PANDUAN KOMPREHENSIF UNTUK JOMBLO BELAJAR KODING

PANDUAN
JOMBLO
KODING PROSEDUR INA-CBG
OLEH:
Teman Yang Tidak Mau Disebutkan Namanya
TIM JOMBLO WANT-TO-MIX CENTRE

1
2014
To V
The Passionate Shepherd to His Love

Christopher Marlowe (1564-1593)
Come live with me and be my love,
And we will all the pleasures prove,
That valleys, groves, hills and fields,
Woods or steepy mountains yields.
And we will sit upon the rocks,
Seeing the shepherds feed their flocks
By shallow rivers, to whose falls
Melodious birds sing madrigals.
And I will make thee beds of roses,
And a thousand fragrant posies,
A cap of flowers and a kirtle
Embroidered all with leaves of myrtle;
A gown made of the finest wool,
Which from our pretty lambs we pull;
Fair-lined slippers for the cold,
With buckles of the purest gold;
A belt of straw and ivy buds,
With coral clasps and amber studs;
And if these pleasures may thee move,
Come live with me and be my love.
The shepherd swains shall dance and sing
For thy delight each May morning;
If these delights thy mind may move,
Then live with me and be my love.
DAFTAR ISI
DAFTAR ISI............................................................................................................. 3
B-1-01 PROSEDUR PENCANGKOKAN HATI...........................................................14
B-1-10 PROSEDUR HATI DAN PANKREAS.............................................................15
B-1-11 PROSEDUR SALURAN EMPEDU KOMPLEK.................................................17
B-1-12 PROSEDUR CHOLESISTEKTOMI TANPA LAPAROSKOPIK............................19
B-1-13 PROSEDUR PANKREAS DAN HEPATOBILLIARI LAIN-LAIN..........................20
B-1-14 PROSEDUR CHOLESISTEKTOMI DENGAN LAPAROSKOPIK.........................21
B-2-10 PROSEDUR PADA HATI DAN PANKREAS....................................................22
B-2-11 PROSEDUR BESAR PADA SALURAN EMPEDU............................................23
B-2-12 PROSEDUR KOLESISTEKTOMI TANPA LAPAROSKOPI.................................24
B-2-13 PROSEDUR LAIN-LAIN PADA HEPATOBILIARI & PANKREAS.......................25
B-2-14 PROSEDUR KOLESISTEKTOMI DENGAN LAPAROSKOPI.............................26
B-3-10 PROSEDUR PADA PERKUTAN HATI & SALURAN EMPEDU..........................27
B-3-11 PROSEDUR ENDOSKOPI SALURAN EMPEDU.............................................28
B-3-12 PROSEDUR LAIN-LAIN PADA SISTEM HEPATOBILIARI DAN PANKREAS......29
C-3-10 PROSEDUR RADIOTERAPI........................................................................30
C-3-11 KEMOTERAPI PADA TUMOR PARU & KANDUNG KEMIH............................31
C-3-12 KEMOTERAPI PADA TUMOR KOLON.........................................................32
C-3-13 KEMOTERAPI PADA TUMOR PAYUDARA ATAU OVARIUM...........................33
C-3-14 KEMOTERAPI PADA TUMOR GASTROINTESTINAL...................................34
C-3-15 KEMOTERAPI PADA TUMOR MELANOMA, GINJAL ATAU PROSTAT.............35
C-3-16 KEMOTERAPI PADA TUMOR OTAK............................................................36
C-3-17 KEMOTERAPI PADA TUMOR KEPALA ATAU LEHER.....................................37
C-3-18 KEMOTERAPI PADA LEUKEMIA AKUT........................................................38
C-3-19 KEMOTERAPI PADA TUMOR LIMFOMA, MYELOMA ATAU TESTIS................39
C-3-20 KEMOTERAPI PADA TUMOR KULIT............................................................40
C-3-21 KEMOTERAPI PADA TUMOR GINEKOLOGI.................................................41
C-3-22 KEMOTERAPI PADA TUMOR METASTASE..................................................42
C-3-23 KEMOTERAPI PADA TUMOR LAIN-LAIN.....................................................43
D-1-10 PROSEDUR PENCANGKOKAN SUMSUM TULANG......................................44
D-1-11 PROSEDUR LIMPA...................................................................................45
D-1-20 PROSEDUR PADA DARAH DAN ORGAN PEMBENTUK DARAH LAIN-LAIN....46
D-2-10 PROSEDUR PENCANGKOKAN SUMSUM TULANG......................................48
3
D-2-11 PROSEDUR LIMPA.................................................................................... 49

D-2-21 PROSEDUR BESAR PADA NODUL LIMPA DAN TYMUS...............................50
D-2-22 PROSEDUR KECIL PADA NODUL LIMPA DAN TYMUS.................................51
D-3-10 PROSEDUR TRANSFUSI & TERAPI SUMSUM TULANG...............................52
D-3-11 PROSEDUR DIAGNOSTIK DARAH DAN ORGAN PEMBENTUK DARAH.........53
E-1-01 PROSEDUR KELENJAR PITUITARI DAN PINEAL..........................................54
E-1-10 PROSEDUR KELENJAR ADRENAL.............................................................55
E-1-20 PROSEDUR PADA TIROID, PARATIROID DAN SALURAN TIROGLOSAL.......56
E-2-10 PROSEDUR PADA KELENJAR ADRENAL.....................................................57
E-2-21 PROSEDUR BESAR PADA KELENJAR TIROID DAN PARATIROID..................58
E-2-22 PROSEDUR KECIL PADA KELENJAR TIROID,PARATIROID DAN SALURAN
THYROGLOSSAL................................................................................................... 59
E-3-10 PROSEDUR DIAGNOSTIK PADA KELENJAR ENDOKRIN...............................60
F-3-10 TERAPI SHOCK......................................................................................... 61
F-5-10 PELAYANAN KESEHATAN MENTAL EKSTENSIF...........................................62
F-5-11 TERAPI KELOMPOK...................................................................................64
F-5-12 PROSEDUR TES DIAGNOSTIK KESEHATAN JIWA........................................65
G-1-01 PROSEDUR PADA PEMBULUH DARAH INTRA KRANIAL..............................66
G-1-10 PROSEDUR KRANIOTOMI.........................................................................67
G-1-11 PROSEDUR VENTRICULAR SHUNT...........................................................69
G-1-12 PROSEDUR PEMBULUH DARAH EXTRA KRANIAL......................................70
G-1-13 PROSEDUR CARPAL TUNNEL RELEASE....................................................71
G-1-20 PROSEDUR SARAF KRANIAL DAN PERIFER...............................................72
G-1-30 PROSEDUR TULANG BELAKANG..............................................................74
G-2-10 PROSEDUR KRANIOTOMI.........................................................................75
G-2-11 PROSEDUR SHUNT VENTRIKEL................................................................76
G-2-12 PROSEDUR PADA PEMBULUH DARAH EKSTRAKRANIAL............................77
G-2-13 PROSEDUR CARPAL TUNNEL RELEASE....................................................78
G-2-21 PROSEDUR BESAR PADA SARAF PERIFER................................................79
G-2-22 PROSEDUR KECIL PADA SARAF PERIFER..................................................81
G-2-31 PROSEDUR BESAR PADA TULANG BELAKANG.........................................82
G-2-32 PROSEDUR KECIL PADA TULANG BELAKANG...........................................83
G-3-10 PROSEDUR TAP & INJEKSI PADA SPINAL..................................................84
G-3-11 PROSEDUR INJEKSI PADA SARAF PERIFER...............................................85
G-3-12 PROSEDUR PEMERIKSAAN NEUROLOGIS LAIN.........................................86
G-3-13 PROSEDUR ELEKROENSEFALOGRAFI EEG................................................87
4
H-1-20 PROSEDUR EKTRAOKULER DAN MATA.....................................................88

H-1-30 PROSEDUR LENSA DAN INTRA OKULER...................................................94
H-2-21 PROSEDUR BESAR PADA MATA................................................................99
H-2-22 PROSEDUR SEDANG PADA MATA...........................................................101
H-2-23 PROSEDUR KECIL PADA MATA................................................................104
H-2-31 PROSEDUR BESAR PADA SEGMEN ANTERIOR MATA..............................106
H-2-32 PROSEDUR SEDANG PADA SEGMEN ANTERIOR MATA............................107
H-2-33 PROSEDUR KECIL PADA SEGMEN ANTERIOR MATA................................109
H-2-34 PROSEDUR BESAR PADA SEGMEN POSTERIOR MATA............................111
H-2-35 PROSEDUR KECIL PADA SEGMEN POSTERIOR MATA.............................112
H-2-36 PROSEDUR OPERASI KATARAK...............................................................113
H-2-37 PROSEDUR PHOTOKOAGULASI DAN KRIOTHERAPI PADA RETINA..........114
H-3-10 PROSEDUR LASER SEDANG PADA MATA................................................115
H-3-11 PROSEDUR KECIL PADA EKTRAOKULER.................................................116
H-3-12 PROSEDUR LAIN-LAIN PADA MATA.........................................................117
H-3-13 PROSEDUR DIAGNOSTIK & IMAGING PADA MATA..................................118
I-1-01 PROSEDUR TRANPLANTASI PARU ATAU/DAN JANTUNG............................119
I-1-02 PROSEDUR KATUP JANTUNG DENGAN KATETERISASI..............................120
I-1-03 PROSEDUR OPERASI KARDIOTORASIK KOMPLEKS PADA JANTUNG ANOMALI
.......................................................................................................................... 122
I-1-04 PROSEDUR KATUP JANTUNG TANPA KATETERISASI JANTUNG.................123
I-1-05 PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER DENGAN
KATETERISASI JANTUNG..................................................................................... 124
I-1-06 PROSEDUR KARDIOTORASIK LAIN...........................................................125
I-1-07 PROSEDUR PEMBEDAHAN BYPASS PEMBULUH KORONER TANPA
KATETERISASI JANTUNG..................................................................................... 127
I-1-11 PROSEDUR DEFIBRILATOR JANTUNG DAN PEMASANGAN SISTEM BANTUAN
JANTUNG............................................................................................................ 128
I-1-12 PROSEDUR PEMBULUH DARAH TORASIK KOMPLEKS...............................129
I-1-13 PROSEDUR PEMBULUH DARAH ABDOMINAL KOMPLEK...........................130
I-1-14 PROSEDUR PEMASANGAN PACEMAKER JANTUNG PERMANEN................131
I-1-15 PROSEDUR KATETERISASI JANTUNG.......................................................132
I-1-16 PROSEDUR REVISI DEFIBRILATOR & PACEMAKER JANTUNG TIDAK
TERMASUK PENGGANTIAN ALAT........................................................................133
I-1-17 PROSEDUR LIGASI DAN STRIPPING PEMBULUH DARAH VENA.................134
I-1-20 PROSEDUR SISTIM PEREDARAN DARAH LAIN-LAIN.................................135
I-1-30 PROSEDUR PENGGANTIAN ALAT DEFIBRILATOR DAN PACEMAKER JANTUNG

.......................................................................................................................... 138
I-1-40 PROSEDUR KARDIOVASKULAR PERKUTAN...............................................139
I-2-11 PEMASANGAN/PENYISIPAN DEFIBRILATOR JANTUNG & SISTEM BANTU
JANTUNG............................................................................................................ 140
I-2-12 PROSEDUR BESAR PADA PEMBULUH DARAH TORASIK............................141
I-2-13 PROSEDUR BESAR PADA PEMBULUH DARAH ABDOMEN.........................142
I-2-14 PROSEDUR PEMASANGAN/PENYISIPAN ALAT PACU PERMANEN PADA
JANTUNG............................................................................................................ 143
I-2-15 PROSEDUR KATETERISASI JANTUNG.......................................................144
I-2-16 PROSEDUR REVISI DEFIBRILATOR DAN ALAT PACU JANTUNG TIDAK
TERMASUK PENGGANTIAN ALAT........................................................................145
I-2-17 PROSEDUR LIGASI DAN STRIPPING PEMBULUH DARAH VENA.................146
I-2-21 ANGIOGRAFI ARTERI BUKAN JANTUNG....................................................147
I-2-22 PROSEDUR SEDANG PADA PEMBULUH DARAH........................................148
I-2-23 PROSEDUR KECIL PADA PEMBULUH DARAH............................................150
I-2-31 PEMASANGAN ATAU PENGGANTIAN ALAT DEFIBRILATOR JANTUNG........151
I-2-32 PEMASANGAN ATAU PENGGANTIAN ALAT PACU JANTUNG.....................152
I-2-41 PROSEDUR ELEKTROFISIOLOGIK.............................................................153
I-2-42 PROSEDUR ANGIOPLASTI PEMBULUH DARAH KORONER DAN
KARDIOVASKULAR PERKUTAN LAIN....................................................................154
I-3-10 PROSEDUR RESUSITASI...........................................................................155
I-3-11 PROSEDUR KARDIOVERSI.......................................................................156
I-3-12 PROSEDUR KECIL LAIN-LAIN PADA JANTUNG..........................................157
I-3-13 PROSEDUR EKOKARDIOGRAFI.................................................................158
I-3-14 PROSEDUR STRESS TESTING..................................................................159
I-3-15 PROSEDUR PENGAWASAN FUNGSI KARDIOVASKULAR...........................160
J-1-01 PROSEDUR VENTILASI MEKANIKAL LONG TERM DENGAN TRAKEOSTOMI161
J-1-02 PROSEDUR VENTILASI MEKANIKAL LONG TERM TANPA TRAKEOSTOMI. . .162
J-1-10 PROSEDUR SISTEM PERNAFASAN KOMPLEKS..........................................163
J-1-20 PROSEDUR SISTEM PERNAFASAN NON KOMPLEKS..................................164
J-1-30 PROSEDUR SISTEM PERNAFASAN MODERAT KOMPLEKS.........................165
J-2-10 PROSEDUR BESAR PADA SISTEM SALURAN PERNAFASAN.......................168
J-2-21 PROSEDUR VENTILASI MEKANIKAL JANGKA PENDEK...............................169
J-2-22 PROSEDUR PADA LARING DAN TRAKEA..................................................170
J-2-31 PROSEDUR THORAKOSKOPI/MEDIASTINOSKOPI......................................171
J-2-32 PROSEDUR DADA INTERMEDIATE............................................................172
6
J-3-10 PROSEDUR PADA DINDING DADA............................................................175

J-3-11 PROSEDUR PEMASANGAN/PENYISIPAN TUBE PADA DADA.......................176
J-3-12 PROSEDUR THORACENTESIS...................................................................177
J-3-13 PROSEDUR TERAPI SALURAN PERNAFASAN............................................178
J-3-14 PROSEDUR BIOPSI PERKUTAN DAN ASPIRASI..........................................179
J-3-15 PROSEDUR BRONKOSKOPI......................................................................180
J-3-16 PROSEDUR UJI FUNGSI PARU..................................................................181
J-3-17 PROSEDUR LAIN-LAIN PADA SISTEM SALURAN PERNAFASAN..................182
K-1-10 PROSEDUR NON KOMPLEKS USUS HALUS & USUS BESAR.....................183
K-1-11 PROSEDUR ADHESIOLISIS PERITONEAL.................................................185
K-1-12 PROSEDUR HERNIA TIDAK TERMASUK INGUINAL & FEMORAL................186
K-1-13 PROSEDUR APPENDIK............................................................................ 187
K-1-14 PROSEDUR HERNIA INGUINAL DAN FEMORAL........................................188
K-1-20 PROSEDUR INTESTINAL KOMPLEKS........................................................189
K-1-30 PROSEDUR DUODENUM, ESOFAGUS & LAMBUNG NON KOMPLEKS........193
K-1-40 PROSEDUR SISTEM PENCERNAAN LAIN-LAIN.........................................195
K-1-50 PROSEDUR ANAL................................................................................... 196
K-2-10 PROSEDUR KECIL PADA USUS BESAR DAN KECIL...................................198
K-2-11 PROSEDUR ADHESIOLYSIS PADA PERITONEUM......................................200
K-2-12 PROSEDUR PADA HERNIA TIDAK TERMASUK HERNIA INGUINALIS DAN
FEMORALIS........................................................................................................ 201
K-2-13 PROSEDUR PADA USUS BUNTU..............................................................202
K-2-14 PROSEDUR PADA HERNIA INGUINALIS DAN FEMORALIS.........................203
K-2-21 PROSEDUR BESAR PADA USUS HALUS DAN USUS BESAR.....................204
K-2-22 PROSEDUR BESAR PADA GASTROINTESTINAL ATAS...............................205
K-2-31 PROSEDUR SEDANG PADA GASTROINTESTINAL ATAS............................206
K-2-32 PROSEDUR LAIN-LAIN PADA GASTROINTESTINAL ATAS..........................207
K-2-41 PROSEDUR LAPAROSKOPI......................................................................208
K-2-42 PROSEDUR LAPAROTOMI & GASTROINTESTINAL LAINNYA.....................209
K-2-51 PROSEDUR UNTUK WASIR......................................................................210
K-2-52 PROSEDUR SEDANG PADA ANUS & REKTUM..........................................211
K-2-53 PROSEDUR KECIL PADA ANUS & REKTUM..............................................212
K-3-10 PROSEDUR KECIL LAIN-LAIN PADA GASTROINTESTINAL.........................214
K-3-11 PROSEDUR KECIL PADA ANUS & REKTUM..............................................216
K-3-12 PROSEDUR SIGMOIDOSKOPI DAN ANOSKOPI.........................................217
K-3-13 PROSEDUR KOLONOSKOPI.....................................................................218
7
K-3-14 PROSEDUR ENDOSKOPI BESAR PADA GASTROINTESTINAL ATAS...........219

