ABC

DAFTAR ICD X PENYAKIT FAVORIT DI PRAVINKA

A B
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT KODE
1 ABDOMINAL PAIN – ABD. TENDERNESS R10.4 1 BEKAS SECTIO O34.2
2 ABDOMINAL PAIN – ABD. RIGID R10.0 2 BELL’S PALSY G51.0
3 ABORTUS SPONTAN O03 3 BLEPHARITIS H01.0
4 ABSCESS OF EXTERNAL EAR H60.0 4 BRONCHIECTASIS J47
5 ALERGI L25.3 5 BRONCHITIS J40
6 AMENORHOE N91.2 6 BRONCHITIS ACUTE J20.9
7 AMENORHOE SECONDARY N91.1 7 BRONCHITIS CHRONIS J42
8 ANEMIA D50.9 8 BRONCHOPNEUMONI UNSP J18.0
9 ANGINA PECTORIS I20.9 9 BSK – BATU SALURAN KEMIH R39.1
10 ANGKAT JAHITAN Z48.0 10 BPH N40
11 APB J17 11 BITTEN BY RAT W53
12 APPENDICITIS DGN PERFORASI K3.0 12 BITTEN OR STRUCK BY DOG W54
13 APPENDICITIS AKUT UNSPECIFIELD K35.9 13 BITTEN OR STRUCK BY OTHER W55
14 ARITMIA I49.9
15 ARTHRITIS UNSP M13.9
16 ASD I51.0
17 ASMA J45
18 ASMA BRONCHIALE J45.9
19 ASTENIA R53
20 ATEROMA/UCI-UCI/SEBACEOUS CYST L72.1
21 ATHEROSCLEROTIC HEART DISEASE / PJK I25.1
22 ATRALGIA M25.5
23 ATRIAL FIBRILIATION I48
24

Page 1
 ABC
ORIT DI PRAVINKA

C
NO NAMA PENYAKIT KODE
1 CA BULI C67.9
2 CA MAMMAE C50.9
3 CA OVARIUM C59
4 CALCULUS OF KIDNEY N20.0
5 CALLUS / CORN & CALLOSITIES L84
6 CAMPAK/MORBILI B05.9
7 CANDIDIASIS STOMATITIS B.37.0
8 CANDIDIASIS UNSP B37.0
9 CARDIAC ARITMIA UNSP I49.9
10 CARDIO VASCULER UNSP I51.6
11 CARDIOMEGALI I51.7
12 CATARACT SINILIS UNSP H25.9
13 CATARACT UNSP H26.9
14 CELLULITIS UNSP L03.9
15 CEPHALGIA G44.8
16 CHEST PAIN / CHEST DISCOMFORT R07.4
17 CHOLELITHIASIS K.80-2
18 CHRONIC RENAL FAILURE / CKD N18.9
19 CLOSE FRAKTUR TIBIA S82.10
20 CLOSE FRAKTUR ULNA S52.0
21 COLIC ABDOMEN R10.4
22 COMBUSTIO GRADE 1 T31.0
23 COMBUTIO MULTIPLE T.29.0
24 COMMON COLD / CC J00
25 CONDYLOMA / ANOGENITAL WARTS A63.0
26 CONJUNGTIVITIS H10.9
27 CONTUSIO MUSCULORUM T14.8
28 CONTUSIO OF EXTERNAL GENITAL ORGANS S30.2
29 CONTUSION OF ANKLE S90.0
30 CORPAL PADA TONSIL T17.2
31 CPD O33.9
32 CRAMP & SPASME R25.2
33 CRS M53.1
34 CTS / CARPAL TUNNEL SYNDROME G56.0
35 CVA INFARK I63.9
36 CYSTA ADNEXIA N83.8
37 CONSTIPASI K59.0

Page 2
 DEF
DAFTAR ICD X PENYAKIT FAVORIT DI PRAVINKA

D E
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT
1 DECOMP CORDIS / HEART FAILURE UNSP I50.9 1 EMMETROPIA / MATA SEHAT
2 DENGUE FEVER A90 2 ENDOMETRIOSIS
3 DERMATITIS L30.9 3 ENTERITIS
4 DERMATITIS ALERGI L23.0 4 EPILEPSI
5 DERMATITIS ATOPIC L20 5 EPISTAKSIS
6 DERMATITIS INFECTIVE L30.3 6 EROSI SCALP DI KEPALA
7 DERMATITIS KONTAK L25.1
8 DERMATITIS KONTAK ALERGI L25.3
9 DERMATITIS STASIS I83.1
10 DERMATOPHITOSIS UNSP B35.9
11 DHF A91
12 DIABETIC CATARACT H28.0
13 DIABETIC RETINOPATHY H36.0
14 DIAPER RUSH L22
15 DISLIPIDEMIA E78
16 DM E11.8
17 DM TYPE II E11.6
18 DRY EYE SYNDROME H04.1
19 DYSMENORRHOE UNSP/PRIMARY N94.4
20 DYSPEPSIA K30
21 DYSURI R30
22 DYSPHAGIA R13
23 DEHIDRASI E86.0
24 DYSHIDROSIS (POMPHOLYX) L30.1

Page 3
 DEF
T FAVORIT DI PRAVINKA

F
KODE NO NAMA PENYAKIT KODE
Z01.0 1 FAM D24
M80 2 FARINGITIS ACUTE J02.9
K52.9 3 FARINGITIS CHRONIS J31.2
G40.9 4 FASOMOTOR RHINITIS J30.0
R04.0 5 FATIQUE / MALAISE R53
S01.0 6 FATTY LIVER K76.0
7 FISURA ANI K60.2
8 FLU / INFLUENZA J11.1
9 FLU SINGAPURA / HFMD B08.8
10 FLUOR ALBUS N89.8
11 FOLICULITIS L08.0
12 FROZEN SHOULDER M75.0
13 FURUNKEL / CARBUNKEL L02
14 FURUNKEL DI KAKI/TANGAN L02.4
15 FURUNKEL DI MUKA L02.0
16 FURUNKEL DI PUNGGUNG L02.2
17 FURUNKEL DI MATA / HORDEOLUM H00.0
18 FOLIKULTIS L72.9

