No.

Diagnosis Tindakan
1. H-1-20-II (Prosedur Ekstraokuler dan
Orbita)

a. (H44.5) absolute glaucoma - 1641 : Enucleation of eyeball with

synchronous implant (enukleasi +
DFG)

- 1639 : Other evisceration of eyeball

- 1272 : Cyclocryotherapy

- 1229: Other diagnostic procedures

on iris, ciliary body, sclera, and
anterior chamber

2. H-1-30-II (Prosedur Lensa dan

Intraokuler)

a.
H40.1Primary open-angle glaucoma
Glaucoma (primary)(residual
stage):
 capsular with
pseudoexfoliation of lens
 chronic simple
 low-tension
 pigmentary
- 1264 : Trabeculectomy ab externo
- 133 : Extracapsular extraction of
lens by simple aspiration (and
irrigation) technique
- 1371 : Insertion of intraocular lens
prosthesis at time of cataract
extraction, one-stage
- 1221 : Diagnostic aspiration of
anterior chamber of eye

b. H40.2Primary angle-closure glaucoma - 1292 : Injection into anterior

Angle-closure glaucoma
(primary)(residual stage):
 acute
 chronic
 intermittent
chamber
- 1475 : Injection of vitreous subtitute
- 1214 : Other Iridectomy
- 1229: Other diagnostic procedures
on iris, ciliary body, sclera, and
anterior chamber
 H40.5Glaucoma secondary to other
eye disorders
Use additional code, if desired,
to identify cause.

3. H4-12-II Gangguan Mata Lain-lain

- 1229: Other diagnostic procedures

H40.8Other glaucoma on iris, ciliary body, sclera, and
anterior chamber
H40.9Glaucoma, unspecified

-
4. H2-31-0

a. 1212 : Other Iridotomy

H40.2Primary angle-closure glaucoma
Angle-closure glaucoma - 1229: Other diagnostic procedures
(primary)(residual stage): on iris, ciliary body, sclera, and
anterior chamber
 acute
 chronic
 intermittent

b.  1229: Other diagnostic

H40.1Primary open-angle glaucoma procedures on iris, ciliary
Glaucoma (primary)(residual body, sclera, and anterior
stage): chamber

 capsular with
pseudoexfoliation of lens
 chronic simple
 low-tension
 pigmentary

6. H-2-22-0 (Prosedure Sedang pada

Mata Eksternal)
-