K-3-15 PROSEDUR ENDOSKOPI KECIL PADA GASTROINTESTINAL ATAS.............220
K-3-16 PROSEDUR LAIN-LAIN PADA GASTROINTESTINAL..................................221
L-1-20 PROSEDUR PEMINDAHAN KULIT PADA LUKA BAKAR...............................222
L-1-30 PROSEDUR PEMINDAHAN KULIT TANPA LUKA BAKAR.............................223
L-1-40 PROSEDUR PADA KULIT, JARINGAN BAWAH KULIT DAN PAYUDARA.......224
L-1-50 PROSEDUR PADA PAYUDARA..................................................................225
L-2-21 PROSEDUR BESAR PEMINDAHAN KULIT PADA LUKA BAKAR..................227
L-2-22 PROSEDUR KECIL PEMINDAHAN KULIT PADA LUKA BAKAR....................228
L-2-31 PROSEDUR BESAR PEMINDAHAN KULIT TANPA LUKA BAKAR.................229
L-2-32 PROSEDUR KECIL PEMINDAHAN KULIT TANPA LUKA BAKAR..................230
L-2-41 PROSEDUR BEDAH PLASTIK...................................................................231
L-2-42 PROSEDUR LAIN-LAIN PADA KULIT DAN JARINGAN BAWAH KULIT..........232
L-2-51 PROSEDUR PENGANGKATAN PAYUDARA.................................................233
L-2-52 PROSEDUR BESAR PADA PAYUDARA TANPA PENGANGKATAN PAYUDARA
.......................................................................................................................... 234
L-2-53 PROSEDUR KECIL PADA PAYUDARA TANPA PENGANGKATAN PAYUDARA. 235
L-3-10 PROSEDUR KECIL LAIN-LAIN PADA PAYUDARA.......................................236
L-3-11 PROSEDUR BESAR PADA KULIT..............................................................237
L-3-12 PROSEDUR KECIL PADA KULIT................................................................238
M-1-01 PROSEDUR BILATERAL DAN MULTIPLE SENDI ANGGOTA TUBUH BAWAH
MAYOR............................................................................................................... 239
M-1-02 PROSEDUR AMPUTASI...........................................................................240
M-1-03 PROSEDUR FUSI TULANG BELAKANG PADA LENGKUNGAN TULANG
BELAKANG......................................................................................................... 241
M-1-04 PROSEDUR PADA SENDI TUNGKAI/ANGGOTA TUBUH BAGIAN BAWAH
MAYOR............................................................................................................... 242
M-1-05 PROSEDUR PADA SENDI LENGAN/ANGGOTA TUBUH BAGIAN BAWAH
MAYOR............................................................................................................... 243
M-1-10 PROSEDUR KRANIAL DAN REKONSTRUKSI TULANG WAJAH...................244
M-1-20 PROSEDUR PAHA DAN SENDI PANGGUL SELAIN SENDI MAYOR............245
M-1-30 PROSEDUR KAKI.................................................................................... 247
M-1-40 PROSEDUR EKSISI LOKAL DAN PENGANGKATAN ALAT FIKSASI INTERNAL
.......................................................................................................................... 249
M-1-50 PROSEDUR JARINGAN LUNAK................................................................251
M-1-60 PROSEDUR SISTEM MUSKULOSKLETAL & JARINGAN PENGHUBUNG LAINLAIN................................................................................................................... 253
8
M-1-70 PROSEDUR LUTUT DAN TUNGKAI BAWAH SELAIN KAKI.........................258

M-1-80 PROSEDUR ANGGOTA TUBUH ATAS......................................................261
M-2-10 PROSEDUR REKONTRUKSI TULANG KRANIAL DAN WAJAH.....................267
M-2-21 PROSEDUR BESAR PADA SENDI PANGGUL DAN PAHA...........................268
M-2-22 PROSEDUR KECIL PADA SENDI PANGGUL DAN PAHA.............................269
M-2-31 PROSEDUR BUNION.............................................................................. 270
M-2-32 PROSEDUR LAIN-LAIN PADA KAKI..........................................................271
M-2-41 PROSEDUR EKSISI, INSISI DAN ARTHROTOMI TULANG..........................273
M-2-42 PROSEDUR PEMINDAHAN ALAT IMPLAN................................................275
M-2-51 PROSEDUR BESAR PADA JARINGAN LUNAK...........................................276
M-2-52 PROSEDUR KECIL PADA JARINGAN LUNAK.............................................277
M-2-61 PROSEDUR ARTROSKOPI.......................................................................279
M-2-62 PROSEDUR LAIN-LAIN PADA SENDI & TULANG......................................280
M-2-63 PROSEDUR INSISI, BIOPSI DAN GRAFT PADA TULANG...........................282
M-2-64 PROSEDUR BESAR PADA TULANG KEPALA & WAJAH.............................284
M-2-65 PROSEDUR KECIL PADA TULANG KEPALA & WAJAH...............................285
M-2-71 PROSEDUR BESAR PADA LUTUT & TUNGKAI BAWAH.............................286
M-2-72 PROSEDUR KECIL PADA LUTUT & TUNGKAI BAWAH..............................288
M-2-81 PROSEDUR BESAR PADA LENGAN, SIKU & BAHU..................................289
M-2-82 PROSEDUR KECIL PADA LENGAN, SIKU & BAHU....................................291
M-2-83 PROSEDUR BESAR PADA TANGAN & PERGELANGAN TANGAN...............293
M-2-84 PROSEDUR KECIL PADA TANGAN & PERGELANGAN TANGAN................295
M-3-10 PROSEDUR MANIPULATIVE OSTEOPATHIC.............................................298
M-3-11 PROSEDUR DIAGNOSTIK DAN TERAPEUTIK MUSKULOSKELETAL...........299
M-3-12 PROSEDUR BIOPSI SENDI DAN TRAKSI SKELETAL..................................300
M-3-13 PROSEDUR REDUKSI FRAKTUR TERTUTUP.............................................301
M-3-14 PROSEDUR REDUKSI FRAKTUR WAJAH TERTUTUP.................................302
M-3-15 PROSEDUR APLIKASI CASTS DAN SPLINTS............................................303
M-3-16 PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL MUSKULOSKLETAL...304
M-3-17 PROSEDUR PEMASANGAN ALAT PROSTETIK..........................................306
N-1-01 PROSEDUR PENCANGKOKAN GINJAL......................................................307
N-1-11 PROSEDUR KANDUNG KEMIH KOMPLEK................................................308
N-1-12 PROSEDUR MEMBUAT BARU, MEREVISI DAN MEMINDAHKAN ALAT
DIALISIS............................................................................................................. 309
N-1-20 PROSEDUR SALURAN URIN ATAS...........................................................310
N-1-30 PROSEDUR KANDUNG KEMIH DAN SALURAN URIN BAWAH...................313
9
N-1-40 PROSEDUR PADA URETRA DAN TRANSURETRA.....................................315

N-2-11 PROSEDUR BESAR PADA KANDUNG KEMIH...........................................317
N-2-12 PROSEDUR MEMBUAT BARU, MEREVISI DAN MEMINDAHKAN ALAT
DIALISIS............................................................................................................. 318
N-2-21 EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY ESWL PADA SALURAN
KEMIH................................................................................................................ 319
N-2-22 PROSEDUR BESAR PADA GINJAL DAN URETER......................................320
N-2-23 PROSEDUR SEDANG PADA GINJAL DAN URETER....................................322
N-2-24 PROSEDUR KECIL PADA GINJAL DAN URETER........................................323
N-2-31 PROSEDUR BESAR PADA KANDUNG KEMIH DAN URETHRA...................324
N-2-32 PROSEDUR KECIL PADA KANDUNG KEMIH DAN URETHRA.....................325
N-2-41 PROSEDUR BESAR PADA URETHRA DAN TRANSURETHRA.....................326
N-2-42 PROSEDUR KECIL PADA URETHRA DAN TRANSURETHRA.......................327
N-3-10 PROSEDUR PADA GINJAL DAN URETER..................................................328
N-3-11 PROSEDUR DIAGNOSTIK LAIN PADA STUDI SALURAN KEMIH.................329
N-3-12 PROSEDUR CYSTOSCOPI & PROSEDUR KECIL ENDOSKOPI SALURAN KEMIH
.......................................................................................................................... 330
N-3-13 PROSEDUR BESAR ENDOSKOPI PADA SALURAN KEMIH.........................331
N-3-14 PROSEDUR KECIL ENDOSKOPI PADA SALURAN KEMIH...........................332
N-3-15 PROSEDUR DIALISIS.............................................................................. 333
O-6-10 PROSEDUR OPERASI PEMBEDAHAN CAESAR.........................................334
O-6-11 PROSEDUR PERSALINAN VAGINAL DENGAN STERILISASI &/ DILATASI &
KURET................................................................................................................ 335
O-7-10 PROSEDUR PERSALINAN DENGAN BEDAH CAESAR...............................336
O-7-11 PERSALINAN VAGINAL DENGAN STERILISASI DAN ATAU PELEBARAN DAN
KURETASE.......................................................................................................... 337
P-8-01 PROSEDUR NEONATAL DENGAN PENCANGKOKAN ORGAN ATAU
OKSIGENASI SELAPUT EKSTRAKORPORAL..........................................................338
P-8-07 PROSEDUR NEONATAL, BERAT BADAN LAHIR GROUP-5 DENGAN
PROSEDUR MAYOR............................................................................................. 339
Q-5-13 MEDICAL CHECK-UP............................................................................... 340
Q-5-14 RONGENT PLAIN FILM........................................................................... 341
Q-5-15 ELEKTROKARDIOGRAM ECG..................................................................343
Q-5-16 VAKSINASI............................................................................................. 344
Q-5-17 PASANG INFUS...................................................................................... 346
Q-5-18 KONSULTASI ATAU PEMERIKSAAN LAIN-LAIN.........................................347
T-1-10 TERAPI REHABILITASI &/ DETOKSIKASI ALKOHOL & OBAT......................348
10
T-2-10 PEMULIHAN ALKOHOL, OBAT DAN ATAU TERAPI DETOKSIKASI..............349

U-1-10 PROSEDUR KOMPLEKS LARING..............................................................350
U-1-11 PROSEDUR KOMPLEK LEHER DAN KEPALA LAIN-LAIN............................351
U-1-12 PROSEDUR MASTOID DAN SINUS..........................................................352
U-1-13 PROSEDUR KELENJAR LUDAH................................................................353
U-1-14 PROSEDUR OPERASI BIBIR SUMBING & LANGIT-LANGIT MULUT............354
U-1-15 PROSEDUR TONSIL & ADENOID.............................................................355
U-1-20 PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN TELINGA LAIN-LAIN
.......................................................................................................................... 356
U-1-30 PROSEDUR MULUT................................................................................ 360
U-2-10 PROSEDUR BESAR PADA LARING...........................................................362
U-2-11 PROSEDUR BESAR LAIN-LAIN PADA KEPALA & LEHER...........................363
U-2-12 PROSEDUR PADA SINUS & MASTOID.....................................................364
U-2-13 PROSEDUR KELENJAR LUDAH................................................................365
U-2-14 PROSEDUR OPERASI BIBIR SUMBING & LANGIT-LANGIT MULUT............366
U-2-15 PROSEDUR OPERASI TONSIL & AMANDEL.............................................367
U-2-21 PROSEDUR BESAR PADA TELINGA, HIDUNG, MULUT DAN TENGGOROKAN
.......................................................................................................................... 368
U-2-22 PROSEDUR SEDANG PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN.................................................................................................. 370
U-2-23 PROSEDUR PERBAIKAN HIDUNG RHINOPLASTY.....................................371
U-2-24 PROSEDUR KECIL PADA HIDUNG...........................................................372
U-2-25 PROSEDUR PADA TELINGA TENGAH......................................................373
U-2-31 PROSEDUR BESAR PADA MULUT DAN LIDAH.........................................375
U-2-32 PROSEDUR KECIL PADA MULUT DAN LIDAH...........................................376
U-3-10 PROSEDUR SEDANG LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN.................................................................................................. 377
U-3-11 PROSEDUR KECIL LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN.................................................................................................. 378
U-3-12 PROSEDUR KAUTERISASI & PACKING PADA RONGGA HIDUNG..............380
U-3-13 PROSEDUR DIAGNOSTIK LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN.................................................................................................. 381
U-3-14 PROSEDUR TES FUNGSI PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN.................................................................................................. 382
U-3-15 PROSEDUR LAIN-LAIN PADA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN.................................................................................................. 383
U-3-16 PROSEDUR PADA GIGI...........................................................................384
11
V-1-10 PROSEDUR PENGANGKATAN PROSTAT KOMPLEK..................................386

V-1-11 PROSEDUR PADA PENIS.........................................................................387
V-1-12 PROSEDUR PADA SKROTUM DAN PROSTAT KOMPLEK-MODERAT...........388
V-1-13 PROSEDUR PADA SKROTUM DAN PROSTAT NON KOMPLEK...................389
V-1-14 PROSEDUR PENGANGKATAN PROSTAT MELALUI URETRA.......................391
V-1-15 PROSEDUR SIRKUMSISI..........................................................................392
V-2-10 PROSEDUR BESAR PADA PENGANGKATAN PROSTAT.............................393
V-2-11 PROSEDUR PADA PENIS.........................................................................394
V-2-12 PROSEDUR SEDANG PADA PROSTAT DAN SKROTUM.............................395
V-2-13 PROSEDUR KECIL PADA PROSTAT DAN SKROTUM..................................396
V-2-14 PENGANGKATAN PROSTAT MELALUI TRANSURETHRAL...........................398
V-2-15 SIRKUMSISI/SUNAT.................................................................................399
V-3-10 PROSEDUR STERILISASI PADA LAKI-LAKI...............................................400
V-3-11 PROSEDUR DIAGNOSTIK DAN TERAPEUTIK PADA ALAT GENITAL LAKI-LAKI
.......................................................................................................................... 401
V-3-12 PROSEDUR LAIN PADA ALAT GENITAL LAKI-LAKI....................................402
W-1-01 PROSEDUR OPERASI PENGANGKATAN RAHIM DAN VULVA RADIKAL &
EVISCERASI........................................................................................................ 403
W-1-10 PROSEDUR ABORSI............................................................................... 404
W-1-11 PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK.........................405
W-1-12 PROSEDUR OPERASI MEMBUKA TUBA YANG TERHALANG/TERGANGGU406
W-1-13 PROSEDUR INTERUPSI TUBA DENGAN ENDOSKOP...............................407
W-1-20 PROSEDUR PADA RAHIM & ADNEKSA...................................................408
W-1-30 PROSEDUR PADA VAGINA, SERVIK & VULVA..........................................412
W-2-10 PROSEDUR ABORSI............................................................................... 415
W-2-11 PROSEDUR PELEBARAN, KURETASE DALAM RAHIM & LEHER RAHIM.....416
W-2-12 PROSEDUR MEMBUKA TUBA YANG TERHALANG/TERGANGGU..............417
W-2-13 PROSEDUR ENDOSKOPI TUBA YANG TERHALANG/TERGANGGU...........418
W-2-21 PROSEDUR BESAR PADA FRAKTUR RONGGA PANGGUL TERBUKA.........419
W-2-22 PROSEDUR KECIL PADA FRAKTUR RONGGA PANGGUL TERBUKA..........420
W-2-23 PROSEDUR LAPAROSKOPI GINEKOLOGI................................................423
W-2-31 PROSEDUR PEMBUANGAN RAHIM MELALUI JALAN LAHIR......................424
W-2-32 PROSEDUR PERBAIKAN CYSTOCELE DAN VULVOVAGINAL INTERMEDIATE
.......................................................................................................................... 425
W-2-33 PROSEDUR KECIL VULVOVAGINAL.........................................................426
W-2-34 PROSEDUR GINEKOLOGI LAIN-LAIN......................................................428
12
W-3-10 PROSEDUR KECIL GINEKOLOGI & ENDOSKOPI......................................429