Page 4
 GHIJ
DAFTAR ICD X PENYAKIT FAVORI

G H
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT KODE
1 GANGGUAN PENCERNAAN K93.8 1 HAEMOPTOE R04.2
2 GANGGUAN TUMBANG R62.9 2 HAEMOROID EXTERNA I84.5
3 GANGGUAN VISUS H52.7 3 HAEMOROID INTERNA I84.0
4 GANGLION D16.9 4 HAMIL BAYI KEMBAR 3 O30.1
5 GASTRITIS K29.1 5 HAMIL BAYI KEMBAR GENELLA O30.0
6 GEA K52.9 6 HAMIL BEKAS SC Z35.8
7 GEA DEHIDRASI SEDANG R19.7 7 HERNIA K40.9
8 GERD K21.9 8 HERNIA INGUILARIS K40.0
9 GLAUCOMA DM H42.0 9 HERPES B00.1
10 GLAUCOMA UNSPECIFIED H40.9 10 HERPES ZOOSTER B02.9
11 GLOSSITIS K14.0 11 HFMD / FLU SINGAPURA B08.8
12 GOITER E04.9 12 HHD / HYPERTENSIVE HEART DISEASE I11.9
13 GOUT M10.9 13 HNP M51.2
14 GOUT ARTHRITIS M10.0 14 HORDIEOLOM & OTHER UP INFLAM. H00.0
15 GANGLION M67.4 15 HT TERKONTROL / HHF I11.0
16 16 HYDRONEFROSIS UNSP N13.3
HYDRONEFROSIS WITH RENAL &
17 URETERAL N13.2
CALCULOUS OBSTRUCTION
18 HYPERBILIRUBIN P59.9
19 HYPERCHOLESTEROL E78.0
20 HYPEREMESIS GRAVIDARUM (MILD) O21.9
21 HYPERLIPIDEMIA E78.5
22 HYPERMETROPI H52.0
23 HYPERTENSIA I10
24 HYPERTIROID E05.0
25 HYPERURICEMIA E79.0
26 HYPOTENSI I95.9
27 HIGH RISK PREGNANCY UNSP Z35.9
28 HYPERKINETIC DISORDER/HYPERACTIVE F90

Page 5
 GHIJ
X PENYAKIT FAVORIT DI PRAVINKA

I J
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT
1 ICH I62.9 1
2 IMA I21.9
3 IMPETIGO L01
4 IMPINGEMENT SYNDROME OF SHOULDER M75.4
5 IMUNISASI BCG Z23.2
6 IMUNISASI DPT Z27.1
7 IMUNISASI POLIO Z24.0
8 IMUNISASI DPT + POLIO Z27.3
9 IMUNISASI MR Z27.4
10 INFEKSI LUKA POST OP T81.4
11 INFEKSI SEKUNDER B34.9
12 INFLUENZA J11
13 INGROWING NAIL L60.0
14 INSECT BITES T14.0
15 INSULIN DEPENDENT / DM WITH UNSP E10.8
16 ISK N39.0

17 ICTERUS NEONATORUM P59.9

18 INJURY OF EAR EXTERNAL S09.9

19 IUFD O36.4
INJURY OF ANKLE AND FOOT

Page 6
 GHIJ

J
KODE

Page 7
 KLM
DAFTAR ICD X PENYAKIT FAVORIT DI PRAVINK

K L
NO NAMA PENYAKIT KODE NO
1 KB SUNTIK 3 BULAN Z30-4 1
2 KEROTITIS KRN CONJUNGTIVITIS H16.2 2
3 KET P0.1 3
4 KONTRASEPSI Z30.0 4
5 KONTROL 1 HAMIL Z34.0 5
6 KONTROL HAMIL Z34.8 6
7 KONSTIPASI K59.0 7
8 KISTA OVARIUM N83.2 8
9 KUTIL / VIRAL WARTS B07

Page 8
 KLM
DAFTAR ICD X PENYAKIT FAVORIT DI PRAVINKA

L M
NAMA PENYAKIT KODE NO
LARINGITIS AKUT J04.0 1
LARINGOPHARINGITIS AKUT J06.0 2
LBP M54.5 3
LEUCOSITOSIS K50.9 4
LIMPADENITIS L04.0 5
LIPOMA D17.9 6
LUKA DM E11.5 7
LYMPHADENOPATHI R59.1 8
9
10
11
12
13
14
15
16
17
18
19

Page 9
 KLM
AVINKA

M
NAMA PENYAKIT KODE
MALAISE / FATIQUE R53
MALPRESENTATION OF FETUS O32
MASTITIS O91.2
MATA KELUAR KOTORAN Z03.8
MATA SEHAT / EMMETROPIA Z01.0
MENOMETRORHAGIA N91.0
METEORISMUS R14
METRORHAGI EXCESSIVE / N92.1
FREQUENT MENSTRUASI IRREGULAR
MIGRAINE G43.9
MILIARIA L74.3
MONILIASIS B37.9
MORBILI / CAMPAK B05.9
MULTIPLE VULNUS T00.9
MUMPS B26.9
MUSCULUS SPASMA / MUSCLE SPASM R25.2
MYALGIA M79.1
MYOMA UTERI D25.9
MYOPIA H52.1
METABOLIC DISORDER SYNDROME E88

