 Other reconstruction of eyelid, partial-thickness
917 Other repair of entropion or ectropion
918 Other repair of laceration of eyelid, full-thickness
919 Other repair of laceration of eyelid, partial-thickness
920 Other repair of punctum
921 Other transmyocardial revascularization
922 Ovarian denervation
923 palidotomy
924 pallidoansectomy
925 pancreatic duct
926 Pancreatic sphincteroplasty
927 Pancreatic sphincterotomy
928 Pancreatic transplant, not otherwise specified
929 Paracervical uterine denervation
930 Parathyroid tissue reimplantation
931 Paraurethral suspension
932 partial
933 partial
934 Partial cystectomy
935 Partial esophagectomy
936 Partial excision of pineal gland
937 Partial excision of pituitary gland, transfrontal approach
938 Partial excision of thymus
939 Partial gastrectomy with anastomosis to duodenum
940 Partial gastrectomy with anastomosis to esophagus

NO JENIS TINDAKAN
941 Partial gastrectomy with anastomosis to jejunum
942 Partial hepatectomy
943 Partial nephrectomy
944 Partial substernal thyroidectomy
945 Partial thyroidectomy NOS
946 Partial ureterectomy
947 Partial ventriculectomy
948 patellar component
950 pelvic (female)
951 Pelvic evisceration
952 percutaneous transluminal coronary angioplasti (PTCA) or coronary atherectomy
953 Percutaneous (endoscopic) jejunostomy
954 Percutaneous [endoscopic] gastrojejunostomy
955 Percutaneous [endoscopic] gastrostomy
956 Percutaneous ablation of liver lesion or tissue
957 Percutaneous ablation of lung lesion or tissue!:
958 Percutaneous ablation of renal lesion or tissue
959 Percutaneous angioscopy
960 Percutaneous aspiration of Bartholin's gland (cyst)
961 Percutaneous aspiration of bladder
962 Percutaneous aspiration of gallbladder
963 Percutaneous aspiration of kidney (pelvis)
964 Percutaneous aspiration of liver
965 Percutaneous aspiration of prostate
966 Percutaneous aspiration of seminal vesicle
967 Percutaneous aspiration of tunica vaginalis
968 Percutaneous cardiopulmonary bypass
969 Percutaneous cystostomy
970 Percutaneous extraction of common duct stones
971 percutaneous insertion of carotid artery stent
972 percutaneous insertion of intracranial vascular stent
973 Percutaneous nephrostomy with fragmentation
974 Percutaneous nephrostomy without fragmentation
975 Percutaneous or needle drainage of thyroid field
976 percutaneous transmyocardial revascularization
977 Percutaneous valvuloplasty
978 percutaneus angioplasty or atheerctom of intracranial vesel
979 percutaneus angioplasty or atherectomy of paracerebral (extracranal) vesel
980 perianal
981 Pericardiectomy
982 Pericardiotomy
983 perigastric
984 Perineal prostatectomy
985 Perineal urethroscopy
986 perisplenic
987 peritoneal NEC
988 Permanent colostomy
989 Pharyngeal diverticulectomy
990 Pharyngectomy
991 Pharyngotomy
992 pineal gland, and thymus
993 placement of intracerebral catheter via burr holes
994 Pleural biopsy
995 Plication of emphysematous bleb
996 Plication of the diaphragm
997 Plication of urethrovesical junction
998 Pneumoperitoneum for collapse of lung
999 portion of other lobe)
1000 Posterior anal sphincterotomy
1001 Posterior resection of rectum
1002 postoperative aspiration of field (06.02)
1003 Probing of lacrimal canaliculi
1004 Probing of lacrimal punctum
1005 Probing of nasolacrimal duct
1006 Probing of salivary duct
1007 Proctotomy
1008 Production of subcutaneous tunnel without esophageal anastomosis
1009 prosthetic cardiac support device
1010 Proximal pancreatectomy
1011 Pubiotomy to assist delivery
1012 pulmonary
1014 Puncture of lung