W-3-11 PROSEDUR SEDANG GINEKOLOGI.........................................................430
W-3-12 PROSEDUR KECIL GINEKOLOGI.............................................................431
Z-3-10 PROSEDUR RADIOSURGICAL..................................................................432
Z-3-11 EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY ESWL SELAIN URINARI DAN
SALURAN EMPEDU............................................................................................. 433
Z-3-12 PROSEDUR REHABILITASI......................................................................434
Z-3-13 PROSEDUR KECIL PELAYANAN PENUNJANG LAIN-LAIN...........................435
Z-3-14 DIAGNOSTIK TIDUR................................................................................ 436
Z-3-15 IMAGING NUKLIR JANTUNG....................................................................437
Z-3-16 PROSEDUR MAGNETIC RESONANCE IMAGING MRI.................................438
Z-3-17 PENGOBATAN NUKLIR............................................................................ 439
Z-3-18 CT-SCAN KEPALA................................................................................... 440
Z-3-19 CT SCAN LAIN-LAIN................................................................................ 441
Z-3-20 IMAGING KONTRAS SALURAN URINARI...................................................442
Z-3-21 IMAGING KONTRAS PEMBULUH DARAH..................................................443
Z-3-22 IMAGING KONTRAS LAIN-LAIN................................................................444
Z-3-23 PROSEDUR ULTRASOUND LAIN-LAIN......................................................446
Z-3-24 PROSEDUR ULTRASOUND PEMBULUH DARAH........................................447
Z-3-25 PROSEDUR ULTRASOUND GINEKOLOGIK................................................448
Z-3-26 PROSEDUR BESAR RADIOGRAFI.............................................................449
Z-3-27 PERAWATAN LUKA..................................................................................450
Z-3-28 IMAGING PAYUDARA............................................................................... 451
Z-3-29 IMAGING LAIN-LAIN...............................................................................452
Z-3-30 FOTOTERAPI.......................................................................................... 453
13
B-1-01 PROSEDUR PENCANGKOKAN

HATI
- 5051 Auxiliary liver transplant Class I
- 5059 Other transplant of liver Class I
14
B-1-10 PROSEDUR HATI DAN

PANKREAS
- 500 Hepatotomy Class II
- 5021 Marsupialization of lesion of liver Class II
- 5022 Partial hepatectomy Class I
- 5029 Other destruction of lesion of liver Class II
- 503 Lobectomy of liver Class I
- 504 Total hepatectomy Class I
- 5061 Closure of laceration of liver Class II
- 5069 Other repair of liver Class II
- 5092 Extracorporeal hepatic assistance Class I
- 5182 Pancreatic sphincterotomy Class II
- 5183 Pancreatic sphincteroplasty Class II
- 5201 Drainage of pancreatic cyst by catheter Class II
- 5209 Other pancreatotomy Class II
- 5222 Other excision or destruction of lesion or tissue of pancreas or pancreatic
duct Class II
- 523 Marsupialization of pancreatic cyst Class II
- 524 Internal drainage of pancreatic cyst Class II
- 5251 Proximal pancreatectomy Class I
- 5252 Distal pancreatectomy Class I
- 5253 Radical subtotal pancreatectomy Class I
- 5259 Other partial pancreatectomy Class I
- 526 Total pancreatectomy Class I
- 527 Radical pancreaticoduodenectomy Class I
- 5280 Pancreatic transplant, not otherwise specified Class I
- 5281 Reimplantation of pancreatic tissue Class I
15
- 5282 Homotransplant of pancreas Class I

- 5283 Heterotransplant of pancreas Class I
- 5292 Cannulation of pancreatic duct Class II
- 5295 Other repair of pancreas Class I
- 5296 Anastomosis of pancreas Class I
- 5299 Other operations on pancreas Class II
16
B-1-11 PROSEDUR SALURAN

EMPEDU KOMPLEK
- 5102 Trocar cholecystostomy Class II
- 5103 Other cholecystostomy Class II
- 5104 Other cholecystotomy Class II
- 5131 Anastomosis of gallbladder to hepatic ducts Class I
- 5132 Anastomosis of gallbladder to intestine Class I
- 5133 Anastomosis of gallbladder to pancreas Class I
- 5134 Anastomosis of gallbladder to stomach Class I
- 5135 Other gallbladder anastomosis Class I
- 5136 Choledochoenterostomy Class I
- 5137 Anastomosis of hepatic duct to gastrointestinal tract Class I
- 5139 Other bile duct anastomosis Class I
- 5143 Insertion of choledochohepatic tube for decompression Class II
- 5149 Incision of other bile ducts for relief of obstruction Class II
- 5159 Incision of bile duct Class II
- 5161 Excision of cystic duct remnant Class II
- 5162 Excision of ampulla of vater (with reimplantation of common duct) Class
II
- 5163 Other excision of common duct Class II
- 5169 Excision of other bile duct Class II
- 5171 Simple suture of common bile duct Class II
- 5172 Choledochoplasty Class II
- 5179 Repair of other bile ducts Class II
- 5181 Dilation of sphincter of Oddi Class II
- 5189 Other operations on sphincter of Oddi Class II
- 5191 Repair of laceration of gallbladder Class I
17
- 5192 Closure of cholecystostomy Class II

- 5193 Closure of other biliary fistula Class II
- 5194 Revision of anastomosis of biliary tract Class I
- 5195 Removal of prosthetic device from bile duct Class II
- 5199 Other operations on biliary tract Class II
18
B-1-12 PROSEDUR
CHOLESISTEKTOMI TANPA
LAPAROSKOPIK
- 5121 Other partial cholecystectomy Class II
- 5122 Cholecystectomy Class II
19
B-1-13 PROSEDUR PANKREAS DAN

HEPATOBILLIARI LAIN-LAIN
- 5012 Open biopsy of liver Class II
- 5019 Other diagnostic procedures on liver Class II
- 5113 Open biopsy of gallbladder or bile ducts Class II
- 5119 Other diagnostic procedures on biliary tract Class II
- 5141 Common duct exploration for removal of calculus Class II
- 5142 Common duct exploration for relief of other obstruction Class II
- 5151 Exploration of common bile duct Class II
- 5212 Open biopsy of pancreas Class II
- 5219 Other diagnostic procedures on pancreas Class II
- 8753 Intraoperative cholangiogram Class II
- 9852 Extracorporeal shockwave lithotripsy (ESWL) of the gallbladder and/or
bile duct Class II
20
B-1-14 PROSEDUR
CHOLESISTEKTOMI DENGAN
LAPAROSKOPIK
- 5123 Laparoscopic cholecystectomy Class II
- 5124 Laparoscopic partial cholecystectomy Class II
21
B-2-10 PROSEDUR PADA HATI DAN

PANKREAS
- 500 Hepatotomy Class II
- 5021 Marsupialization of lesion of liver Class II
- 5029 Other destruction of lesion of liver Class II
- 5061 Closure of laceration of liver Class II
- 5069 Other repair of liver Class II
- 5182 Pancreatic sphincterotomy Class II
- 5183 Pancreatic sphincteroplasty Class II
- 5201 Drainage of pancreatic cyst by catheter Class II
- 5209 Other pancreatotomy Class II
- 5222 Other excision or destruction of lesion or tissue of pancreas or pancreatic
duct Class II
- 523 Marsupialization of pancreatic cyst Class II
- 524 Internal drainage of pancreatic cyst Class II
- 5292 Cannulation of pancreatic duct Class II
- 5299 Other operations on pancreas Class II
22
B-2-11 PROSEDUR BESAR PADA

SALURAN EMPEDU
- 5102 Trocar cholecystostomy Class II
- 5103 Other cholecystostomy Class II
- 5104 Other cholecystotomy Class II
- 5143 Insertion of choledochohepatic tube for decompression Class II
- 5149 Incision of other bile ducts for relief of obstruction Class II
- 5159 Incision of bile duct Class II
- 5161 Excision of cystic duct remnant Class II
- 5162 Excision of ampulla of vater (with reimplantation of common duct) Class
II
- 5163 Other excision of common duct Class II
- 5169 Excision of other bile duct Class II
- 5171 Simple suture of common bile duct Class II
- 5172 Choledochoplasty Class II
- 5179 Repair of other bile ducts Class II
- 5181 Dilation of sphincter of Oddi Class II
- 5189 Other operations on sphincter of Oddi Class II
- 5192 Closure of cholecystostomy Class II
- 5193 Closure of other biliary fistula Class II
- 5195 Removal of prosthetic device from bile duct Class II
- 5199 Other operations on biliary tract Class II
23
B-2-12 PROSEDUR
KOLESISTEKTOMI TANPA
LAPAROSKOPI
- 5121 Other partial cholecystectomy Class II
- 5122 Cholecystectomy Class II
24
B-2-13 PROSEDUR LAIN-LAIN PADA

HEPATOBILIARI & PANKREAS
- 5012 Open biopsy of liver Class II
- 5019 Other diagnostic procedures on liver Class II
- 5113 Open biopsy of gallbladder or bile ducts Class II
- 5119 Other diagnostic procedures on biliary tract Class II
- 5141 Common duct exploration for removal of calculus Class II
- 5142 Common duct exploration for relief of other obstruction Class II
- 5151 Exploration of common bile duct Class II
- 5212 Open biopsy of pancreas Class II
- 5219 Other diagnostic procedures on pancreas Class II
- 8753 Intraoperative cholangiogram Class II
- 9852 Extracorporeal shockwave lithotripsy (ESWL) of the gallbladder and/or
bile duct Class II
25
B-2-14 PROSEDUR
KOLESISTEKTOMI DENGAN
LAPAROSKOPI
- 5123 Laparoscopic cholecystectomy Class II
- 5124 Laparoscopic partial cholecystectomy Class II
26
B-3-10 PROSEDUR PADA PERKUTAN

HATI & SALURAN EMPEDU
- 5011 Closed (percutaneous) (needle) biopsy of liver Class III
- 5091 Percutaneous aspiration of liver Class III
- 5093 Localized perfusion of liver Class III
- 5094 Other injection of therapeutic substance into liver Class III
- 5101 Percutaneous aspiration of gallbladder Class III
- 5112 Percutaneous biopsy of gallbladder or bile ducts Class III
- 5196 Percutaneous extraction of common duct stones Class III
- 5198 Other percutaneous procedures on biliary tract Class III
- 5211 Closed [aspiration] [needle][percutaneous] biopsy of pancreas Class III
27
B-3-11 PROSEDUR ENDOSKOPI

SALURAN EMPEDU
- 5110 Endoscopic retrograde cholangiopancreatography (ERCP) Class III
- 5111 Endoscopic retrograde cholangiography (ERC) Class III
- 5114 Other closed (endoscopic) biopsy of biliary duct or sphincter of Oddi
Class III
- 5115 Pressure measurement of sphincter of Oddi Class III
- 5164 Endoscopic excision or destruction of lesion of biliary ducts or sphincter
of Oddi Class III
- 5184 Endoscopic dilation of ampulla and biliary duct Class III
- 5185 Endoscopic sphincterotomy and papillotomy Class III
- 5186 Endoscopic insertion of nasobiliary drainage tube Class III
- 5187 Endoscopic insertion of stent (tube) into bile duct Class III
- 5188 Endoscopic removal of stone(s) from biliary tract Class III
- 5213 Endoscopic retrograde pancreatography (ERP) Class III
- 5214 Closed [endoscopic] biopsy of pancreatic duct Class III
- 5221 Endoscopic excision or destruction of lesion or tissue of pancreatic Class
III
- 5293 Endoscopic insertion of stent (tube) into pancreatic duct Class III
- 5294 Endoscopic removal of stone(s) from pancreatic duct Class III
- 5297 Endoscopic insertion of nasopancreatic drainage tube Class III
- 5298 Endoscopic dilation of pancreatic duct Class III
- 9705 Replacement of stent (tube) in biliary or pancreatic duct Class III
28
B-3-12 PROSEDUR LAIN-LAIN PADA

SISTEM HEPATOBILIARI DAN
PANKREAS
- 5099 Other operations on liver Class III
- 5284 Autotransplantation of cells of Islets of Langerhans Class III
- 5285 Allotransplantation of cells of Islets of Langerhans Class III
- 5286 Transplantation of cells of Islets of Langerhans, not otherwise specified
Class III
- 9641 Irrigation of cholecystostomy and other biliary tube Class III
- 9642 Irrigation of pancreatic tube Class III
- 9754 Removal of cholecystostomy tube Class III
- 9755 Removal of t-tube, other bile duct tube, or liver tube Class III
- 9756 Removal of pancreatic tube or drain Class III
29
C-3-10 PROSEDUR RADIOTERAPI

- 9221 Superficial radiation Class III
- 9222 Orthovoltage radiation Class III
- 9223 Radioisotopic teleradiotherapy Class III
- 9224 Teleradiotherapy using protons Class III
- 9225 Teleradiotherapy using electrons Class III
- 9226 Teleradiotherapy of other particulate radiation Class III
- 9227 Implantation or insertion of radioactive elements Class III
- 9228 Injection or instillation of radioisotopes Class III
- 9229 Other radiotherapeutic procedure Class III
30
C-3-11 KEMOTERAPI PADA TUMOR

PARU & KANDUNG KEMIH
- 0010 Implantation of chemotherapeutic agent Class III
- 0015 High-dose infusion interleukin-2(il-2) Class III
- 9925 Injection or infusion of cancer chemotherapeutic substance Class III
- 9928 Injection or infusion of biological response modifier [BRM] as an
antineoplastic agent Class III
31

KOLON
32

PAYUDARA ATAU OVARIUM
33

GASTROINTESTINAL
34

MELANOMA, GINJAL ATAU PROSTAT
35

OTAK
36

KEPALA ATAU LEHER
37
C-3-18 KEMOTERAPI PADA

LEUKEMIA AKUT
38

LIMFOMA, MYELOMA ATAU TESTIS
39

KULIT
40

GINEKOLOGI
41

METASTASE
42

LAIN-LAIN
43
D-1-10 PROSEDUR PENCANGKOKAN

SUMSUM TULANG
- 4100 Bone marrow transplant, not otherwise specified Class II
- 4101 Autologous bone marrow transplant without purging Class II
- 4102 Allogeneic bone marrow transplant with purging Class II
- 4103 Allogeneic bone marrow transplant without purging Class II
- 4104 Autologous hematopoietic stem cell transplant without purging Class II
- 4105 Allogeneic hematopoietic stem cell transplant without purging Class II
- 4106 Cord blood stem cell transplant Class II
- 4107 Autologous hematopoietic stem cell transplant with purging Class II
- 4108 Autologous hematopoietic stem cell transplant Class II
- 4109 Autologous bone marrow transplant with purging Class II
44
D-1-11 PROSEDUR LIMPA

- 412 Splenotomy Class II
- 4133 Open biopsy of spleen Class II
- 4141 Marsupialization of splenic cyst Class II
- 4142 Excision of lesion or tissue of spleen Class II
- 4143 Partial splenectomy Class II
- 415 Total splenectomy Class II
- 4193 Excision of accessory spleen Class II
- 4194 Transplantation of spleen Class II
- 4195 Repair and plastic operations on spleen Class II
- 4199 Other operations on spleen Class II
45
D-1-20 PROSEDUR PADA DARAH