Page 10
 NOPQ
DAFTAR ICD X PENYAKIT FAVORI

N O
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT KODE
1 NASOPHARINGITIS J31 1 OA / OSTEO ARTHRITIS LUTUT M17.9
2 NASOPHARINGITIS AKUT J00 2 OA POST TRAUMATIK M19.17
3 NASOPHARINGITIS KRONIS J31.1 3 OAB / OVER ACTIVE BLADDER N31.9
4 NEUROPATHY G62.9 4 OBS. CHEST PAIN R07.4
E11.4
5 NEUROPATHY POST DM / 5 OBS. FEBRIS R50.9
G59.0
6 NON TRAUMATIK I62.9 6 OBSTIPASI K59.0
NASOLACRIMAL DUCT
7 H04.5 7 OBSTRUKSI LARINGITIS J05.0
OBSTRUCTION
8 OEDEMA R60.9
9 OPEN WOUND OF SCALP S01.0
10 ORCHITIS NON ABSES N45.9

11 ORCHITIS WITH ABSES N45.0

12 OSTEOMIELITIS K10.2
13 OSTEOPOROSIS UNSP M81.9
14 OTALGIA H92.0
15 OTHER IDIOPATHIC SCOLIOSIS M41.2
16 OTHER PERIPHERAL VERTIGO H81.3
17 OTITIS EXTERNA H60.9
18 OTITIS MEDIA / OMA H66.9
OTHER LACK OF EXPECTED NORMAL
19 PHYSIOLOGICAL DEVELOPMENT R62.8
20 OTOMIKOSIS H62.2

Page 11
 NOPQ
X PENYAKIT FAVORIT DI PRAVINKA

P Q
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT
1 PARANOID F20 1
2 PARASTHESE R20.2
3 PARONIKIA / CELLULITIS DI JARI / CANTENGE L03.0
4 PAROTITIS K11.2

5 PARTUS NORMAL O80.0

6 PERICHONDRITIS AURICLE H61.0

7 PHARINGO TONSILITIS J03.8

8 PJK / ATHEROSCLEROTIC HEART DISEASE I25.1

9 PLACENTA PRAEVIA O44
PLACENTA PRAEVIA (TOTALIS
10 O44.1
PARTIAL, MARGINAL)
11 PLANTAR FASCIAL FIBROSI M72.2
12 PLEURAL INFECTION J91
13 PNC Z39.2
14 POLYHYDRAMMOS HYDRAMNIOS D40
15 POLYNEUROPATHY G62.9
16 POLYP OF COLON K63.5
17 POST HECTING Z48.8
18 POST SECTIO O34.2
POST TRAUMATIC ARTROSIS
19 M19.1
OF OTHER JOIN
20 PPOK J44.9
21 PRE MENOPAUSE E28.3
22 PREAURICULAR SINUS & CYST Q18.1
23 PREMATURE RUPHERA OF MEMBRANS O42
24 PRESBIOPIE H52.4
25 PRESENTASI BOKONG O32.1
26 PRESENTATION TRANSVERI/LINTANG O32.2
27 PREVIOUOS SURGERY O34.2
28 PRIMARY AMENORE N91.0
29 PRIMARY DYSMENORRHOE N94.4
30 PROLONGED PREGNANCY O48
31 PRURITUS L29
32 PRURITUS SENILIS L29.8
33 PYODERMA L08.0
34 PHYMOSIS N47
35 PTERYGIUM H11.0
PALPITASI R00.2

Page 12
 NOPQ

Q
KODE

Page 13
 RSTU
DAFTAR ICD X PENYAKIT FAVORIT DI PRAVI

R S T
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT KODE NO
1 RA / RHEUMATHOID ARTHRITM06.9 1 SCABIES B86 1
2 RESIDUAL SCHIZOPHRENIA F20.5 2 SECONDARY DYSMENORRHE N94.5 2
3 RETENSI URINE R33 3 SECONDARY AMENORRHEA N91.1 3

4 RHINITIS ALERGI J30.4 4 SEMBELIT K59.0 4

5 RHINITIS AKUT J00 5 SERUM OBSTRUKSI T16 5

6 RHINITIS CHRONIS J31.0 6 SERUMEN IMPACTED H61.2 6

SINGLE DELIVERY BY
7 RHINITIS VASOMOTOR J30.0 7 SC082 7
CAEAREAN SECTION
8 RHINOPHARINGITIS AKUT J00 8 SINUSITIS AKUT J01.9 8

9 RHINOPHARINGITIS CHRONI J31.1 9 SINUSITIS MAXILARIS ACUTE J01.0 9

10 SINUSITIS MAXILARIS CHRON J32.0 10
11 SLE M32.9 11
12 SPEECH DELAY F80.8 12
13 STATUS ASTHMATICUS J46 13
14 STOMATITIS K12.1 14
15 STROKE BARU/UNSP HEMORA I64 15
16 SUB CONJUNTIVA BLEEDING H11.3 16
17 SUSP STROKE/KONTROL RUT I69.4 17
18 SPRAIN AND STRAIN OF ANK S93.4 18
SCOLIOSIS M41.9 19
20
21
22

23

24
25

Page 14
 RSTU
NYAKIT FAVORIT DI PRAVINKA

T U
NAMA PENYAKIT KODE NO NAMA PENYAKIT KODE
TAA Z03.8 1 ULCUS MOLE / CHANCROID A57
TBC OF LUNG CONFIRM A15.3 2 ULKUS DI BAGIAN KAKI KRN L97
UNSTABLE PATELA POST
TBC PARU A16.2 3 S80.1
TRAUMA DGN MEMAR
UNSTABLE PATELA POST
TB LIMPHADENOPATHY A18.2 4 S80.8
TRAUMA TDK MEMAR
TENDINITIS M75.2 5 URI / ISPA J06.9

