NO DIAGNOSA DIAGNOSA INA-CBG's

1 Appendik perforasi - Perforationof intestine(non-traumatic)K63.1

- Other spesified septicaemia.A41.8

2 Lipoma - Benign lipomatous neoplasm of other sites

D17.7

3 Incisi Abses -Cutaneous abscess,furuncle and carbuncle,

unspecified.L02.9

4 Sindaktil - Webbed fingers.Q70.1

-Syndactyly unspecified.Q70.9
-Polysyndactyly.Q70.4

5 Fraktur Radius Distal Malunion of fracture, multiple sitesM84.00

Disruption of operation wound, not elsewhere
classifiedT81.3

6 Irigasi sinus Chronic maxillary sinusitisJ32.0

Chronic pharyngitisJ31.2

7 Fracture Clavicula(Revisi post op) Fracture of clavicle, closedS42.00

dan Bone graf Disruption of operation wound,
not elsewhere classifiedT81.3

Fracture of bony thorax, part unspecified,

closedS22.90
TINDAKAN KELAS 3 KELAS 2 KELAS 1
-Exploratory laparotomy 54.11 Rp 10.806.200,- Rp 12.967.400,- Rp 15.128.700,-

-Other local excision or destruction of Rp 3.274.200,- Rp 3.929.100,- Rp 4.583.900,-

lesion or tissue of skin and subcutaneous
tissue.86.3

-Other local excision or destruction of Rp 3.274.200,- Rp 3.929.100,- Rp 4.583.900,-

lesion or tissue of skin and subcutaneous
tissue.86.3

- Full-thickness skin graf to hand.86.61 Rp 6.888.200,- Rp 8.265.800,- Rp 9.643.500,-

- Other tenoplasty of hand.82.86
- Reattachment of tendon of hand.82.53

Open reduction of fracture of radius and ulna Rp14,829,500.00 Rp17,795,500.00 Rp20,761,400.00

with internal fixation79.32
Bone graf of radius and ulna78.03

Other external maxillary antrotomy22.39 Rp3,843,700.00 Rp4,612,400.00 Rp5,381,100.00

Open reduction of fracture with internal fixation,

unspecified site79.30 device from scapula,
Removal of implanted
clavicle, and thorax [ribs and sternum]78.61

Removal of implanted device from scapula,

clavicle, and thorax [ribs and sternum]78.61
1