DAN ORGAN PEMBENTUK DARAH
LAIN-LAIN
- 0716 Biopsy of thymus Class II
- 0780 Thymectomy, not otherwise specified Class II
- 0781 Partial excision of thymus Class II
- 0782 Total excision of thymus Class II
- 0791 Exploration of thymus field Class II
- 0792 Incision of thymus Class II
- 0793 Repair of thymus Class II
- 0794 Transplantation of thymus Class II
- 0799 Other and unspecified operations on thymus Class II
- 400 Incision of lymphatic structures Class II
- 4011 Biopsy of lymphatic structure Class II
- 4019 Other diagnostic procedures on lymphatic structures Class II
- 4021 Excision of deep cervical lymph node Class II
- 4022 Excision of internal mammary lymph node Class II
- 4023 Excision of axillary lymph node Class II
- 4024 Excision of inguinal lymph node Class II
- 4029 Simple excision of other lymphatic structure Class II
- 403 Regional lymph node excision Class II
- 4050 Radical excision of lymph nodes, not otherwise specified Class II
- 4051 Radical excision of axillary lymph nodes Class II
- 4052 Radical excision of periaortic lymph nodes Class II
- 4053 Radical excision of iliac lymph nodes Class II
- 4054 Radical groin dissection Class II
- 4059 Radical excision of other lymph nodes Class II
46
- 409 Other operations on lymphatic structures Class II
47
D-2-10 PROSEDUR PENCANGKOKAN

SUMSUM TULANG
- 4100 Bone marrow transplant, not otherwise specified Class II
- 4101 Autologous bone marrow transplant without purging Class II
- 4102 Allogeneic bone marrow transplant with purging Class II
- 4103 Allogeneic bone marrow transplant without purging Class II
- 4104 Autologous hematopoietic stem cell transplant without purging Class II
- 4105 Allogeneic hematopoietic stem cell transplant without purging Class II
- 4106 Cord blood stem cell transplant Class II
- 4107 Autologous hematopoietic stem cell transplant with purging Class II
- 4108 Autologous hematopoietic stem cell transplant Class II
- 4109 Autologous bone marrow transplant with purging Class II
48
D-2-11 PROSEDUR LIMPA

- 412 Splenotomy Class II
- 4133 Open biopsy of spleen Class II
- 4141 Marsupialization of splenic cyst Class II
- 4142 Excision of lesion or tissue of spleen Class II
- 4143 Partial splenectomy Class II
- 415 Total splenectomy Class II
- 4193 Excision of accessory spleen Class II
- 4194 Transplantation of spleen Class II
- 4195 Repair and plastic operations on spleen Class II
- 4199 Other operations on spleen Class II
49
D-2-21 PROSEDUR BESAR PADA

NODUL LIMPA DAN TYMUS
- 0780 Thymectomy, not otherwise specified Class II
- 0781 Partial excision of thymus Class II
- 0782 Total excision of thymus Class II
- 0791 Exploration of thymus field Class II
- 0792 Incision of thymus Class II
- 0793 Repair of thymus Class II
- 0794 Transplantation of thymus Class II
- 0799 Other and unspecified operations on thymus Class II
- 403 Regional lymph node excision Class II
- 4050 Radical excision of lymph nodes, not otherwise specified Class II
- 4051 Radical excision of axillary lymph nodes Class II
- 4052 Radical excision of periaortic lymph nodes Class II
- 4053 Radical excision of iliac lymph nodes Class II
- 4054 Radical groin dissection Class II
- 4059 Radical excision of other lymph nodes Class II
50
D-2-22 PROSEDUR KECIL PADA

NODUL LIMPA DAN TYMUS
- 0716 Biopsy of thymus Class II
- 400 Incision of lymphatic structures Class II
- 4011 Biopsy of lymphatic structure Class II
- 4019 Other diagnostic procedures on lymphatic structures Class II
- 4021 Excision of deep cervical lymph node Class II
- 4022 Excision of internal mammary lymph node Class II
- 4023 Excision of axillary lymph node Class II
- 4024 Excision of inguinal lymph node Class II
- 4029 Simple excision of other lymphatic structure Class II
- 409 Other operations on lymphatic structures Class II
51
D-3-10 PROSEDUR TRANSFUSI &

TERAPI SUMSUM TULANG
- 411 Puncture of spleen Class III
- 4191 Aspiration of bone marrow from donor for transplant Class III
- 4192 Injection into bone marrow Class III
- 4198 Other operations on bone marrow Class III
- 752 Intrauterine transfusion Class III
- 9900 Perioperative autologous transfusion of whole blood or blood
components Class III
- 9901 Exchange transfusion Class III
- 9902 Transfusion of previously collected autologous blood Class III
- 9903 Other transfusion of whole blood Class III
- 9904 Transfusion of packed cells Class III
- 9905 Transfusion of platelets Class III
- 9906 Transfusion of coagulation factors Class III
- 9907 Transfusion of other serum Class III
- 9908 Transfusion of blood expander Class III
- 9909 Transfusion of other substance Class III
- 9910 Injection or infusion of thrombolytic agent Class III
- 9971 Therapeutic plasmapheresis Class III
- 9972 Therapeutic leukopheresis Class III
- 9973 Therapeutic erythrocytapheresis Class III
- 9974 Therapeutic plateletpheresis Class III
52
D-3-11 PROSEDUR DIAGNOSTIK

DARAH DAN ORGAN PEMBENTUK
DARAH
- 4131 Biopsy of bone marrow Class III
- 4132 Closed (aspiration) (percutaneous) biopsy of spleen Class III
- 4138 Other diagnostic procedures on bone marrow Class III
- 4139 Other diagnostic procedures on spleen Class III
53
E-1-01 PROSEDUR KELENJAR

PITUITARI DAN PINEAL
- 0713 Biopsy of pituitary gland, transfrontal approach Class I
- 0714 Biopsy of pituitary gland, transsphenoidal approach Class I
- 0715 Biopsy of pituitary gland, unspecified approach Class I
- 0717 Biopsy of pineal gland Class I
- 0751 Exploration of pineal field Class I
- 0752 Incision of pineal gland Class I
- 0753 Partial excision of pineal gland Class I
- 0754 Total excision of pineal gland Class I
- 0759 Other operations on pineal gland Class I
- 0761 Partial excision of pituitary gland, transfrontal approach Class I
- 0762 Partial excision of pituitary gland, transsphenoidal approach Class I
- 0763 Partial excision of pituitary gland, unspecified approach Class I
- 0764 Total excision of pituitary gland, transfrontal approach Class I
- 0765 Total excision of pituitary gland, transsphenoidal approach Class I
- 0768 Total excision of pituitary gland, other specified approach Class I
- 0769 Total excision of pituitary gland, unspecified approach Class I
- 0771 Exploration of pituitary fossa Class I
- 0772 Incision of pituitary gland Class I
- 0779 Other operations on hypophysis Class I
54
E-1-10 PROSEDUR KELENJAR

ADRENAL
- 0700 Exploration of adrenal field, not otherwise specified Class II
- 0701 Unilateral exploration of adrenal field Class II
- 0702 Bilateral exploration of adrenal field Class II
- 0712 Open biopsy of adrenal gland Class II
- 0719 Other diagnostic procedures on adrenal glands, pituitary gland, pineal
and thymus Class II
- 0721 Excision of lesion of adrenal gland Class II
- 0722 Unilateral adrenalectomy Class I
- 0729 Other partial adrenalectomy Class I
- 073 Bilateral adrenalectomy Class I
- 0741 Incision of adrenal gland Class II
- 0742 Division of nerves to adrenal glands Class II
- 0743 Ligation of adrenal vessels Class II
- 0744 Repair of adrenal gland Class II
- 0745 Reimplantation of adrenal tissue Class II
- 0749 Other operations on adrenal glands, nerves, and vessels Class II
55
E-1-20 PROSEDUR PADA TIROID,

PARATIROID DAN SALURAN
TIROGLOSAL
- 0602 Reopening of wound of thyroid field Class II
- 0609 Other incision of thyroid field Class II
- 0612 Open biopsy of thyroid gland Class II
- 0613 Biopsy of parathyroid gland Class II
- 0619 Other diagnostic procedures on thyroid and parathyroid glands Class II
- 062 Unilateral thyroid lobectomy Class II
- 0631 Excision of lesion of thyroid Class II
- 0639 Other partial thyroidectomy Class II
- 064 Complete thyroidectomy Class II
- 0650 Substernal thyroidectomy, not otherwise specified Class II
- 0651 Partial substernal thyroidectomy Class II
- 0652 Complete substernal thyroidectomy Class II
- 066 Excision of lingual thyroid Class II
- 067 Excision of thyroglossal duct or tract Class II
- 0681 Complete parathyroidectomy Class II
- 0689 Other parathyroidectomy Class II
- 0691 Division of thyroid isthmus Class II
- 0692 Ligation of thyroid vessels Class II
- 0693 Suture of thyroid gland Class II
- 0694 Thyroid tissue reimplantation Class II
- 0695 Parathyroid tissue reimplantation Class II
- 0698 Other operations on thyroid glands Class II
- 0699 Other operations on parathyroid glands Class II
56
E-2-10 PROSEDUR PADA KELENJAR

ADRENAL
- 0700 Exploration of adrenal field, not otherwise specified Class II
- 0701 Unilateral exploration of adrenal field Class II
- 0702 Bilateral exploration of adrenal field Class II
- 0712 Open biopsy of adrenal gland Class II
- 0719 Other diagnostic procedures on adrenal glands, pituitary gland, pineal
and thymus Class II
- 0721 Excision of lesion of adrenal gland Class II
- 0741 Incision of adrenal gland Class II
- 0742 Division of nerves to adrenal glands Class II
- 0743 Ligation of adrenal vessels Class II
- 0744 Repair of adrenal gland Class II
- 0745 Reimplantation of adrenal tissue Class II
- 0749 Other operations on adrenal glands, nerves, and vessels Class II
57
E-2-21 PROSEDUR BESAR PADA

KELENJAR TIROID DAN PARATIROID
- 062 Unilateral thyroid lobectomy Class II
- 0631 Excision of lesion of thyroid Class II
- 0639 Other partial thyroidectomy Class II
- 064 Complete thyroidectomy Class II
- 0650 Substernal thyroidectomy, not otherwise specified Class II
- 0651 Partial substernal thyroidectomy Class II
- 0652 Complete substernal thyroidectomy Class II
- 066 Excision of lingual thyroid Class II
- 0681 Complete parathyroidectomy Class II
- 0689 Other parathyroidectomy Class II
58
E-2-22 PROSEDUR KECIL PADA

KELENJAR TIROID,PARATIROID DAN
SALURAN THYROGLOSSAL
- 0602 Reopening of wound of thyroid field Class II
- 0609 Other incision of thyroid field Class II
- 0612 Open biopsy of thyroid gland Class II
- 0613 Biopsy of parathyroid gland Class II
- 0619 Other diagnostic procedures on thyroid and parathyroid glands Class II
- 067 Excision of thyroglossal duct or tract Class II
- 0691 Division of thyroid isthmus Class II
- 0692 Ligation of thyroid vessels Class II
- 0693 Suture of thyroid gland Class II
- 0694 Thyroid tissue reimplantation Class II
- 0695 Parathyroid tissue reimplantation Class II
- 0698 Other operations on thyroid glands Class II
- 0699 Other operations on parathyroid glands Class II
59
E-3-10 PROSEDUR DIAGNOSTIK

PADA KELENJAR ENDOKRIN
- 0601 Aspiration of thyroid field Class III
- 0611 Closed (percutaneous) (needle) biopsy of thyroid gland Class III
- 0711 Closed (percutaneous) (needle) biopsy of adrenal gland Class III
60
F-3-10 TERAPI SHOCK

- 9424 Chemical shock therapy Class V
- 9426 Subconvulsive electroshock therapy Class III
- 9427 Other electroshock therapy Class III
61
F-5-10 PELAYANAN KESEHATAN

MENTAL EKSTENSIF
- 9401 Administration of intelligence test Class IV
- 9402 Administration of psychologic test Class IV
- 9403 Character analysis Class IV
- 9408 Other psychologic evaluation and testing Class IV
- 9409 Psychologic mental status determination, not otherwise specified Class
IV
- 9411 Psychiatric mental status determination Class IV
- 9412 Routine psychiatric visit, not otherwise specified Class IV
- 9413 Psychiatric commitment evaluation Class IV
- 9419 Other psychiatric interview and evaluation Class IV
- 9421 Narcoanalysis Class IV
- 9422 Lithium therapy Class IV
- 9423 Neuroleptic therapy Class IV
- 9425 Other psychiatric drug therapy Class IV
- 9429 Other psychiatric somatotherapy Class IV
- 9431 Psychoanalysis Class IV
- 9432 Hypnotherapy Class IV
- 9433 Behavior therapy Class IV
- 9434 Individual therapy for psychosexual dysfunction Class IV
- 9435 Crisis intervention Class IV
- 9436 Play psychotherapy Class IV
- 9437 Exploratory verbal psychotherapy Class IV
- 9438 Supportive verbal psychotherapy Class IV
- 9439 Other individual psychotherapy Class IV
- 9441 Group therapy for psychosexual dysfunction Class IV
62
- 9442 Family therapy Class IV

- 9443 Psychodrama Class IV
- 9444 Other group therapy Class IV
- 9445 Drug addiction counselling Class IV
- 9446 Alcoholism counselling Class IV
- 9449 Other counselling Class IV
63
F-5-11 TERAPI KELOMPOK

- 9441 Group therapy for psychosexual dysfunction Class IV
- 9442 Family therapy Class IV
- 9444 Other group therapy Class IV
64
F-5-12 PROSEDUR TES DIAGNOSTIK

KESEHATAN JIWA
- 9401 Administration of intelligence test Class IV
- 9402 Administration of psychologic test Class IV
- 9403 Character analysis Class IV
- 9408 Other psychologic evaluation and testing Class IV
- 9409 Psychologic mental status determination, not otherwise specified Class
IV
- 9411 Psychiatric mental status determination Class IV
- 9412 Routine psychiatric visit, not otherwise specified Class IV
- 9413 Psychiatric commitment evaluation Class IV
- 9419 Other psychiatric interview and evaluation Class IV
65
G-1-01 PROSEDUR PADA

PEMBULUH DARAH INTRA KRANIAL
- 0213 Ligation of meningeal vessel Class I
- 3801 Incision of intracranial vessels Class I
- 3811 Endarterectomy of intracranial vessels Class I
- 3831 Resection of intracranial vessels with anastomosis Class I
- 3841 Resection of vessel with replacement , intracranial vessels Class I
- 3851 Ligation and stripping of varicose veins, intracranial vessels Class I
- 3861 Other excision of vessels, intracranial vessels Class I
- 3881 Other surgical occlusion of vessels,intracranial vessels Class I
- 3928 Extracranial-intracranial (EC-IC) vascular bypass Class I
66
G-1-10 PROSEDUR KRANIOTOMI

- 0112 Open biopsy of cerebral meninges Class I
- 0113 Closed (percutaneous) (needle) biopsy of brain Class II
- 0114 Open biopsy of brain Class I
- 0118 Other diagnostic procedures on brain and cerebral meninges Class II
- 0121 Incision and drainage of cranial sinus Class II
- 0122 Removal of intracranial neurostimulator Class II
- 0123 Reopening of craniotomy site Class II
- 0124 Other craniotomy Class II
- 0125 Other craniectomy Class II
- 0131 Incision of cerebral meninges Class II
- 0132 Lobotomy and tractotomy Class I
- 0139 Other incision of brain Class II
- 0141 Operations on thalamus Class I
- 0142 Operations on globus pallidus Class I
- 0151 Excision of lesion or tissue of cerebral meninges Class I
- 0152 Hemispherectomy Class I
- 0153 Lobectomy of brain Class I
- 0159 Other excision or destruction of lesion or tissue of brain Class I
- 016 Excision of lesion of skull Class II
- 0201 Opening of cranial suture Class II
- 0202 Elevation of skull fracture fragments Class II
- 0203 Formation of cranial bone flap Class I
- 0204 Bone graft to skull Class II
- 0205 Insertion of skull plate Class I
- 0206 Other cranial osteoplasty Class I
- 0207 Removal of skull plate Class II
67
- 0211 Simple suture of dura mater of brain Class I