NO JENIS TINDAKAN
1015 Puncture of nasal sinus for aspiration or lavage
1016 Pyelostomy
1017 Pyelotomy
1018 Pyloromyotomy
1019 Radical cystectomy
1020 Radical electrocoagulation of rectal lesion or tissue
1021 Radical excision of axillary lymph nodes
1022 Radical excision of iliac lymph nodes
1023 Radical excision of lymph nodes
1024 Radical excision of other lymph nodes
1025 Radical glossectomy
1026 Radical groin dissection
1027 Radical laryngectomy
1028 Radical mastoidectomy
1029 Radical maxillary antrotomy
1030 Radical neck dissection, bilateral
1031 Radical neck dissection, not otherwise specified
1032 Radical neck dissection, unilateral
1033 Radical prostatectomy
1034 Radical subtotal pancreatectomy
1035 Radical vulvectomy
1036 Reanastomosis of urethra
1037 Reattachment of amputated ear
1038 Reconstruction of conjunctival cul-de-sac with free graft
1039 Reconstruction of external auditory canal
1040 Reconstruction of eyelid involving lid margin, full-thickness
1041 Reconstruction of eyelid involving lid margin, partial-thickness
1042 Reconstruction of eyelid with hair follicle graft
1043 Reconstruction of eyelid with mucous membrane flap or graft
1044 Reconstruction of eyelid with skin flap or graft
1045 Reconstruction of eyelid with tarsoconjunctival flap
1046 Reconstruction of eyelid, not otherwise specified
1047 Reconstruction of penis
1048 Reconstruction of surgically divided vas deferens
1049 Reconstruction of trachea and construction of artificial larynx
1050 Reconstruction of urinary bladder
1051 Rectorectostomy
1052 Reduction of anal prolapse
1053 Reduction of hemorrhoids
1054 Reduction of overcorrection of ptosis
1055 Reduction of torsion of renal pedicle
1056 Re-entry operation (aorta)
1057 Regional lymph node excision
1058 Reimplantation of aberrant renal vessel
1059 Reimplantation of adrenal tissue
1060 Reimplantation of pancreatic tissue
1061 reinsertion
1062 Release of chordee
1063 Release of torsion of ovary
1064 Release of urethral stricture
1065 Removal of arteriovenous shunt for renal dialysis
1066 Removal of artificial anal sphincter
1067 removal of catheter from cranial caviti or tissue
1068 Removal of electronic bladder stimulator
1069 Removal of electronic ureteral stimulator
1070 Removal of embedded foreign body from conjunctiva by incision
1071 Removal of foreign body by incision
1072 Removal of foreign body from tonsil and adenoid by incision
1073 Removal of gastric bubble (balloon)
1074 Removal of heart assist system
1075 removal of hematoma
1076 removal of hematoma by aspiration
1077 Removal of internal prosthesis of penis
1078 removal of intrcranial neurostimulatr lead
1079 Removal of lead(s) [electrode] without replacement
1080 Removal of lesion of eyelid, not otherwise specified
1081 Removal of ligature from ureter
1082 Removal of ligature from vas deferens
1083 Removal of mechanical kidney
1084 Removal of meibomian gland NOS
1085 Removal of prosthetic device from bile duct
1086 | Removal of residual root