TENSION TYPE HEADACHE / G44.2 6 UROLITIASIS N20.1

THYROTOXICOSIS E05 7 URTICARIA UNSPECIFIED L50.9

UNSPECIFIED INJURY OF
TIA G45.9 8 ANKLE S99.9
AND FOOT
TINEA CORPORIS B35.4 ULKUS DIABETIKUM L89-9
TINEA CRURIS B35.6
TINEA MANUUM B35.2
TINEA PEDIS B35.3
TONSILITIS AKUT J03.9
TONSILITIS KRONIS J35.0
TONSILO PHARYNGITIS J06.8
TORTICOLIS M43.6
TRAUMA PEDIS S99.0
TRICHIASIS H02
TRIGEMINAL NEURALGI G51.9
TRIGER FINGER M65.3
TUMOR COLLI D21.0
TWIN PREGNANCY/KEMBAR 2 O30.0
TYPHUS ABDOMINALIS /
A01.0
TYPHOID FEVER
TINNITUS H93.1
TACHYCARDIA / PALPITASI R00.0

Page 15
 VWXYZ
DAFTAR ICD X PENYAKIT FAVORIT

V W
NO NAMA PENYAKIT KODE NO NAMA PENYAKIT
1 VARICELLA B01.9 1 WRIST & HAND INJURY
2 VARICES I83.1
3 VERTIGO R42
4 VIRAL EXANTHEMA / ENANTHEMA B09
5 VIRAL INFECTION B34.9
6 VIRAL WARTS / KUTIL B07
7 VISUAL DISTURBANCE UNSP H53.9
8 VITILIGO L81.9
9 VOLVULUS K56.2
10 VOMITING R11
11 VULNUS APPERTUM DI JARI TANGAN S61.0
12 VULNUS APPERTUM DI KAKI (ANKLE + S90.9
13 VULNUS APPERTUM MULTIPLE T00.9
14 VULNUS LACERASI DI AREA GENITAL S30.2
15 VARICOSE VEINS OF OTHER SITES I86
16 VAGINITIS AKUT N76.0
17
18

Page 16
 VWXYZ
ICD X PENYAKIT FAVORIT DI PRAVINKA

X&Y Z
KODE NO NAMA PENYAKIT KODE NO NAMA PENYAKIT
S69 1 XANTHELASMA OF EYED H02.6 1
2

Page 17
 VWXYZ

KODE

Page 18
 GIGI
DAFTAR ICD UTK KASUS GIGI

NO NAMA PENYAKIT KODE NO

1 DRY SOCKET K10.3 19
2 ERUPTION OF TOOTH K00.6 20
3 EXTRUDED / PALATOVERSI / ANOMALI OF TOOTH POSITION K07.3 21
4 FRACTURE MAHKOTA S02.5 22
5 FRACTURE OF TOOTH S02.6 23
6 GINGIVAL ABSES / ABSES PERI APIKAL / ACUTE PERIODONTITIS K05.2 24
7 GINGIVITIS AKUT K05.0 25
8 GINGIVITIS KRONIS K05.1 26
9 GP (GANGREN PULPAE) / NECROSIS PULPAE TOTALIS / GOYANG 2-3 K04.1 27
10 GR (GANGREN RADIX) / SISA AKAR K08.3 28
11 HP (HYPERAEMIC PULPAE) / KARIES GIGI / PULPITIS REVERSIBLE K02.1 29
12 IMPAKSI K01.1 30
13 INZETTEN Z46.3 31
14 IRITATIO PROTESA Z06.3 32
15 IRITATIO PULPAE K03.1 33
16 KG (KARANG GIGI) / KALKULUS K03.6 34
17 LEPAS JAHITAN GIGI Z48.0 35
18 SUPERNUMERARY TEETH K00.1 36

Page 19
 GIGI
D UTK KASUS GIGI

NAMA PENYAKIT KODE

MALOKLUSI K07.4
MUCOCELE K13.7
ODONTOLOSE RIDGE / POST EKSTRAKSI / LOSS OF TEETH DUE TO K08.1
ODONTOMA D16.5
OSTEOMA D16.5
PALATOVERSI POST KECELAKAAN LANTAS T90.8
PEMERIKSAAN (KONTROL SEHAT) Z01.2
PERICORONITIS K05.3
PERIOD / PERIDONTITIS APICALIS AKUT K04.4
PERIOD / PERIDONTITIS APICALIS KRONIS K04.5
PERIODONTITIS KRONIS K05.3
PERIODONTOSIS K05.4
PERSISTENSI / EMBEDED TEETH / EXCOLIASI K01.0
POCKET K05.6
PULPITIS / PULPITIS IRREVERSIBLE K04.0
TMJ / TEMPORO MANDIBULAR JOINT K07.6
TRISMUS R25.2
ULCER / LUKA K08.9

Page 20
 PIPP

DAFTAR PETUGAS PEMBERIAN INFORMASI & PENANGANAN PENGADUAN PE

BPJS KESEHATAN SURABAYA

NO NAMA PIPP NO HP LOKASI PIPP

1 DWI 08113161199 RSUD DR. MOH. SOEWANDI

2 TARA 08113385193 KANTOR BPJS JL DHARMAHUSADA

3 DHEA & AMRI

08113099143 RSUD DR. SOETOMO
08113010333

4 AMRI 08113010333 RSUD DR. SOETOMO

5 ADIT 082244373103 RSU HAJI SUKOLILO

6 ROSA 08113427469 RS ISLAM JEMURSARI

7 RESTU 08113007338 RSAL DR. RAMELAN

8 ANI 08123102612 RS BHAYANGKARA

Page 21
 PIPP

9 LILA 0811301176 RSU BDH

Page 22
 PIPP

ANAN PENGADUAN PESERTA (PIPP)