- 0212 Other repair of cerebral meninges Class I
- 0214 Choroid plexectomy Class I
- 022 Ventriculostomy Class II
- 0291 Lysis of cortical adhesions Class I
- 0292 Repair of brain Class I
- 0293 Implantation of intracranial neurostimulator Class II
- 0299 Other operations on skull, brain, and cerebral meninges Class II
- 0401 Excision of acoustic neuroma Class II
- 0441 Decompression of trigeminal nerve root Class II
68
G-1-11 PROSEDUR VENTRICULAR

SHUNT
- 0231 Ventricular shunt to structure in head and neck Class II
- 0232 Ventricular shunt to circulatory system Class II
- 0233 Ventricular shunt to thoracic cavity Class II
- 0234 Ventricular shunt to abdominal cavity and organs Class II
- 0235 Ventricular shunt to urinary system Class II
- 0239 Other operations to establish drainage of ventricle Class II
- 0242 Replacement of ventricular shunt Class II
- 0243 Removal of ventricular shunt Class II
69
G-1-12 PROSEDUR PEMBULUH

DARAH EXTRA KRANIAL
- 3802 Incision of other vessels of head and neck Class II
- 3812 Endarterectomy of other vessels of head and neck Class II
- 3832 Resection of other vessels of head and neck with anastomosis Class II
- 3842 Resection of vessel with replacement, other vessels of head and neck
Class II
- 3852 Ligation and stripping of varicose veins, other vessels of head an Class II
- 3862 Other excision of vessels, other vessels of head and neck Class II
- 3882 Other surgical occlusion of vessels, other vessels of head and neck Class
II
- 3972 Endovascular repair or occlusion of head and neck vessels Class II
- 3974 Endovascular removal of obstruction from head and neck vessel (s) Class
II
70
G-1-13 PROSEDUR CARPAL TUNNEL

RELEASE
- 0443 Release of carpal tunnel Class II
71
G-1-20 PROSEDUR SARAF KRANIAL

DAN PERIFER
- 0402 Division of trigeminal nerve Class II
- 0403 Division or crushing of other cranial and peripheral nerves Class II
- 0404 Other incision of cranial and peripheral nerves Class II
- 0405 Gasserian ganglionectomy Class II
- 0406 Other cranial or peripheral ganglionectomy Class II
- 0407 Other excision or avulsion of cranial and peripheral nerves Class II
- 0412 Open biopsy of cranial or peripheral nerve or ganglion Class II
- 0419 Other diagnostic procedures on cranial and peripheral nerves and
ganglia Class II
- 043 Suture of cranial and peripheral nerves Class II
- 0442 Other cranial nerve decompression Class II
- 0449 Other peripheral nerve or ganglion decompression or lysis of adhesions
Class II
- 045 Cranial or peripheral nerve graft Class II
- 046 Transposition of cranial and peripheral nerves Class II
- 0471 Hypoglossal-facial anastomosis Class II
- 0472 Accessory-facial anastomosis Class II
- 0473 Accessory-hypoglossal anastomosis Class II
- 0474 Other anastomosis of cranial or peripheral nerve Class II
- 0475 Revision of previous repair of cranial and peripheral nerves Class II
- 0476 Repair of old traumatic injury of cranial and peripheral nerves Class II
- 0479 Other neuroplasty Class II
- 0491 Neurectasis Class II
- 0492 Implantation or replacement of peripheral neurostimulator lead(s) Class
II
- 0493 Removal of peripheral neurostimulator lead(s) Class II
72
- 0499 Other operations on cranial and peripheral nerves Class II

- 050 Division of sympathetic nerve or ganglion Class II
- 0511 Biopsy of sympathetic nerve or ganglion Class II
- 0519 Other diagnostic procedures on sympathetic nerves or ganglia Class II
- 0521 Sphenopalatine ganglionectomy Class II
- 0522 Cervical sympathectomy Class II
- 0523 Lumbar sympathectomy Class II
- 0524 Presacral sympathectomy Class II
- 0525 Periarterial sympathectomy Class II
- 0529 Other sympathectomy and ganglionectomy Class II
- 0581 Repair of sympathetic nerve or ganglion Class II
- 0589 Other operations on sympathetic nerves or ganglia Class II
- 059 Other operations on nervous system Class II
- 397 Endovascular Repair of Vessel Class II
- 4400 Vagotomy, not otherwise specified Class II
- 4401 Truncal vagotomy Class I
- 4402 Highly selective vagotomy Class I
- 4403 Other selective vagotomy Class I
73
G-1-30 PROSEDUR TULANG

BELAKANG
- 0301 Removal of foreign body from spinal canal Class II
- 0302 Reopening of laminectomy site Class II
- 0309 Other exploration and decompression of spinal canal Class I
- 031 Division of intraspinal nerve root Class I
- 0321 Percutaneous chordotomy Class II
- 0329 Other chordotomy Class II
- 0332 Biopsy of spinal cord or spinal meninges Class II
- 0339 Other diagnostic procedures on spinal cord and spinal canal structur
Class II
- 034 Excision or destruction of lesion of spinal cord or spinal meninges Class I
- 0351 Repair of spinal meningocele Class I
- 0352 Repair of spinal myelomeningocele Class I
- 0359 Other repair and plastic operations on spinal cord structures Class II
- 036 Lysis of adhesions of spinal cord and nerve roots Class II
- 0371 Spinal subarachnoid-peritoneal shunt Class II
- 0372 Spinal subarachnoid-ureteral shunt Class II
- 0379 Other shunt of spinal theca Class II
- 0393 Implantation or replacement of spinal neurostimulator lead(s) Class II
- 0394 Removal of spinal neurostimulator lead(s) Class II
- 0397 Revision of spinal thecal shunt Class II
- 0398 Removal of spinal thecal shunt Class II
- 0399 Other operations on spinal cord and spinal canal structures Class II
74
G-2-10 PROSEDUR KRANIOTOMI

- 0113 Closed (percutaneous) (needle) biopsy of brain Class II
- 0118 Other diagnostic procedures on brain and cerebral meninges Class II
- 0121 Incision and drainage of cranial sinus Class II
- 0122 Removal of intracranial neurostimulator Class II
- 0123 Reopening of craniotomy site Class II
- 0124 Other craniotomy Class II
- 0125 Other craniectomy Class II
- 0131 Incision of cerebral meninges Class II
- 0139 Other incision of brain Class II
- 016 Excision of lesion of skull Class II
- 0201 Opening of cranial suture Class II
- 0202 Elevation of skull fracture fragments Class II
- 0204 Bone graft to skull Class II
- 0207 Removal of skull plate Class II
- 022 Ventriculostomy Class II
- 0293 Implantation of intracranial neurostimulator Class II
- 0299 Other operations on skull, brain, and cerebral meninges Class II
- 0401 Excision of acoustic neuroma Class II
- 0441 Decompression of trigeminal nerve root Class II
75
G-2-11 PROSEDUR SHUNT

VENTRIKEL
- 0231 Ventricular shunt to structure in head and neck Class II
- 0232 Ventricular shunt to circulatory system Class II
- 0233 Ventricular shunt to thoracic cavity Class II
- 0234 Ventricular shunt to abdominal cavity and organs Class II
- 0235 Ventricular shunt to urinary system Class II
- 0239 Other operations to establish drainage of ventricle Class II
- 0242 Replacement of ventricular shunt Class II
- 0243 Removal of ventricular shunt Class II
76
G-2-12 PROSEDUR PADA

PEMBULUH DARAH EKSTRAKRANIAL
- 3802 Incision of other vessels of head and neck Class II
- 3812 Endarterectomy of other vessels of head and neck Class II
- 3832 Resection of other vessels of head and neck with anastomosis Class II
- 3842 Resection of vessel with replacement, other vessels of head and neck
Class II
- 3852 Ligation and stripping of varicose veins, other vessels of head an Class II
- 3862 Other excision of vessels, other vessels of head and neck Class II
- 3882 Other surgical occlusion of vessels, other vessels of head and neck Class
II
- 3972 Endovascular repair or occlusion of head and neck vessels Class II
- 3974 Endovascular removal of obstruction from head and neck vessel (s) Class
II
77
G-2-13 PROSEDUR CARPAL TUNNEL

RELEASE
- 0443 Release of carpal tunnel Class II
78
G-2-21 PROSEDUR BESAR PADA

SARAF PERIFER
- 0405 Gasserian ganglionectomy Class II
- 0406 Other cranial or peripheral ganglionectomy Class II
- 0407 Other excision or avulsion of cranial and peripheral nerves Class II
- 043 Suture of cranial and peripheral nerves Class II
- 0442 Other cranial nerve decompression Class II
- 045 Cranial or peripheral nerve graft Class II
- 046 Transposition of cranial and peripheral nerves Class II
- 0471 Hypoglossal-facial anastomosis Class II
- 0472 Accessory-facial anastomosis Class II
- 0473 Accessory-hypoglossal anastomosis Class II
- 0474 Other anastomosis of cranial or peripheral nerve Class II
- 0475 Revision of previous repair of cranial and peripheral nerves Class II
- 0476 Repair of old traumatic injury of cranial and peripheral nerves Class II
- 0492 Implantation or replacement of peripheral neurostimulator lead(s) Class
II
- 0521 Sphenopalatine ganglionectomy Class II
- 0522 Cervical sympathectomy Class II
- 0523 Lumbar sympathectomy Class II
- 0524 Presacral sympathectomy Class II
- 0525 Periarterial sympathectomy Class II
- 0529 Other sympathectomy and ganglionectomy Class II
- 0581 Repair of sympathetic nerve or ganglion Class II
- 0589 Other operations on sympathetic nerves or ganglia Class II
- 397 Endovascular Repair of Vessel Class II
- 4400 Vagotomy, not otherwise specified Class II
79
80
G-2-22 PROSEDUR KECIL PADA

SARAF PERIFER
- 0402 Division of trigeminal nerve Class II
- 0403 Division or crushing of other cranial and peripheral nerves Class II
- 0404 Other incision of cranial and peripheral nerves Class II
- 0412 Open biopsy of cranial or peripheral nerve or ganglion Class II
- 0419 Other diagnostic procedures on cranial and peripheral nerves and
ganglia Class II
- 0449 Other peripheral nerve or ganglion decompression or lysis of adhesions
Class II
- 0479 Other neuroplasty Class II
- 0491 Neurectasis Class II
- 0493 Removal of peripheral neurostimulator lead(s) Class II
- 0499 Other operations on cranial and peripheral nerves Class II
- 050 Division of sympathetic nerve or ganglion Class II
- 0511 Biopsy of sympathetic nerve or ganglion Class II
- 0519 Other diagnostic procedures on sympathetic nerves or ganglia Class II
- 059 Other operations on nervous system Class II
81
G-2-31 PROSEDUR BESAR PADA

TULANG BELAKANG
- 0302 Reopening of laminectomy site Class II
- 0321 Percutaneous chordotomy Class II
- 0329 Other chordotomy Class II
- 0359 Other repair and plastic operations on spinal cord structures Class II
- 036 Lysis of adhesions of spinal cord and nerve roots Class II
- 0393 Implantation or replacement of spinal neurostimulator lead(s) Class II
82
G-2-32 PROSEDUR KECIL PADA

TULANG BELAKANG
- 0301 Removal of foreign body from spinal canal Class II
- 0332 Biopsy of spinal cord or spinal meninges Class II
- 0339 Other diagnostic procedures on spinal cord and spinal canal structur
Class II
- 0371 Spinal subarachnoid-peritoneal shunt Class II
- 0372 Spinal subarachnoid-ureteral shunt Class II
- 0379 Other shunt of spinal theca Class II
- 0394 Removal of spinal neurostimulator lead(s) Class II
- 0397 Revision of spinal thecal shunt Class II
- 0398 Removal of spinal thecal shunt Class II
- 0399 Other operations on spinal cord and spinal canal structures Class II
83
G-3-10 PROSEDUR TAP & INJEKSI

PADA SPINAL
- 0241 Irrigation of ventricular shunt Class III
- 0331 Spinal tap Class III
- 038 Injection of destructive agent into spinal canal Class III
- 0390 Insertion of catheter into spinal canal for infusion of therapeutic Class III
- 0391 Injection of anesthetic into spinal canal for analgesia Class III
- 0392 Injection of other agent into spinal canal Class III
- 0395 Spinal blood patch Class III
84
G-3-11 PROSEDUR INJEKSI PADA

SARAF PERIFER
- 0480 Peripheral nerve injection, not otherwise specified Class III
- 0481 Injection of anesthetic into peripheral nerve for analgesia Class III
- 0489 Injection of other agent, except neurolytic Class III
- 0531 Injection of anesthetic into sympathetic nerve for analgesia Class III
- 0532 Injection of neurolytic agent into sympathetic nerve Class III
85
G-3-12 PROSEDUR PEMERIKSAAN

NEUROLOGIS LAIN
- 0101 Cisternal puncture Class III
- 0102 Ventriculopuncture through previously implanted catheter Class III
- 0109 Other cranial puncture Class III
- 0111 Closed (percutaneous) (needle) biopsy of cerebral meninges Class III
- 0294 Insertion or replacement of skull tongs or halo traction device Class III
- 0295 Removal of skull tongs or halo traction device Class III
- 0296 Insertion of sphenoid electrodes Class III
- 0396 Percutaneous denervation of facet Class III
- 0411 Closed (percutaneous) (needle) biopsy of cranial or peripheral nerve or
ganglion Class III
- 042 Destruction of cranial and peripheral nerves Class III
86
G-3-13 PROSEDUR
ELEKROENSEFALOGRAFI EEG
- 8914 Electroencephalogram Class III
- 8919 Video and radio-telemetered electroencephalographic monitoring Class
III
87
H-1-20 PROSEDUR EKTRAOKULER

DAN MATA
- 0820 Removal of lesion of eyelid, not otherwise specified Class II
- 0821 Excision of chalazion Class II
- 0822 Excision of other minor lesion of eyelid Class II
- 0823 Excision of major lesion of eyelid, partial-thickness Class II
- 0824 Excision of major lesion of eyelid, full-thickness Class II
- 0825 Destruction of lesion of eyelid Class II
- 0831 Repair of blepharoptosis by frontalis muscle technique with suture Class
II
- 0832 Repair of blepharoptosis by frontalis muscle technique with fascial Class
II
- 0833 Repair of blepharoptosis by resection or advancement of levator musc
Class II
- 0834 Repair of blepharoptosis by other levator muscle techniques Class II
- 0835 Repair of blepharoptosis by tarsal technique Class II
- 0836 Repair of blepharoptosis by other techniques Class II
- 0837 Reduction of overcorrection of ptosis Class II
- 0838 Correction of lid retraction Class II
- 0841 Repair of entropion or ectropion by thermocauterization Class II
- 0842 Repair of entropion or ectropion by suture technique Class II
- 0843 Repair of entropion or ectropion with wedge resection Class II
- 0844 Repair of entropion or ectropion with lid reconstruction Class II
- 0849 Other repair of entropion or ectropion Class II
- 0851 Canthotomy Class II
- 0852 Blepharorrhaphy Class II
- 0859 Other adjustment of lid position Class II
- 0861 Reconstruction of eyelid with skin flap or graft Class II
88
- 0862 Reconstruction of eyelid with mucous membrane flap or graft Class II