NO JENIS TINDAKAN
1087 Removal of transplanted or rejected kidney
1088 Removal of valve from vas deferens
1089 Renal allotransplantation
1090 Reopening of recent laparotomy site
1091 Reopening of recent thoracotomy site
1092 reopening of wound of the thyroid field
1093 Reopening of wound of thyroid field for:
1094 Repair of aneurysm of coronary vessel
1095 Repair of arteriovenous fistula
1096 Repair of atrial septal defect with prosthesis, closed technique
1097 Repair of atrial septal defect with prosthesis, open technique
1098 Repair of atrial septal defect with tissue graft
1099 Repair of bladder exstrophy
1100 Repair of blepharoptosis by frontalis muscle technique with
1101 Repair of blepharoptosis by frontalis muscle technique with suture
1102 Repair of blepharoptosis by other levator muscle techniques
1103 Repair of blepharoptosis by other techniques
1104 Repair of blepharoptosis by resection or advancement of levator
1105 Repair of blepharoptosis by tarsal technique
1106 Repair of blood vessel with synthetic patch graft
1107 Repair of blood vessel with tissue patch graft
1108 Repair of canaliculus
1109 Repair of colovaginal fistula
1110 Repair of current obstetric laceration of uterus
1111 Repair of cystocele
1112 Repair of cystocele and rectocele
1113 Repair of diaphragmatic hernia with thoracic approach
1114 Repair of diaphragmatic hernia, abdominal approach
1115 Repair of direct inguinal hernia
1116 Repair of direct inguinal hernia with graft or prosthesis
1117 Repair of endocardial cushion defect with tissue graft
1118 Repair of entropion or ectropion by suture technique
1119 Repair of entropion or ectropion by thermocauterization
1120 Repair of entropion or ectropion with lid reconstruction
1121 Repair of entropion or ectropion with wedge resection
1122 Repair of esophageal fistula
1123 Repair of esophageal stricture
1124 Repair of fistula involving bladder and intestine
1125 Repair of fistula of cervix
1126 Repair of fistula of vulva or perineum
1127 Repair of heart assist system
1128 Repair of hypospadias or epispadias
1129 Repair of indirect inguinal hernia
1130 Repair of indirect inguinal hernia with graft or prosthesis
1131 Repair of inguinal hernia with graft or prosthesis
1132 Repair of laceration involving lid margin, full-thickness
1133 Repair of laceration involving lid margin, partial-thickness
1134 Repair of laceration of conjunctiva
1135 Repair of laceration of gallbladder
1136 Repair of laryngeal fracture
1137 Repair of other fistula of bladder
1138 Repair of other hernia of anterior abdominal wall
1139 Repair of other hernia of anterior abdominal wall with prosthesis
1140 Repair of other vaginoenteric fistula
1141 Repair of parasternal hernia
1142 Repair of pectus deformity
1143 Repair of pericolostomy hemla
1144 Repair of pleura
1145 Repair of prostate
1146 Repair of rectocele
1147 Repair of rectovaginal fistula
1148 Repair of scrotal fistula
1149 Repair of spermatic cord and epididymis
1150 Repair of symblepharon with free graft
1151 Repair of tongue and glossoplasty
1152 Repair of umbilical hernia with prosthesis
1153 Repair of unspecified septal defect of heart with prosthesis
1154 Repair of unspecified septal defect of heart with tissue graft
1155 Repair of ventricular septal defect with prosthesis, open
1156 Repair of ventricular septal defect with tissue graft
1157 repening of craniotomy site
1158 Replacement of aortic valve with tissue graft

NO JENIS TINDAKAN
1159 Replacement of automatic cardioverter/defibrillator lead(s) only
1160 Replacement of automatic cardioverter/defibrillator pulse
1161 Replacement of electronic bladder stimulator
1162 Replacement of electronic ureteral stimulator
1163 Replacement of indwelling urinary catheter
1164 Replacement of mitral valve with tissue graft
1165 Replacement of nephrostomy tube
1166 Replacement of pulmonary valve with tissue graft
1167 Replacement of pyelostomy tube
1168 Replacement of transvenous atrial and/or ventricular lead(s)
1169 Replacement of tricuspid valve with tissue graft
1170 Replacement of unspecified heart valve
1171 Replacement of vessel-to-vessel cannula
1172 Replacement or repair of other implantable component of total
1173 Replacement or repair of thoracic unit of total replacement heart
1174 Replantation of penis
1175 Resection of exteriorized segment of large intestine
1176 Resection of exteriorized segment of small intestine
1177 Resection of nose
1178 Resection of transverse colon
1179 Resection of vessel with anastomosis
1180 Resection of vessel with replacement
1181 Restoration of tooth by filling
1182 Restoration of tooth by inlay
1183 retroperitoneal
1184 Retroperitoneal dissection
1185 Retropubic prostatectomy
1186 Retropubic urethral suspension
1194 revision (acetabular and femoral components)
1195 revision NOS
1196 revision NOS
1197 revision NOS
1198 Revision of anastomosis of biliary tract
1199 Revision of anastomosis of large intestine
1200 Revision of anastomosis of small intestine
1201 Revision of arteriovenous shunt for renal dialysis
1202 Revision of cleft palate repair
1203 Revision of corrective procedure on heart
1204 Revision of cutaneous ureteroileostomy
1205 Revision of fenestration of inner ear
1206 Revision of gastric anastomosis
1207 revision of hip replacement, acetabular component
1208 revision of hip replacement, acetabular linier and /or femoral head only
1209 revision of hip replacement, both acetabular and femoral comonents
1210 revision of hip replacement, femoral component
1211 Revision of laryngostomy
1212 Revision of mastoidectomy
1213 Revision of other cutaneous ureterostomy
1214 Revision of stapedectomy with incus replacement
1215 Revision of stoma of small intestine
1216 Revision of tracheostomy
1217 Revision of tympanoplasty
1218 Revision of ureterointestinal anastomosis
1219 Revision or closure of vesicostomy
1220 Revision or relocation of pacemaker pocket
1221 Revision rhinoplasty
1222 Right heart cardiac catheterization
1223 Right hemicolectomy
1224 Root canal therapy with Irrigation
1225 Salpingo-oophorostomy
1226 Salpingo-salpingostomy
1227 Salpingostomy
1228 Salpingotomy
1229 Salpingo-uterostomy
1230 sclera
1231 scleral shell (cup) (with evisceration of eyeball)
1232 Segmental resection of lung
1233 septum
1234 Severing of blepharorrhaphy
1235 shoulder (partial)
1236 Sialoadenectom
1237 Sigmoidectomy