BAYA

AREA RS YG DICOVER

RSUD Soewandi,
Rumkital dr. Oepomo,
RS PHC,
RS Al Irsyad,
RS Adi Husada Kapasari

RS Husada Utama,
Klinik HD 3D Clinic,
RS Mata Undaan,
Rumkitban DKT,
Klinik Mata dr Sjamsu

RSUD DR. SOETOMO

Siloam Hospital,
Klinik Mata Tritya,
RSIA Pura Raharja

RSU Haji,
RSJ Menur,
Klinik Welas Asih,
RSIA Putri,
RS Bedah,
RS Universitas Airlangga

RSI Jemursari,
RS Royal,
RSI A Yani,
RSIA Perdana Medika,
Klinik Utama Dasa Medika, RS SMS

RSAL dr. Ramelan,

RS William Booth,
RSAD Brawijaya,
Klinik Mata Java Cataract,
Rumkit RSAU Lanud Soemitro Mulyono

RS Bhayangkara,
Rumkital Marinir Ewa Pangalila,
RS Wijaya,
RS Mata Masyarakat,
RS Bhakti Rahayu,
RS Wiyung Sejahtera,
RS Graha Medika

Page 23
 PIPP

RS BDH,
RS Muji Rahayu,
RS Bunda,
RSI Darus Syifa,
RSIA Lombok 22,
Klinik Utama 3D Clinic

Page 24
 Sheet11

JANTUNG
IHD / GJK /CHD I25.9
COPD J44.9
HHD I11.9
DECOMP CORDIS I50.9
CHF I50.0
HHF I11.9

PJK I25.4
PJB/PDA Q25.0
ASD Q21.1
VES I47.1
OMI I25.2
AF I48
VENTRIKEL FIBRILASI I49.0
CARDIOMEGALI I51.7
ARITMIA I49.9
PVC I49.3
MCI I40.9
IMA I21.9
RHD I09.9
PAD I47.1
LBBB I44.7
RBBB I45.1
PORTAL HT K76.6
MI INFERIOR / ASHD I21.1
TAKIKARDIA R00.0
Mitral stenosis I05.0
Mitral insufisiensi I34.0
UAP/Angina Pectoris I20.0
Insufisiensi Renal N28.9
Valve heart disease I34.0
BRADIKARDIA R00.1
Palpitations R00.2
abnormalities of heart beat R00.8
Chest Pain R07.4

Page 25
 Sheet11

KULIT SARAF
Condiloma talata A63.0 CRS G54.2
Tinea corporis B35.4 CKR S06.0
Scabies B36 LBP M54.5
Impetigo L01.0 CTS G56.0
Pyoderma L08.0 RA M06.8
Erythrasma L08.1 TIA G45.9
Local infection of skin and
Subcutaneous tissue, unsp. L08.9 OA M15.9
Pemphigus, unspecified L10.9 MDS D46
Prurigo L28.2 HNP M51.2
Pompolix L30.1 HNP cervical M50.2
Dermatitis L30.8 THA G44.2
Allergic contact dermatitis, unspecified L23.9 PNP D81.5
Urticaria L50.9 GOUT M10.9
Vitiligo L80 CVA BLEEDING L62.9
Seboroik keratosisi L82 POST CKR F07.2
Scar/fibrosisi skin L90 Cepalgia R51
Lupus M32.9 Parkinson G20
Epilepsi G40.8
Ischialgia R10.2
Vertigo R42
Meniere disease H81.0
BPPV H81.1
Other peripheral vertigo H81.3
Vertigo of central origin H81.4
Insomnia G47.0
Kejang R56.8
Spondylosis, unspecified M47.9
Neuropathy G62.9
Neuralgia M79.2
Mialgia M79.1
Hemiplegi G81.9
ParaPlegi G82.2
Parastesia R20.2
Cram+spasme R25.2
Demensia F03
Trigger finger M65.3

Page 26
Other and
unspecified
diseases of
pulp and
periapical
tissues
Sheet10
Gingivitis
and
periodontal
diseases
K05.0
Acute
gingivitis
K05.1
KULIT
Chronic
gingivitis
SYARAF
K05.2
Acute
periodontiti
s K05.3
Chronic
periodontiti
GIGI
s K05.4
Periodontos
is K05.5
Other
periodontal
diseases
K05.6
Periodontal
disease,
unspecified

Page 27
 Sheet10

INTERNE
A15.3
TBC
N18.8
CKD
A09
GEA
K21.9
GERD
JO6.9
ISPA
A91
DHF
R06.0
Dispnu
R17
Icterus

R53
General
weaknes
R18
Asites
K30
Dispepsia
R50.9
Obs Febris
A18.2
Limfadenitis
TB
K29.7
Gastritis
K29.5
Gastritis
kronis
K25.9
Gastric
ulcer
K27.9
Peptic Ulcer

J18.0
Bronkopne
moni
J18.9
Pneumonia
J20.9
Bronkitis
J47
Bronchiecta
sis J21.9
Acute Page 28
bronchioliti
s,
unspecified

K59.0
 Sheet10

R11
Nausea+Vo
miting

E78.0
HIPERKOLE
STEROL
E79.0
Hiper uric
acid E05.9
Hiperthiroid
E03.9
Hypothyroid
E87.5
Hiperkalemia
E87.6
Hipokalemia
D69.6
Trombositop
enia E75.6
Dislipidemia
E78.5
hiperlipidemi
a R73.9
hiperglikemi
E16.2
hipoglikemi