- 0863 Reconstruction of eyelid with hair follicle graft Class II
- 0864 Reconstruction of eyelid with tarsoconjunctival flap Class II
- 0869 Other reconstruction of eyelid with flaps or grafts Class II
- 0870 Reconstruction of eyelid, not otherwise specified Class II
- 0871 Reconstruction of eyelid involving lid margin, partial- thickness Class II
- 0872 Other reconstruction of eyelid, partial-thickness Class II
- 0873 Reconstruction of eyelid involving lid margin, full-thickness Class II
- 0874 Other reconstruction of eyelid, full-thickness Class II
- 0882 Repair of laceration involving lid margin, partial-thickness Class II
- 0883 Other repair of laceration of eyelid, partial-thickness Class II
- 0884 Repair of laceration of eyelid involving lid margin, full-thickness Class II
- 0885 Other repair of laceration of eyelid, full-thickness Class II
- 0886 Lower eyelid rhytidectomy Class II
- 0887 Upper eyelid rhytidectomy Class II
- 0891 Electrosurgical epilation of eyelid Class II
- 0892 Cryosurgical epilation of eyelid Class II
- 0893 Other epilation of eyelid Class II
- 0899 Other operations on eyelids Class II
- 090 Incision of lacrimal gland Class II
- 0911 Biopsy of lacrimal gland Class II
- 0912 Biopsy of lacrimal sac Class II
- 0919 Other diagnostic procedures on lacrimal system Class II
- 0920 Excision of lacrimal gland, not otherwise specified Class II
- 0921 Excision of lesion of lacrimal gland Class II
- 0922 Other partial dacryoadenectomy Class II
- 0923 Total dacryoadenectomy Class II
- 093 Other operations on lacrimal gland Class II
89
- 0941 Probing of lacrimal punctum Class II

- 0942 Probing of lacrimal canaliculi Class II
- 0943 Probing of nasolacrimal duct Class II
- 0944 Intubation of nasolacrimal duct Class II
- 0949 Other manipulation of lacrimal passage Class II
- 0951 Incision of lacrimal punctum Class II
- 0952 Incision of lacrimal canaliculi Class II
- 0953 Incision of lacrimal sac Class II
- 0959 Other incision of lacrimal passages Class II
- 096 Excision of lacrimal sac and passage Class II
- 0971 Correction of everted punctum Class II
- 0972 Other repair of punctum Class II
- 0973 Repair of canaliculus Class II
- 0981 Dacryocystorhinostomy (DCR) Class II
- 0982 Conjunctivocystorhinostomy Class II
- 0983 Conjunctivorhinostomy with insertion of tube or stent Class II
- 0991 Obliteration of lacrimal punctum Class II
- 0999 Other operations on lacrimal system Class II
- 100 Removal of embedded foreign body from conjunctiva by incision Class II
- 101 Other incision of conjunctiva Class II
- 1031 Excision of lesion or tissue of conjunctiva Class II
- 1032 Destruction of lesion of conjunctiva Class II
- 1033 Other destructive procedures on conjunctiva Class II
- 1041 Repair of symblepharon with free graft Class II
- 1042 Reconstruction of conjunctival cul-de-sac with free graft Class II
- 1043 Other reconstruction of conjunctival cul-de-sac Class II
- 1044 Other free graft to conjunctiva Class II
- 1049 Other conjunctivoplasty Class II
90
- 105 Lysis of adhesions of conjunctiva and eyelid Class II

- 106 Repair of laceration of conjunctiva Class II
- 1099 Other operations on conjunctiva Class II
- 110 Magnetic removal of embedded foreign body from cornea Class II
- 1121 Scraping of cornea for smear or culture Class II
- 1122 Biopsy of cornea Class II
- 1129 Other diagnostic procedures on cornea Class II
- 1131 Transposition of pterygium Class II
- 1132 Excision of pterygium with corneal graft Class II
- 1139 Other excision of pterygium Class II
- 1141 Mechanical removal of corneal epithelium Class II
- 1142 Thermocauterization of corneal lesion Class II
- 1143 Cryotherapy of corneal lesion Class II
- 1149 Other removal or destruction of corneal lesion Class II
- 1191 Tattooing of cornea Class II
- 1284 Excision or destruction of lesion of sclera Class II
- 1287 Scleral reinforcement with graft Class II
- 1288 Other scleral reinforcement Class II
- 1289 Other operations on sclera Class II
- 146 Removal of surgically implanted material from posterior segment of eye
Class II
- 1501 Biopsy of extraocular muscle or tendon Class II
- 1509 Other diagnostic procedures on extraocular muscles and tendons Class II
- 1511 Recession of one extraocular muscle Class II
- 1512 Advancement of one extraocular muscle Class II
- 1513 Resection of one extraocular muscle Class II
- 1519 Other operations on one extraocular muscle involving temporary detac
Class II
- 1521 Lengthening procedure on one extraocular muscle Class II
91
- 1522 Shortening procedure on one extraocular muscle Class II

- 1529 Other operations on one extraocular muscle Class II
- 153 Operations on two or more extraocular muscles involving temporary de
Class II
- 154 Other operations on two or more extraocular muscles, one or both eye
Class II
- 155 Transposition of extraocular muscles Class II
- 156 Revision of extraocular muscle surgery Class II
- 157 Repair of injury of extraocular muscle Class II
- 159 Other operations on extraocular muscles and tendons Class II
- 1601 Orbitotomy with bone flap Class II
- 1602 Orbitotomy with insertion of orbital implant Class II
- 1609 Other orbitotomy Class II
- 1631 Removal of ocular contents with synchronous implant into scleral she
Class II
- 1639 Other evisceration of eyeball Class II
- 1641 Enucleation of eyeball with synchronous implant into tenon\s capsule
Class II
- 1642 Enucleation of eyeball with other synchronous implant Class II
- 1649 Other enucleation of eyeball Class II
- 1651 Exenteration of orbit with removal of adjacent structures Class II
- 1652 Exenteration of orbit with therapeutic removal of orbital bone Class II
- 1659 Other exenteration of orbit Class II
- 1661 Secondary insertion of ocular implant Class II
- 1662 Revision and reinsertion of ocular implant Class II
- 1663 Revision of enucleation socket with graft Class II
- 1664 Other revision of enucleation socket Class II
- 1665 Secondary graft to exenteration cavity Class II
- 1666 Other revision of exenteration cavity Class II
- 1669 Other secondary procedures after removal of eyeball Class II
92
- 1671 Removal of ocular implant Class II

- 1672 Removal of orbital implant Class II
- 1681 Repair of wound of orbit Class II
- 1682 Repair of rupture of eyeball Class II
- 1689 Other repair of injury of eyeball or orbit Class II
- 1692 Excision of lesion of orbit Class II
- 1693 Excision of lesion of eye, unspecified structure Class II
- 1698 Other operations on orbit Class II
- 1699 Other operations on eyeball Class II
93
H-1-30 PROSEDUR LENSA DAN

INTRA OKULER
- 111 Incision of cornea Class II
- 1151 Suture of corneal laceration Class II
- 1152 Repair of postoperative wound dehiscence of cornea Class II
- 1153 Repair of corneal laceration or wound with conjunctival flap Class II
- 1159 Other repair of cornea Class II
- 1160 Corneal transplant, not otherwise specified Class II
- 1161 Lamellar keratoplasty with autograft Class II
- 1162 Other lamellar keratoplasty Class II
- 1163 Penetrating keratoplasty with autograft Class II
- 1164 Other penetrating keratoplasty Class II
- 1169 Other corneal transplant Class II
- 1171 Keratomeleusis Class II
- 1172 Keratophakia Class II
- 1173 Keratoprosthesis Class II
- 1174 Thermokeratoplasty Class II
- 1175 Radial keratotomy Class II
- 1176 Epikeratophakia Class II
- 1179 Other reconstructive surgery on cornea Class II
- 1192 Removal of artificial implant from cornea Class II
- 1199 Other operations on cornea Class II
- 1200 Removal of intraocular foreign body from anterior segment of eye, no
Class II
- 1201 Removal of intraocular foreign body from anterior segment of eye wit
Class II
Class II
94
- 1211 Iridotomy with transfixion Class II

- 1212 Other iridotomy Class II
- 1213 Excision of prolapsed iris Class II
- 1214 Other iridectomy Class II
- 1221 Diagnostic aspiration of anterior chamber of eye Class II
- 1222 Biopsy of iris Class II
- 1229 Other diagnostic procedures on iris, ciliary body, sclera, and anter Class
II
- 1231 Lysis of goniosynechiae Class II
- 1232 Lysis of other anterior synechiae Class II
- 1233 Lysis of posterior synechiae Class II
- 1234 Lysis of corneovitreal adhesions Class II
- 1235 Coreoplasty Class II
- 1239 Other iridoplasty Class II
- 1240 Removal of lesion of anterior segment of eye, not otherwise specifie
Class II
- 1241 Destruction of lesion of iris, nonexcisional Class II
- 1242 Excision of lesion of iris Class II
- 1243 Destruction of lesion of ciliary body, nonexcisional Class II
- 1244 Excision of lesion of ciliary body Class II
- 1251 Goniopuncture without goniotomy Class II
- 1252 Goniotomy without goniopuncture Class II
- 1253 Goniotomy with goniopuncture Class II
- 1254 Trabeculotomy ab externo Class II
- 1255 Cyclodialysis Class II
- 1259 Other facilitation of intraocular circulation Class II
- 1261 Trephination of sclera with iridectomy Class II
- 1262 Thermocauterization of sclera with iridectomy Class II
- 1263 Iridencleisis and iridotasis Class II
95
- 1264 Trabeculectomy ab externo Class II

- 1265 Other scleral fistulization with iridectomy Class II
- 1266 Postoperative revision of scleral fistulization procedure Class II
- 1269 Other scleral fistulizing procedure Class II
- 1271 Cyclodiathermy Class II
- 1272 Cyclocryotherapy Class II
- 1273 Cyclophotocoagulation Class II
- 1274 Diminution of ciliary body, not otherwise specified Class II
- 1279 Other glaucoma procedures Class II
- 1281 Suture of laceration of sclera Class II
- 1282 Repair of scleral fistula Class II
- 1283 Revision of operative wound of anterior segment, not elsewhere class
Class II
- 1285 Repair of scleral staphyloma with graft Class II
- 1286 Other repair of scleral staphyloma Class II
- 1291 Therapeutic evacuation of anterior chamber Class II
- 1292 Injection into anterior chamber Class II
- 1293 Removal or destruction of epithelial downgrowth from anterior chambe
Class II
- 1297 Other operations on iris Class II
- 1298 Other operations on ciliary body Class II
- 1299 Other operations on anterior chamber Class II
- 1300 Removal of foreign body from lens, not otherwise specified Class II
- 1301 Removal of foreign body from lens with use of magnet Class II
- 1302 Removal of foreign body from lens without use of magnet Class II
- 1311 Intracapsular extraction of lens by temporal inferior route Class II
- 1319 Other intracapsular extraction of lens Class II
- 132 Extracapsular extraction of lens by linear extraction technique Class II
- 133 Extracapsular extraction of lens by simple aspiration (and irrigatio Class II
96
- 1341 Phacoemulsification and aspiration of cataract Class II

- 1342 Mechanical phacofragmentation and aspiration of cataract by posterio
Class II
- 1343 Mechanical phacofragmentation and other aspiration of cataract Class II
- 1351 Extracapsular extraction of lens by temporal inferior route Class II
- 1359 Other extracapsular extraction of lens Class II
- 1364 Discission of secondary membrane (after cataract) Class II
- 1365 Excision of secondary membrane (after cataract) Class II
- 1366 Mechanical fragmentation of secondary membrane (after cataract) Class
II
- 1369 Other cataract extraction Class II
- 1370 Insertion of pseudophakos, not otherwise specified Class II
- 1371 Insertion of intraocular lens prosthesis at time of cataract extract Class II
- 1372 Secondary insertion of intraocular lens prosthesis Class II
- 138 Removal of implanted lens Class II
- 139 Other operations on lens Class II
- 1400 Removal of foreign body from posterior segment of eye, not otherwise
Class II
- 1401 Removal of foreign body from posterior segment of eye with use of ma
Class II
- 1402 Removal of foreign body from posterior segment of eye without use of
Class II
- 1421 Destruction of chorioretinal lesion by diathermy Class II
- 1422 Destruction of chorioretinal lesion by cryotherapy Class II
- 1426 Destruction of chorioretinal lesion by radiation therapy Class II
- 1427 Destruction of chorioretinal lesion by implantation of radiation sou Class
II
- 1429 Other destruction of chorioretinal lesion Class II
- 1431 Repair of retinal tear by diathermy Class II
- 1432 Repair of retinal tear by cryotherapy Class II
- 1433 Repair of retinal tear by xenon arc photocoagulation Class II
97
- 1434 Repair of retinal tear by laser photocoagulation Class II

- 1435 Repair of retinal tear by photocoagulation of unspecified type Class II
- 1439 Other repair of retinal tear Class II
- 1441 Scleral buckling with implant Class II
- 1449 Other scleral buckling Class II
- 1451 Repair of retinal detachment with diathermy Class II
- 1452 Repair of retinal detachment with cryotherapy Class II
- 1453 Repair of retinal detachment with xenon arc photocoagulation Class II
- 1454 Repair of retinal detachment with laser photocoagulation Class II
- 1455 Repair of retinal detachment with photocoagulation of unspecified ty
Class II
- 1459 Other repair of retinal detachment Class II
- 1471 Removal of vitreous, anterior approach Class II
- 1472 Other removal of vitreous Class II
- 1473 Mechanical vitrectomy by anterior approach Class II
- 1474 Other mechanical vitrectomy Class II
- 1475 Injection of vitreous substitute Class II
- 1479 Other operations on vitreous Class II
- 149 Other operations on retina, choroid, and posterior chamber Class II
- 161 Removal of penetrating foreign body from eye, not otherwise specifie
Class II
- 1623 Biopsy of eyeball and orbit Class II
- 1629 Other diagnostic procedures on orbit and eyeball Class II
98
H-2-21 PROSEDUR BESAR PADA

MATA
- 0861 Reconstruction of eyelid with skin flap or graft Class II
- 0862 Reconstruction of eyelid with mucous membrane flap or graft Class II
- 0863 Reconstruction of eyelid with hair follicle graft Class II
- 0864 Reconstruction of eyelid with tarsoconjunctival flap Class II
- 0869 Other reconstruction of eyelid with flaps or grafts Class II
- 0870 Reconstruction of eyelid, not otherwise specified Class II
- 0871 Reconstruction of eyelid involving lid margin, partial- thickness Class II
- 0872 Other reconstruction of eyelid, partial-thickness Class II
- 0873 Reconstruction of eyelid involving lid margin, full-thickness Class II
- 0874 Other reconstruction of eyelid, full-thickness Class II
- 0923 Total dacryoadenectomy Class II
- 1501 Biopsy of extraocular muscle or tendon Class II
- 1509 Other diagnostic procedures on extraocular muscles and tendons Class II
- 1511 Recession of one extraocular muscle Class II
- 1512 Advancement of one extraocular muscle Class II
- 1513 Resection of one extraocular muscle Class II
- 1519 Other operations on one extraocular muscle involving temporary detac
Class II
- 1521 Lengthening procedure on one extraocular muscle Class II
- 1522 Shortening procedure on one extraocular muscle Class II
- 1529 Other operations on one extraocular muscle Class II
- 153 Operations on two or more extraocular muscles involving temporary de
Class II
- 154 Other operations on two or more extraocular muscles, one or both eye
Class II
- 155 Transposition of extraocular muscles Class II
99
- 156 Revision of extraocular muscle surgery Class II

- 157 Repair of injury of extraocular muscle Class II
- 159 Other operations on extraocular muscles and tendons Class II
- 1601 Orbitotomy with bone flap Class II
- 1602 Orbitotomy with insertion of orbital implant Class II
- 1609 Other orbitotomy Class II
- 1651 Exenteration of orbit with removal of adjacent structures Class II
- 1652 Exenteration of orbit with therapeutic removal of orbital bone Class II
- 1659 Other exenteration of orbit Class II
- 1666 Other revision of exenteration cavity Class II
100
H-2-22 PROSEDUR SEDANG PADA