NO JENIS TINDAKAN
1238 Simple excision of other lymphatic structure
1239 Simple mastoidectomy
1240 Simple suture of common bile duct
1241 Simple suture of fallopian tube
1242 single channel
1243 Single internal mammary-coronary artery bypass
1244 Sinusectomy
1245 skin
1246 Small-to-smail intestinal anastomosis
1247 Soave submucosal resection of rectum
1248 Sphenoidotomy
1249 Sphincterotomy of bladder
1250 splenotomy
1251 Stapedectomy with incus replacement
1252 Stapes mobilization
1253 subcutaneous tissue
1254 subdiaphragmatic
1255 subhepatic
1256 Submucous resection of nasal septum
1257 subphrenic
1258 substances in bronchus or lung
1259 Substernal thyroidectomy
1260 Substernal thyroidectomy, not otherwise specified
1261 Suprapubic prostatectomy
1262 Suprapubic sling operation
1263 Surgical correction of prominent ear
1264 Suture of artery
1265 Suture of duodenal ulcer site
1266 Suture of gastric ulcer site
1267 Suture of laceration of anus
1268 Suture of laceration of bladder
1269 Suture of laceration of bronchus
1270 Suture of laceration of cervix
1271 Suture of laceration of diaphragm
1272 Suture of laceration of duodenum
1273 Suture of laceration of esophagus
1274 Suture of laceration of kidney
1275 Suture of laceration of large intestine
1276 Suture of laceration of larynx
1277 Suture of laceration of lip
1278 Suture of laceration of other part of mouth
1279 Suture of laceration of palate
1280 Suture of laceration of penis
1281 Suture of laceration of pharynx
1282 Suture of laceration of rectum
1283 Suture of laceration of salivary gland
1284 Suture of laceration of scrotum and tunica vaginalis
1285 Suture of laceration of small intestine
1286 Suture of laceration of testis
1287 Suture of laceration of tongue
1288 Suture of laceration of trachea
1289 Suture of laceration of ureter
1290 Suture of laceration of urethra
1291 Suture of laceration of uterus
1292 Suture of laceration of vagina
1293 Suture of laceration of vas deferens and epididymis
1294 Suture of laceration of vulva or perineum
1295 Suture of peptic ulcer
1296 Suture of thyroid gland
1297 Suture of unspecified blood vessel
1298 Suture of vein
1299 Symphysiotomy for horseshoe kidney
1300 Systemic to pulmonary artery shunt
1301 Tarsorrhaphy
1302 Temporary colostomy
1303 Temporary ileostomy
1304 temporary pacemaker system; or revision of cardiac device po
1305 Temporarv tracheostomy
1306 Tenon's capsule (with enucleation of eyeball)
1307 thalamotomy
1308 Thoracentesis
1309 Thoracoplasty