Page 29
 Sheet10

E11.5+I79.2
DM
angiopaty
E11.6+M14.6
DM
Neuropati
E11.2+N08.3
DM + CKD
E11.6+M14.2
DM
artropati
E11.6+G63.2
DM
polineuropati
E11.3+H36.0
DM
Retinopati
E11.3+H28.0
DM
cataract
E11.5
DM
gangrene

N20.0
Batu ginjal
N20.1
Batu ureter
N20.2
Batu ginjal +
batu ureter
N20.9
batu sal
kencing
N21.0
Batu
bladder
N21.1
Batu
urethra

Page 30
 Sheet10

C22.0
Hepatoma
K75.9
Hepatitis
B15.9
Hepatitis A
B16.9
Hepatitis B
B17.1
Hepatitis C
K74.6
Sirosis
Hepatis
K73.9
Hepatitis
Kronis
K76.0
Fatty liver
D69.3
Evans
syndrome
Bedah
L91.0
Keloid
N40
BPH

K80.8
Cholelitiasis
K81.9
Cholecystitis,
unspecified
L04.0
lymphadeniti
s face, head
& neck I88.9

lymphadeniti
s NOS

Page 31
 Sheet10

B07
Veruca
D17.9
Lipoma
L84
Clavus
M67.4
Ganglion
L02.9
Abses
L72.0
Ateroma
M72.4
Fibroma
L89
Decubitus
M77.3
Calcaneus
spur K11.6
Mucocele

Page 32
 Sheet10

T30.0
Combustio
T01.9 V
Apertum
D17.0 Tu
Coli L03.9
Selulitis NOS
Z41.2
Sirkumsisi
D18.0
Hemangioma

E04.0
Struma
E04.1
SNT
E04.2
SMNNT
E05.0
Struma toxic
E05.1
hyperthyroid
+SNT
E05.2
hyperthyroid
+SMNNT
E05.9
hyperthyroid,
unspecified
C73 CA
tyroid

D24 Tu
Mama
N61
Mamae
aberen
N60.0
FCD N60.2
FAM
N60.9
Benign
mammary
dysplasia
D05.9 CA
Mama D05.1
Intraductal
carcinoma
breast
D05.9
Carcinoma
breast,
Page 33
 Sheet10

R33
Retensi urine
R34
Anuri+Oliguri
a R35
Poliuria
R30
Disuria
N30.2
Cystitis N39.
0 ISK
Q55.2
Microtestis
N35.9
Strictur
uretra
I86.1
Varicocel
N43.0
Hidrocel
N45.9
Orchitis
tanpa
abscess
N45.0
Orchitis +
Abses
Scrotum
C61 CA
Prostat
N13.3
Hidronefrosis
N13.2
Hidronefrosis
batu
N43.0
Hidrocele

D36
Apendic
K37 App
NOS
K35.9 App
acut K45.0
HIL I84.2
HE interna
I84.5 HE
Externa
I84.6
Skintag

K92.9 Page 34
trauma
thorax
D76.2
tumor
Abdomen
 Sheet10
MATA
08.24
Exsisi eyelid

D03.1
Tumor/nevus
D23.1 Tu
palpebra

H00.0
Hordeolum
H01.0
Blefaritis
H02.0
Trichiasis
H04.1 Dry
eye DES
H04.3
Canaloculitis
H10.9
Conjungtivitis
H11.0
Pterigium

H13.1
Secondary
Infection
H15.1
Episcleritis
H16.0
Abses
cornea
H16.2
Keratoconjun
ctivitis
H16.9
Keratitis
H17.0
Leukoma
H17.8
Vitreus
opacity
H18.7
Stafiloma

H20.0
Uveitis
H20.8 Iritis

Page 35
 Sheet10

Senile
cataract
H25.0
Senile
incipient
cataract
H25.1
Senile
nuclear
cataract
H25.2
cataract
matur
H25.8
Other senile
cataract
H25.9
Senile
cataract,
unspecified

Other
cataract
H26.0
catarat
imatur
H26.1
Traumatic
cataract
H26.2
Complicate
d cataract
H26.3
Drug-
induced
cataract
H26.4
After
catarak
H26.8
Other
specified
cataract
H26.9
Cataract,
unspecified

Page 36
 Sheet10

H30.8
Retinitis
H31.0
Macula
cornea
H35.7
Ablatio
Retina

H40.9
Glaucoma
H43.3
Floaters
H43.8
PVD (vitreus
disease)
H46
TON H52.0

Hypermetrop
ia H52.1
Myopia
H52.2
Astigmatism
H52.3
Anisometropi
a and
aniseikonia
H52.4
Presbyopia
H52.5
Disorders of
accommodati
on H52.6
Pinguecula
H52.7
Disorder of
refraction,
unspecified

H53.0
Amblyopia
ex anopsia
H53.1
Astenophia
H53.2
Diplopia
H35.3
ARMD, Papil
atrofi

Page 37
 Sheet10

S05.9
Injury of eye
and orbit,
part
unspecified
T26.6+
Trauma
kimia mata
Z96.1
Pseudofakia

THT

J03.9 TE
J03.8 Te
acut
J35.0
TEcronis
J35.9
CHRONIC
AdenoTE
J36
Peritonsilar
abses
J03.9/J02.9

Tonsilofaringi
tis

J30.0
Vasomotor
rhinitis
J30.1
Allergic
rhinitis due to
pollen
J30.2
Other
seasonal
allergic
rhinitis
J30.3
Other allergic
rhinitis
J30.4
Allergic
rhinitis,
unspecified