MATA
- 0823 Excision of major lesion of eyelid, partial-thickness Class II
- 0824 Excision of major lesion of eyelid, full-thickness Class II
- 0831 Repair of blepharoptosis by frontalis muscle technique with suture Class
II
- 0832 Repair of blepharoptosis by frontalis muscle technique with fascial Class
II
- 0833 Repair of blepharoptosis by resection or advancement of levator musc
Class II
- 0834 Repair of blepharoptosis by other levator muscle techniques Class II
- 0835 Repair of blepharoptosis by tarsal technique Class II
- 0836 Repair of blepharoptosis by other techniques Class II
- 0837 Reduction of overcorrection of ptosis Class II
- 0838 Correction of lid retraction Class II
- 0842 Repair of entropion or ectropion by suture technique Class II
- 0843 Repair of entropion or ectropion with wedge resection Class II
- 0844 Repair of entropion or ectropion with lid reconstruction Class II
- 0852 Blepharorrhaphy Class II
- 0859 Other adjustment of lid position Class II
- 0882 Repair of laceration involving lid margin, partial-thickness Class II
- 0883 Other repair of laceration of eyelid, partial-thickness Class II
- 0884 Repair of laceration of eyelid involving lid margin, full-thickness Class II
- 0885 Other repair of laceration of eyelid, full-thickness Class II
- 0886 Lower eyelid rhytidectomy Class II
- 0887 Upper eyelid rhytidectomy Class II
- 0911 Biopsy of lacrimal gland Class II
- 0920 Excision of lacrimal gland, not otherwise specified Class II
101
- 0921 Excision of lesion of lacrimal gland Class II

- 0922 Other partial dacryoadenectomy Class II
- 093 Other operations on lacrimal gland Class II
- 0959 Other incision of lacrimal passages Class II
- 096 Excision of lacrimal sac and passage Class II
- 0973 Repair of canaliculus Class II
- 0981 Dacryocystorhinostomy (DCR) Class II
- 0982 Conjunctivocystorhinostomy Class II
- 0983 Conjunctivorhinostomy with insertion of tube or stent Class II
- 0991 Obliteration of lacrimal punctum Class II
- 1041 Repair of symblepharon with free graft Class II
- 1042 Reconstruction of conjunctival cul-de-sac with free graft Class II
- 1043 Other reconstruction of conjunctival cul-de-sac Class II
- 1044 Other free graft to conjunctiva Class II
- 1049 Other conjunctivoplasty Class II
- 105 Lysis of adhesions of conjunctiva and eyelid Class II
- 106 Repair of laceration of conjunctiva Class II
- 1131 Transposition of pterygium Class II
- 1132 Excision of pterygium with corneal graft Class II
- 1139 Other excision of pterygium Class II
- 1141 Mechanical removal of corneal epithelium Class II
- 1149 Other removal or destruction of corneal lesion Class II
- 1284 Excision or destruction of lesion of sclera Class II
- 1287 Scleral reinforcement with graft Class II
- 1288 Other scleral reinforcement Class II
- 1289 Other operations on sclera Class II
- 146 Removal of surgically implanted material from posterior segment of eye
Class II
102
- 1631 Removal of ocular contents with synchronous implant into scleral she
Class II
- 1639 Other evisceration of eyeball Class II
- 1641 Enucleation of eyeball with synchronous implant into tenon\s capsule
Class II
- 1642 Enucleation of eyeball with other synchronous implant Class II
- 1649 Other enucleation of eyeball Class II
- 1661 Secondary insertion of ocular implant Class II
- 1662 Revision and reinsertion of ocular implant Class II
- 1663 Revision of enucleation socket with graft Class II
- 1664 Other revision of enucleation socket Class II
- 1665 Secondary graft to exenteration cavity Class II
- 1669 Other secondary procedures after removal of eyeball Class II
- 1671 Removal of ocular implant Class II
- 1672 Removal of orbital implant Class II
- 1681 Repair of wound of orbit Class II
- 1682 Repair of rupture of eyeball Class II
- 1689 Other repair of injury of eyeball or orbit Class II
- 1692 Excision of lesion of orbit Class II
- 1693 Excision of lesion of eye, unspecified structure Class II
- 1698 Other operations on orbit Class II
- 1699 Other operations on eyeball Class II
103
H-2-23 PROSEDUR KECIL PADA

MATA
- 0820 Removal of lesion of eyelid, not otherwise specified Class II
- 0821 Excision of chalazion Class II
- 0822 Excision of other minor lesion of eyelid Class II
- 0825 Destruction of lesion of eyelid Class II
- 0841 Repair of entropion or ectropion by thermocauterization Class II
- 0849 Other repair of entropion or ectropion Class II
- 0851 Canthotomy Class II
- 0891 Electrosurgical epilation of eyelid Class II
- 0892 Cryosurgical epilation of eyelid Class II
- 0893 Other epilation of eyelid Class II
- 0899 Other operations on eyelids Class II
- 090 Incision of lacrimal gland Class II
- 0912 Biopsy of lacrimal sac Class II
- 0919 Other diagnostic procedures on lacrimal system Class II
- 0941 Probing of lacrimal punctum Class II
- 0942 Probing of lacrimal canaliculi Class II
- 0943 Probing of nasolacrimal duct Class II
- 0944 Intubation of nasolacrimal duct Class II
- 0949 Other manipulation of lacrimal passage Class II
- 0951 Incision of lacrimal punctum Class II
- 0952 Incision of lacrimal canaliculi Class II
- 0953 Incision of lacrimal sac Class II
- 0971 Correction of everted punctum Class II
- 0972 Other repair of punctum Class II
- 0999 Other operations on lacrimal system Class II
104
- 100 Removal of embedded foreign body from conjunctiva by incision Class II

- 101 Other incision of conjunctiva Class II
- 1031 Excision of lesion or tissue of conjunctiva Class II
- 1032 Destruction of lesion of conjunctiva Class II
- 1033 Other destructive procedures on conjunctiva Class II
- 1099 Other operations on conjunctiva Class II
- 110 Magnetic removal of embedded foreign body from cornea Class II
- 1121 Scraping of cornea for smear or culture Class II
- 1122 Biopsy of cornea Class II
- 1129 Other diagnostic procedures on cornea Class II
- 1142 Thermocauterization of corneal lesion Class II
- 1143 Cryotherapy of corneal lesion Class II
- 1191 Tattooing of cornea Class II
105

SEGMEN ANTERIOR MATA
- 1153 Repair of corneal laceration or wound with conjunctival flap Class II
- 1160 Corneal transplant, not otherwise specified Class II
- 1161 Lamellar keratoplasty with autograft Class II
- 1162 Other lamellar keratoplasty Class II
- 1163 Penetrating keratoplasty with autograft Class II
- 1164 Other penetrating keratoplasty Class II
- 1169 Other corneal transplant Class II
- 1173 Keratoprosthesis Class II
- 1244 Excision of lesion of ciliary body Class II
- 1254 Trabeculotomy ab externo Class II
- 1262 Thermocauterization of sclera with iridectomy Class II
- 1263 Iridencleisis and iridotasis Class II
- 1264 Trabeculectomy ab externo Class II
- 1265 Other scleral fistulization with iridectomy Class II
- 1279 Other glaucoma procedures Class II
- 1285 Repair of scleral staphyloma with graft Class II
106
H-2-32 PROSEDUR SEDANG PADA

- 1151 Suture of corneal laceration Class II
- 1171 Keratomeleusis Class II
- 1172 Keratophakia Class II
- 1174 Thermokeratoplasty Class II
- 1175 Radial keratotomy Class II
- 1176 Epikeratophakia Class II
- 1179 Other reconstructive surgery on cornea Class II
- 1199 Other operations on cornea Class II
- 1200 Removal of intraocular foreign body from anterior segment of eye, no
Class II
- 1211 Iridotomy with transfixion Class II
- 1213 Excision of prolapsed iris Class II
- 1214 Other iridectomy Class II
- 1231 Lysis of goniosynechiae Class II
- 1232 Lysis of other anterior synechiae Class II
- 1233 Lysis of posterior synechiae Class II
- 1234 Lysis of corneovitreal adhesions Class II
- 1235 Coreoplasty Class II
- 1239 Other iridoplasty Class II
- 1241 Destruction of lesion of iris, nonexcisional Class II
- 1242 Excision of lesion of iris Class II
- 1255 Cyclodialysis Class II
- 1259 Other facilitation of intraocular circulation Class II
- 1261 Trephination of sclera with iridectomy Class II
- 1266 Postoperative revision of scleral fistulization procedure Class II
107
- 1269 Other scleral fistulizing procedure Class II

- 1271 Cyclodiathermy Class II
- 1272 Cyclocryotherapy Class II
- 1273 Cyclophotocoagulation Class II
- 1274 Diminution of ciliary body, not otherwise specified Class II
- 1282 Repair of scleral fistula Class II
- 1283 Revision of operative wound of anterior segment, not elsewhere class
Class II
- 1286 Other repair of scleral staphyloma Class II
- 1291 Therapeutic evacuation of anterior chamber Class II
- 1293 Removal or destruction of epithelial downgrowth from anterior chambe
Class II
- 1299 Other operations on anterior chamber Class II
108

- 111 Incision of cornea Class II
- 1152 Repair of postoperative wound dehiscence of cornea Class II
- 1159 Other repair of cornea Class II
- 1192 Removal of artificial implant from cornea Class II
Class II
Class II
- 1212 Other iridotomy Class II
- 1221 Diagnostic aspiration of anterior chamber of eye Class II
- 1222 Biopsy of iris Class II
- 1229 Other diagnostic procedures on iris, ciliary body, sclera, and anter Class
II
- 1240 Removal of lesion of anterior segment of eye, not otherwise specifie
Class II
- 1243 Destruction of lesion of ciliary body, nonexcisional Class II
- 1251 Goniopuncture without goniotomy Class II
- 1252 Goniotomy without goniopuncture Class II
- 1253 Goniotomy with goniopuncture Class II
- 1281 Suture of laceration of sclera Class II
- 1292 Injection into anterior chamber Class II
- 1297 Other operations on iris Class II
- 1298 Other operations on ciliary body Class II
- 1300 Removal of foreign body from lens, not otherwise specified Class II
- 1301 Removal of foreign body from lens with use of magnet Class II
- 1302 Removal of foreign body from lens without use of magnet Class II
109
- 1366 Mechanical fragmentation of secondary membrane (after cataract) Class

II
- 138 Removal of implanted lens Class II
- 139 Other operations on lens Class II
110

SEGMEN POSTERIOR MATA
- 1400 Removal of foreign body from posterior segment of eye, not otherwise
Class II
- 1401 Removal of foreign body from posterior segment of eye with use of ma
Class II
- 1402 Removal of foreign body from posterior segment of eye without use of
Class II
- 1427 Destruction of chorioretinal lesion by implantation of radiation sou Class
II
- 1431 Repair of retinal tear by diathermy Class II
- 1441 Scleral buckling with implant Class II
- 1449 Other scleral buckling Class II
111

SEGMEN POSTERIOR MATA
- 1421 Destruction of chorioretinal lesion by diathermy Class II
- 1422 Destruction of chorioretinal lesion by cryotherapy Class II
- 1426 Destruction of chorioretinal lesion by radiation therapy Class II
- 1429 Other destruction of chorioretinal lesion Class II
- 1471 Removal of vitreous, anterior approach Class II
- 1472 Other removal of vitreous Class II
- 1473 Mechanical vitrectomy by anterior approach Class II
- 1474 Other mechanical vitrectomy Class II
- 1475 Injection of vitreous substitute Class II
- 1479 Other operations on vitreous Class II
- 149 Other operations on retina, choroid, and posterior chamber Class II
- 161 Removal of penetrating foreign body from eye, not otherwise specifie
Class II
- 1623 Biopsy of eyeball and orbit Class II
- 1629 Other diagnostic procedures on orbit and eyeball Class II
112
H-2-36 PROSEDUR OPERASI

KATARAK
- 1311 Intracapsular extraction of lens by temporal inferior route Class II
- 1319 Other intracapsular extraction of lens Class II
- 132 Extracapsular extraction of lens by linear extraction technique Class II
- 133 Extracapsular extraction of lens by simple aspiration (and irrigatio Class II
- 1341 Phacoemulsification and aspiration of cataract Class II
- 1342 Mechanical phacofragmentation and aspiration of cataract by posterio
Class II
- 1343 Mechanical phacofragmentation and other aspiration of cataract Class II
- 1351 Extracapsular extraction of lens by temporal inferior route Class II
- 1359 Other extracapsular extraction of lens Class II
- 1364 Discission of secondary membrane (after cataract) Class II
- 1365 Excision of secondary membrane (after cataract) Class II
- 1369 Other cataract extraction Class II
- 1370 Insertion of pseudophakos, not otherwise specified Class II
- 1371 Insertion of intraocular lens prosthesis at time of cataract extract Class II
- 1372 Secondary insertion of intraocular lens prosthesis Class II
113
H-2-37 PROSEDUR
PHOTOKOAGULASI DAN
KRIOTHERAPI PADA RETINA
- 1432 Repair of retinal tear by cryotherapy Class II
- 1433 Repair of retinal tear by xenon arc photocoagulation Class II
- 1434 Repair of retinal tear by laser photocoagulation Class II
- 1435 Repair of retinal tear by photocoagulation of unspecified type Class II
- 1439 Other repair of retinal tear Class II
- 1451 Repair of retinal detachment with diathermy Class II
- 1452 Repair of retinal detachment with cryotherapy Class II
- 1453 Repair of retinal detachment with xenon arc photocoagulation Class II
- 1454 Repair of retinal detachment with laser photocoagulation Class II
- 1455 Repair of retinal detachment with photocoagulation of unspecified ty
Class II
- 1459 Other repair of retinal detachment Class II
114
H-3-10 PROSEDUR LASER SEDANG

PADA MATA
- 1423 Destruction of chorioretinal lesion by xenon arc photocoagulation Class
III
- 1424 Destruction of chorioretinal lesion by laser photocoagulation Class III
- 1425 Destruction of chorioretinal lesion by photocoagulation of unspecifi Class
III
115

EKTRAOKULER
- 0801 Incision of lid margin Class III
- 0802 Severing of blepharorrhaphy Class III
- 0809 Other incision of eyelid Class III
- 0811 Biopsy of eyelid Class III
- 0819 Other diagnostic procedures on eyelid Class III
- 0881 Linear repair of laceration of eyelid or eyebrow Class III
- 0889 Other eyelid repair Class III
- 1021 Biopsy of conjunctiva Class III
- 1029 Other diagnostic procedures on conjunctiva Class III
- 1091 Subconjunctival injection Class III
- 1691 Retrobulbar injection of therapeutic agent Class III
- 9731 Removal of eye prosthesis Class V
- 9821 Removal of superficial foreign body from eye without incision Class III
116
H-3-12 PROSEDUR LAIN-LAIN PADA

MATA
- 1411 Diagnostic aspiration of vitreous Class III
- 1419 Other diagnostic procedures on retina, choroid, vitreous, and poster
Class III
- 1621 Ophthalmoscopy Class III
- 1622 Diagnostic aspiration of orbit Class III
- 8911 Tonometry Class III
- 9502 Comprehensive eye examination Class III
- 9503 Extended ophthalmologic work-up Class III
- 9504 Eye examination under anesthesia Class III
- 9505 Visual field study Class III
- 9506 Color vision study Class III
- 9507 Dark adaptation study Class V
- 9515 Ocular motility study Class III
- 9523 Visual evoked potential (VEP) Class III
- 9531 Fitting and dispensing of spectacles Class III
- 9532 Prescription, fitting, and dispensing of contact lens Class III
- 9533 Dispensing of other low vision aids Class III
- 9534 Ocular prosthetics Class III
- 9535 Orthoptic training Class III
- 9536 Ophthalmologic counselling and instruction Class III
- 9651 Irrigation of eye Class III
117
H-3-13 PROSEDUR DIAGNOSTIK &

IMAGING PADA MATA
- 8705 Contrast dacryocystogram Class III
- 8714 Contrast radiogram of orbit Class III
- 8882 Ocular thermography Class III
- 9511 Fundus photography Class III
- 9512 Fluorescein angiography or angioscopy of eye Class III
- 9513 Ultrasound study of eye Class III
- 9514 X-ray study of eye Class III
- 9516 P32 and other tracer studies of eye Class III
- 9521 Electroretinogram (ERG) Class III
- 9522 Electro-oculogram (EOG) Class III
- 9524 Electronystagmogram (ENG) Class III
- 9525 Electromyogram of eye (EMG) Class III
- 9526 Tonography, provocative tests, and other glaucoma testing Class III
118
I-1-01 PROSEDUR TRANPLANTASI