NO JENIS TINDAKAN
1310 Thoracoscope ablation of lung lesion or tissue/)
1311 Thymectomy, not otherwise specified
1312 thyroid (field) by incision
1313 Thyroidotomy NOS by incision
1314 tibial component
1316 tibial insert
1317 tibial insert
1318 tissue graft
1319 toe
1320 Tonsillectomy with adenoidectomy
1321 Tonsillectomy without adenoidectomy
1322 total
1323 total (acetabular and femoral components)
1324 total (acetabular and femoral components)
1325 total (all components)
1326 Total bilateral salpingectomy
1327 Total body perfusion
1328 Total correction of transposition of areat vessels
1329 Total dacryoadenectomy
1330 Total esophagectomy
1331 Total excision of pineal gland
1332 Total excision of thymus
1333 Total gastrectomy with intestinal interposition
1334 Total hepatectomy
1335 Total nasal reconstruction
1336 Total pancreatectomy
1337 Total pancreatectomy
1338 Total repair of tetralogy of Fallot
1339 Total repair of total anomalous pulmonary venous connection
1340 Total repair of truncus arteriosus
1341 total replacement system
1342 total replacement system
1343 Total splenectomy
1344 Total unilateral salpingectomy
1345 Total ureterectomy
1346 Tracheoesophageal fistulization
1347 Transabdominal cerclage of cervix
1348 Transabdominal endoscopy of small inte
1349 Transcatheter embolization for gastric or duodenal bleeding
1350 Transection of thyroid isthmus
1351 Transfer of tarsoconjunctivai flap from opposing lid
1352 Transplant of intestine
1353 Transplantation of cells of Islets of Langerhans,
1354 Transplantation of ovary
1355 Transpleural thoracoscopy
1356 Transsacral rectoslgmoidectomy
1357 Transureteroureterostomy
1358 Transurethral (ultrasound) guided laser induced prostatectomy
1359 Transurethral balloon dilation of the prostatic urethra
1360 Transurethral clearance of bladder
1361 Transurethral destruction of prostate tissue by microwave
1362 Transurethral lysis of intraluminal adhesions
1363 Transurethral removal of obstruction from ureter and renal pelvis
1364 tricuspid
1366 Trocar cho/ecystostomy
1367 Truncal vagotomy
1368 Turbinectomy by diathermy or cryosurgery
1369 Tympanosympathectomv
1370 Type II tympanoplasty
1371 Type IV tympanoplasty
1372 Type V tympanoplasty
1373 unilateral
1375 Unilateral destruction or occlusion of fallopian tube
1376 Unilateral exploration of adrenal field
1377 Unilateral orchiectomy
1378 Unilateral repair of femoral hernia with graft or prosthesis
1379 Unilateral repair of inguinal hernia, not otherwise specified
1380 Unilateral thyroid lobectomy
1381 Unilateral vulvectomy
1382 upper
1383 Upper eyelid rhytidectomy
1384 Ureteral meatotomy

NO JENIS TINDAKAN
1385 Ureterectomy
1386 Ureteroneocystostomy
1387 Ureteropexy
1388 Ureterotomy
1389 urethra
1390 Urethral meatoplasty
1391 Urethral meatotomy
1392 Urethrotomy
1393 Urinary diversion to intestine
1394 uture of laceration of chest wall
1395 Vacuum extraction
1396 Vaginal biopsy
1397 Vaginal construction
1398 Vaginal reconstruction
1399 Vaginal repair of chronic inversion of uterus
1400 Vaginal suspension and fixation
1401 valve(s) prosthesis or synthetic device (partial) (synthetic) (total)
1402 vas deferens
1403 Vasectomy
1404 Vasotomy
1405 Venous catheterization
1406 Venous catheterization for renal dialysis
1407 Venous cutdown
1408 ventricular support device 37.41
1409 ventriculopreitoneal trough previously implanted chateter
1410 Vesicostomy
1411 vocal cord(s)
1412 Vocal cordectomy
1413 Wedge resection of eyelid
1414 Wedge resection of ovary
1415 Wide excision of lesion of lip
1416 Wide excision or destruction of lesion or tissue of bony palate
1417 with appendectomy

Direktur Utama

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