Page 38
 Sheet10

96.52
Irigasi telinga
R04.0
Epistaxis
H61.2
Cerumen
98.11
Extraxi
cerumen

H65.2
OMSK
H66.9
Otitis media
NOS
H60.9
Otitis externa
NOS
H91.9
Gangguan
dengar
H91.1
Presbycusis
H93.1
Tinitus

H73.0
Myringitis
J02.9
Faringitis
J31.2
Chronic
faringitis
D10.6
Polip
Nasofaring
A66.5 CA
nasofaring
H71
Colesteatom
a H61.0
pericondritis

Page 39
 Sheet10

J01.0
Acute
maxillary
sinusitis
J01.1
Acute frontal
sinusitis
J01.2
Acute
ethmoidal
sinusitis
J01.3
Acute
sphenoidal
sinusitis
J01.4
Acute
pansinusitis
J01.8
Other acute
sinusitis
J01.9
Acute
sinusitis,
unspecified

Page 40
 Sheet10

GINEKOLO
GI O20.0
Abortus
iminen
O08.0 Ab
infeksius
O21.1 Ab
Insipien
O04.4 Ab
Incomplet

N83.2
Kista
ovarium
D27
Benigna
neoplasma
ovarium
N77.1
Vulvovaginiti
s N70.9
Adnexitis
D25.9
Myoma uteri
N73.9 PID

N80.9
Endometriosi
s N93.8
DUB
91.41 Pap
smear
N85.0
Hyperplasia
endometrium
D07.0 CA
endometrium
C75.4
Solid
ovarium ciste

N92.0
Hipermenore
N94.6
dismenore
N92.4
menometrorh
agia
N91.2
amenore

Page 41
 Sheet10

N89.8
fluor albus
N81.4
Prolaps uteri
N86
Erosi porsio
B37.3
candidiasis
O21.0
hiperemesis

Z37
melahirkan
Z35.8
Hamil RESTI
Z39.2
Control
melahirkan
Z48.8+O82.0
Kontrol po
SC
Z48.8+O03.9
Kontrol kuret

Page 42
 Sheet10

O99.0
hamil +
anemi
O21.9
hamil +
mual/muntah
O48
hamil + post
date
O98.0
hamil + tbc
O98.4
hamil +
hepatitis
O30.0
hamil +
kembar 2
O10.1
hamil + HHD
O10.2
hamil + HRD
O10.3
hamil + HHD
+ HRD
O10.0
hamil + HT
O15.0
hamil +
eklampsi
O24.9
hamil + DM
O23.4
hamil + ISK
O22.4
hamil + HE
O98.0
hamil + TBC
O99.3
Hamil +
epilepsy
O00.9
KET nos
O20.9
Hamil +
Flek/perdara
han O15.0
Hamil +
eclampsia

Page 43
 Sheet10

Q54.9
Hypospadias
, unspecified
97.74
Removal
pessary
96.18
Insertion
pessary

Page 44
 Sheet10

Tindakan
93.57
Rawat luka
89.52 Ecg
93.96 O2
99.18
Infus
99.16 Inj
Antidot
99.21 Inj
AB 90.59
Lab darah
91.39 Lab
UL 93.94
Nebulizer
96.07
NGT
87.73 IVP
88.76
USG biasa
88.78
USG Hamil
99.52
Kemoterapi
87.49 Foto
thorax
39.95 HD
88.19
EEG

59.8
Pasang
cateter
79.62
Lepas
kateter
97.65 Aff
Dj stent
56.75
TURP
97.84
Angkat
jahitan
86.59
Hecting
56.0
URS
83.94
Aspirasi
Hematros
83.98
Injeksi
articulair
98.51
ESWL 93.53 Page 45
Pasang
gips 86.62
excisi
91.69
 Sheet10

KONTROL
Suspect :
Z03 Control
jiwa : Z09.3
Kontrol Gin :
Z39 Kontrol
Bedah :
Z48.8
Kontrol Orto :
Z47.8
Kontrol Aff
Pen : Z47.0
Kontrol HD :
Z49.1
Kontrol
Interne/anak
: Z09.8

FISIOTERA
PHY M62.4
contracture
of muscle
M24.5
contracture
of join
M25.6
stiffnes of
join M62.8
pain of
muscle
M25.2 pain
of join
S54.0
ulnar nerve
M77.4
metatarsalgi
a M62.6
muscle
strain
M76.6
Tendinitis
M21.3
Foot drop
M25.0
Hematros

Page 46
 Sheet10

93.01
Functional
evaluation
93.05
Range of
motion
testing

93.1
Physical
therapy
exercises
93.11
Assisting
exercise
93.12
Other
musculoexer
cise 93.13
Resistive
exercise
93.14
Training in
joint
movements
93.15
Mobilization
of spine
93.16
Mobilization
of other
joints
93.17
passive
musculoexer
cise 93.19
Exercise, not
elsewhere
classified
93.34
Diathermy
93.35
Other heat
therapy
93.39
Other
physical
therapy
fracture

Page 47
 Sheet10

M48.4
Fatigue fr of
vertebra
M80.8
Other
osteoporosis
+pathological
fr M80.9
Unspecific
osteoporosis
+ptologi fr

Osteoporosis
tanpa
pathological
fr M84.0
Malunion of
fr M84.3
Stress fr, nos
M84.4
Pathological
fr, nos
P13.0 Fr
of skull due
to birth injury
P13.4 Fr
of clavicle
due to birth
injury

Page 48
 Sheet10

Fracture of
skull and
facial bones
S02 Fr
of skull &
facial bones
S02.0 Fr
of vault of
skull
S02.1 Fr
of base of
skull
S02.2 Fr
of nasal
bones
S02.3 Fr
orbital floor
S02.4 Fr
of malar and
maxillary
bones
S02.5 Fr
of tooth
S02.6 Fr
of
mandibula
S02.7
Multiple fr
skull +
facial
bones
S02.8 Fr
of other
skull and
facial bones
S02.9 Fr
of skull and
facial
bones, part
unspecified

Page 49
 Sheet10

Fracture of
neck
S12.0 Fr
of first
cervical
vertebra
S12.1 Fr
of second
cervical
vertebra
S12.2 Fr
of other
specified
cervical
vertebra
S12.7
Multiple fr
of cervical
spine
S12.8 Fr
of other
parts of
neck
S12.9 Fr
of neck, part
unspecified

Page 50
 Sheet10

Fracture of
rib, sternum
& thoracic
spine
S22.0 Fr
of thoracic
vertebra
S22.1
Multiple fr
of thoracic
spine
S22.2 Fr
of sternum
S22.3 Fr
of rib
S22.4
Multiple fr
of ribs
S22.8 Fr
of other
parts of
bony thorax
S22.9 Fr
of bony
thorax, part
unspecified

Fracture of
lumbar
spine and
pelvis
S32.0 Fr
of lumbar
vertebra
S32.1 Fr
of sacrum
S32.2 Fr
of coccyx
S32.3 Fr
of ilium
S32.4 Fr
of
acetabulum
S32.5 Fr
of pubis
S32.7
Multiple fr
lumbar
spine &
pelvis
S32.8 Fr
of other &
unspecified
parts of
lumbar Page 51
spine and
pelvis
 Sheet10

Fracture of
shoulder
and upper
arm S42.0
Fr of
clavicle
S42.1 Fr
of scapula
S42.2 Fr
of upper
end of
humerus
S42.3 Fr
of shaft of
humerus
S42.4 Fr
supracondil
ar humerus
S42.7
Multiple fr
clavicle,
scapula and
humerus
S42.8 Fr
of other
parts of
shoulder
and upper
arm S42.9
Fr of
shoulder
girdle, part
nos

Page 52
 Sheet10

Fracture of
forearm
S52.0 Fr
of upper
end of ulna
S52.1 Fr
of upper
end of
radius
S52.2 Fr
of shaft of
ulna
S52.3 Fr
of shaft of
radius
S52.4 Fr
of shafts of
ulna +
radius
S52.5 Fr
of lower end
of radius
S52.6 Fr
of lower end
of ulna +
radius
S52.7
Multiple frs
of forearm
S52.8 Fr
of other
parts of
forearm
S52.9 Fr
of forearm,
part
unspecified

Page 53
 Sheet10

Fracture at
wrist and
hand level
S62.0 Fr
navicular
bone of
hand
S62.1 Fr
of other
carpal
bone(s)
S62.2 Fr
of first
metacarpal
bone
S62.3 Fr
of other
metacarpal
bone
S62.4
Multiple frs
of
metacarpal
bones
S62.5 Fr
of thumb
S62.6 Fr
of other
finger
S62.7
Multiple fr
of fingers
S62.8 Fr
of other &
unspecified
parts of
wrist and
hand

Page 54
 Sheet10

Fracture of
femur
S72.0 Fr
of neck of
femur
S72.1
Pertrochant
eric fr
S72.2
Subtrochant
eric fr
S72.3 Fr
of shaft of
femur
S72.4 Fr
of lower end
of femur
S72.7
Multiple fr
of femur
S72.9 Fr
of femur,
part
unspecified

Page 55
 Sheet10

Fracture of
lower leg,
including
ankle
S82.0 Fr
of patella
S82.1 Fr
of upper
end of tibia
S82.2 Fr
of shaft of
tibia
S82.3 Fr
of lower end
of tibia
S82.4 Fr
of fibula
alone
S82.5 Fr
of medial
malleolus
S82.6 Fr
of lateral
malleolus
S82.7
Multiple fr
of lower leg
S82.8 Fr
of other
parts of
lower leg
S82.9 Fr
of lower leg,
part
unspecified

Page 56
 Sheet10

Fr of foot,
except
ankle
S92.0 Fr
calcaneus
S92.1 Fr
of talus
S92.2 Fr
other tarsal
bone
S92.3 Fr
metatarsal
bone
S92.4 Fr
great toe
S92.5 Fra
of other toe
S92.7
Multiple fr
of foot
S92.9 Fr
of foot,
unspecified

T02 Fr
multiple body
regions
T02.0 Fr
head with
neck
T02.9
Multiple fr,
unspecified
T08 Fr
of spine,
level
unspecified
T10 Fr
of upper
limb, level
unspecified
T12 Fr
of lower limb,
level
unspecified
T14.2 Fr
of
unspecified
body region

Page 57
 Sheet10

X-RAY
87.0 Soft
tissue RO of
face, head &
neck
87.09 RO
other soft
tisue
face,head &
neck

Page 58
 Sheet10

87.11 RO
full mouth of
teeth
87.12 RO
dental
87.16 RO
of facial
bones
87.17 RO
of skulls

87.22 RO
of cervical
spine
87.23 RO
of thoracic
spine
87.24 RO
of
lumbosacral
spine
87.29 RO
of spine

87.39
other soft
tissue RO of
chest wall

87.43 RO
of ribs,
sternum and
clavicle
87.44
routine chest
RO, so
described
87.49
other chest
RO
87.5
Biliary tract
RO 87.59
other biliary
tract RO
87.65 RO
of intestine
87.69
other
digestive RO Page 59

87.79 RO
of the urinary
system