PARU ATAU/DAN JANTUNG
- 3350 Lung Transplantation, not otherwise specified Class I
- 3351 Uniteral lung transplantation Class I
- 3352 Bilateral lung transplantation Class I
- 335 Lung transplant Class I
- 336 Combined heart-lung transplantation Class I
- 3751 Heart transplantation Class I
- 375 Heart transplantation procedure Class I
119
I-1-02 PROSEDUR KATUP JANTUNG

DENGAN KATETERISASI
- 3510 Open heart valvuloplasty without replacement, unspecified valve Class I
- 3511 Open heart valvuloplasty of aortic valve without replacement Class I
- 3512 Open heart valvuloplasty of mitral valve without replacement Class I
- 3513 Open heart valvuloplasty of pulmonary valve without replacement Class I
- 3514 Open heart valvuloplasty of tricuspid valve without replacement Class I
- 3520 Replacement of unspecified heart valve Class I
- 3521 Replacement of aortic valve with tissue graft Class I
- 3522 Other replacement of aortic valve Class I
- 3523 Replacement of mitral valve with tissue graft Class I
- 3524 Other replacement of mitral valve Class I
- 3525 Replacement of pulmonary valve with tissue graft Class I
- 3526 Other replacement of pulmonary valve Class I
- 3527 Replacement of tricuspid valve with tissue graft Class I
- 3528 Other replacement of tricuspid valve Class I
- 3721 Right heart cardiac catheterization Class II
- 3722 Left heart cardiac catheterization Class II
- 3723 Combined right and left heart cardiac catheterization Class II
- 3726 Catheter based invasive electrophysiologic testing Class II
- 3728 Intracardial echocardiography Class II
- 8852 Angiocardiography of right heart structures Class II
- 8853 Angiocardiography of left heart structures Class II
- 8854 Combined right and left heart angiocardiography Class II
- 8855 Coronary arteriography using a single catheter Class II
- 8856 Coronary arteriography using two catheters Class II
- 8857 Other and unspecified coronary arteriography Class II
120
- 8858 Negative-contrast cardiac roentgenography Class II
121
I-1-03 PROSEDUR OPERASI

KARDIOTORASIK KOMPLEKS PADA
JANTUNG ANOMALI
- 3554 Repair of endocardial cushion defect with prosthesis Class I
- 3563 Repair of endocardial cushion defect with tissue graft Class I
- 3573 Other and unspecified repair of endocardial cushion defect Class I
- 3581 Total repair of tetralogy of fallot Class I
- 3582 Total repair of total anomalous pulmonary venous connection Class I
- 3583 Total repair of truncus arteriosus Class I
- 3584 Total correction of transposition of great vessels, not elsewhere classified
Class I
- 3591 Interatrial transposition of venous return Class I
- 3592 Creation of conduit between right ventricle and pulmonary artery Class I
- 3593 Creation of conduit between left ventricle and aorta Class I
- 3594 Creation of conduit between atrium and pulmonary artery Class I
122
I-1-04 PROSEDUR KATUP JANTUNG

TANPA KATETERISASI JANTUNG
- 3510 Open heart valvuloplasty without replacement, unspecified valve Class I
- 3511 Open heart valvuloplasty of aortic valve without replacement Class I
- 3512 Open heart valvuloplasty of mitral valve without replacement Class I
- 3513 Open heart valvuloplasty of pulmonary valve without replacement Class I
- 3514 Open heart valvuloplasty of tricuspid valve without replacement Class I
- 3520 Replacement of unspecified heart valve Class I
- 3521 Replacement of aortic valve with tissue graft Class I
- 3522 Other replacement of aortic valve Class I
- 3523 Replacement of mitral valve with tissue graft Class I
- 3524 Other replacement of mitral valve Class I
- 3525 Replacement of pulmonary valve with tissue graft Class I
- 3526 Other replacement of pulmonary valve Class I
- 3527 Replacement of tricuspid valve with tissue graft Class I
- 3528 Other replacement of tricuspid valve Class I
123
I-1-05 PROSEDUR PEMBEDAHAN

BYPASS PEMBULUH KORONER
DENGAN KATETERISASI JANTUNG
- 3596 Percutaneous valvuloplasty Class II
- 3605 Multiple vessel (percutaneous) transluminal coronary angioplasty (pt
Class II
- 3610 Aortocoronary bypass for heart revascularization, not otherwise specified
Class I
- 3611 Aortocoronary bypass of one coronary artery Class I
- 3612 Aortocoronary bypass of two coronary arteries Class I
- 3613 Aortocoronary bypass of three coronary arteries Class I
- 3614 Aortocoronary bypass of four or more coronary arteries Class I
- 3615 Single internal mammary-coronary artery bypass Class I
- 3616 Double internal mammary-coronary artery bypass Class I
- 3617 Abdominal-coronary artery bypass Class I
- 3619 Other bypass anastomosis for heart revascularization Class I
124
I-1-06 PROSEDUR KARDIOTORASIK

LAIN
- 3500 Closed heart valvotomy, unspecified valve Class I
- 3501 Closed heart valvotomy, aortic valve Class I
- 3502 Closed heart valvotomy, mitral valve Class I
- 3503 Closed heart valvotomy, pulmonary valve Class I
- 3504 Closed heart valvotomy, tricuspid valve Class I
- 3531 Operations on papillary muscle Class I
- 3532 Operations on chordae tendineae Class I
- 3533 Annuloplasty Class I
- 3534 Infundibulectomy Class I
- 3535 Operations on trabeculae carneae cordis Class I
- 3539 Operations on other structures adjacent to valves of heart Class I
- 3542 Creation of septal defect in heart Class I
- 3550 Repair of unspecified septal defect of heart with prosthesis Class I
- 3551 Repair of atrial septal defect with prosthesis, open technique Class I
- 3552 Repair of atrial septal defect with prosthesis, closed technique Class I
- 3553 Repair of ventricular septal defect with prosthesis, open technique Class
I
- 3560 Repair of unspecified septal defect of heart with tissue graft Class I
- 3561 Repair of atrial septal defect with tissue graft Class I
- 3562 Repair of ventricular septal defect with tissue graft Class I
- 3570 Other and unspecified repair of unspecified septal defect of heart Class I
- 3571 Other and unspecified repair of atrial septal defect Class I
- 3572 Other and unspecified repair of ventricular septal defect Class I
- 3595 Revision of corrective procedure on heart Class I
- 3598 Other operations on septa of heart Class I
125
- 3599 Other operations on valves of heart Class I

- 3603 Open chest coronary artery angioplasty Class I
- 362 Heart revascularization by arterial implant Class I
- 3631 Open chest transmyocardial revascularization Class I
- 3632 Other transmyocardial revascularization Class I
- 3639 Other heart revascularization Class I
- 363 Other heart revascularization Class I
- 3691 Repair of aneurysm of coronary vessel Class I
- 3699 Other operations on vessels of heart Class I
- 3710 Incision of heart, not otherwise specified Class I
- 3711 Cardiotomy Class I
- 3712 Pericardiotomy Class I
- 3724 Biopsy of pericardium Class I
- 3731 Pericardiectomy Class I
- 3732 Excision of aneurysm of heart Class I
- 3733 Excision or destruction of other lesion or tissue of heart, open approach
Class I
- 3735 Partial ventriculectomy Class I
- 374 Repair of heart and pericardium Class I
- 3761 Implant of pulsation balloon Class I
- 3791 Open chest cardiac massage Class I
- 3799 Other operations on heart and pericardium Class I
- 3964 Intraoperative cardiac pacemaker Class I
- 3966 Percutaneous cardiopulmonary bypass Class I
126
I-1-07 PROSEDUR PEMBEDAHAN

BYPASS PEMBULUH KORONER
TANPA KATETERISASI JANTUNG
- 3610 Aortocoronary bypass for heart revascularization, not otherwise specified
Class I
- 3611 Aortocoronary bypass of one coronary artery Class I
- 3612 Aortocoronary bypass of two coronary arteries Class I
- 3613 Aortocoronary bypass of three coronary arteries Class I
- 3614 Aortocoronary bypass of four or more coronary arteries Class I
- 3615 Single internal mammary-coronary artery bypass Class I
- 3616 Double internal mammary-coronary artery bypass Class I
- 3617 Abdominal-coronary artery bypass Class I
- 3619 Other bypass anastomosis for heart revascularization Class I
127
I-1-11 PROSEDUR DEFIBRILATOR

JANTUNG DAN PEMASANGAN
SISTEM BANTUAN JANTUNG
- 0051 Implantation of cardiac resynchronization defibrillation, total system
(CRT-D) Class II
- 3752 Implantation of total internal biventricular heart replacement heart
system Class I
- 3753 Replacement or repair of thoracic unit of (total) replacement heart
system Class I
- 3754 Replacement or repair of other implantable component of (total)
replacement heart system Class I
- 3762 Insertion of temporary non-implantable extracorporeal heart circulatory
assist system device Class I
- 3763 Repair of heart assist system Class I
- 3765 Implant of single ventricular (extracorporeal) external heart assist
system Class I
- 3766 Insertion of implantable heart assist system Class I
- 3767 Implantation of cardiomyostimulation system Class II
- 3794 Implantation or replacement of automatic cardioverter/ defibrillator, total
system (AICD) Class II
- 3795 Implantation of automatic cardioverter/defibrillator leads(s) only Class II
- 3796 Implantation of automatic cardioverter/defibrillator pulse generator only
Class II
- 3797 Replacement of automatic cardioverter/defibrillator leads(s) only Class II
- 3798 Replacement of automatic cardioverter/defibrillator pulse generator only
Class II
- 3965 Extracorporeal membrane oxygenation (ECMO) Class I
128
I-1-12 PROSEDUR PEMBULUH

DARAH TORASIK KOMPLEKS
- 3804 Incision of aorta Class I
- 3805 Incision of other thoracic vessels Class II
- 3814 Endarterectomy of aorta Class II
- 3815 Endarterectomy of other thoracic vessels Class II
- 3834 Resection of aorta with anastomosis Class I
- 3835 Resection of other thoracic vessels with anastomosis Class II
- 3845 Resection of vessel with replacement, thoracic vessels Class I
- 3855 Ligation and stripping of varicose veins, thoracic vessels Class II
- 3864 Other excision of vessels, aorta,abdominal Class I
- 3865 Other excision of vessels, thoracic vessels Class II
- 3884 Other surgical occlusion of vessels, aorta, abdominal Class I
- 390 Systemic to pulmonary artery shunt Class I
- 3921 Caval-pulmonary artery anastomosis Class I
- 3922 Aorta-subclavian-carotid bypass Class I
- 3923 Other intrathoracic vascular shunt or bypass Class I
- 3954 Re-entry operation (aorta) Class I
129
I-1-13 PROSEDUR PEMBULUH

DARAH ABDOMINAL KOMPLEK
- 3806 Incision of abdominal arteries Class II
- 3807 Incision of abdominal veins Class II
- 3816 Endarterectomy of abdominal arteries Class II
- 3836 Resection of abdominal arteries with anastomosis Class II
- 3837 Resection of abdominal veins with anastomosis Class II
- 3844 Resection of vessel with replacement, aorta,abdominal Class I
- 3846 Resection of vessel with replacement ,abdominal arteries Class II
- 3847 Resection of vessel with replacement, abdominal veins Class II
- 3866 Other excision of vessels, abdominal arteries Class II
- 3867 Other excision of vessels, abdominal veins Class II
- 391 Intra-abdominal venous shunt Class I
- 3924 Aorta-renal bypass Class I
- 3925 Aorta-iliac-femoral bypass Class II
- 3926 Other intra-abdominal vascular shunt or bypass Class I
130
I-1-14 PROSEDUR PEMASANGAN

PACEMAKER JANTUNG PERMANEN
- 0050 Implantation of cardiac resynchronization pacemaker without mention of
defibrillation, total system (CRT-P) Class II
- 3770 Initial insertion of lead (electrode), not otherwise specified Class II
- 3771 Initial insertion of transvenous lead (electrode) into ventricle Class II
- 3772 Initial insertion of transvenous lead (electrodes) into atrium and ventricle
Class II
- 3773 Initial insertion of transvenous lead (electrode) into atrium Class II
- 3774 Insertion or replacement of epicardial lead (electrode) into epicardium
Class II
- 3776 Replacement of transvenous atrial and/or ventricular lead(s) (electrode)
Class II
- 3780 Insertion of permanent pacemaker, initial or replacement, type of device
not specified Class II
- 3781 Initial insertion of single-chamber device, not specified as rateresponsive Class II
- 3782 Initial insertion of single-chamber device, rate-responsive Class II
- 3783 Initial insertion of dual-chamber device Class II
- 3785 Replacement of any type of pacemaker device with single-chamber
device, not specified as rate responsive Class II
devive, rate responsive Class II
- 3787 Replacement of any type of pacemaker device with dual-chamber device
Class II
131
I-1-15 PROSEDUR KATETERISASI

JANTUNG
132
I-1-16 PROSEDUR REVISI

DEFIBRILATOR & PACEMAKER
JANTUNG TIDAK TERMASUK
PENGGANTIAN ALAT
- 0052 Implantation or replacement of transvenous lead (electrode) into left
ventricular coronary venous system Class II
Class II
Class II
- 3775 Revision of lead (electrode) Class II
Class II
- 3777 Removal of lead(s) (electrodes) without replacement Class II
- 3779 Revision or relocation of pacemaker pocket Class II
- 3789 Revision or removal of pacemaker device Class II
133
I-1-17 PROSEDUR LIGASI DAN

STRIPPING PEMBULUH DARAH VENA
- 3809 Incision of lower limb veins Class II
- 3839 Resection of lower limb veins with anastomosis Class II
- 3849 Resection of vessel with replacement, lower limb veins Class II
- 3850 Ligation and stripping of varicose veins, unspecified site Class II
- 3853 Ligation and stripping of varicose veins , upper limb vessels Class II
- 3859 Ligation and stripping of varicose veins ,lower limb varicose veins Class II
- 3869 Other excision of vessels, lower limb veins Class II
- 3889 Other surgical occlusion of vessels, lower limb veins Class II
- 3932 Suture of vein Class II
- 3992 Injection of sclerosing agent into vein Class II
134
I-1-20 PROSEDUR SISTIM

PEREDARAN DARAH LAIN-LAIN
- 0055 Insertion of drug-eluting peripheral vessels stent(s) Class II
- 3764 Removal of external heart assist system(s) or device (s) Class II
- 3800 Incision of vessel, unspecified site Class II
- 3803 Incision of upper limb vessels Class II
- 3808 Incision of lower limb arteries Class II
- 3810 Endarterectomy, unspecified site Class II
- 3813 Endarterectomy of upper limb vessels Class II
- 3818 Endarterectomy of lower limb arteries Class II
- 3821 Biopsy of blood vessel Class II
- 3829 Other diagnostic procedures on blood vessels Class II
- 3830 Resection of vessel with anastomosis, unspecified site Class II
- 3833 Resection of upper limb vessels with anastomosis Class II
- 3838 Resection of lower limb arteries with anastomosis Class II
- 3840 Resection of vessel with replacement, unspecified site Class II
- 3843 Resection of vessel with replacement, upper limb vessels Class II
- 3848 Resection of vessel with replacement, lower limb arteries Class II
- 3857 Ligation and stripping of varicose veins ,abdominal varicose veins Class
II
- 3860 Other excision of vessels, unspecified site Class II
- 3863 Other excision of vessels, upper limb vessels Class II
- 3868 Other excision of vessels, lower limb arteries Class II
- 387 Interruption of the vena cava Class II
- 3880 Other surgical occlusion of vessels, unspecified site Class II
- 3883 Other surgical occlusion of vessels, upper limb vessels Class II
- 3885 Other surgical occlusion of vessels, other thoracic vessels Class II
135
- 3886 Other surgical occlusion of vessels, abdominal arteries Class II

- 3887 Other surgical occlusion of vessels, abdominal veins Class II
- 3888 Other surgical occlusion of vessels, lower limb arteries Class II
- 3929 Other (peripheral) vascular shunt or bypass Class II
- 3930 Suture of unspecified blood vessel Class II
- 3931 Suture of artery Class II
- 3941 Control of hemorrhage following vascular surgery Class II
- 3949 Other revision of vascular procedure Class II
- 3950 Angioplasty or atherectomy of other non-coronary vessel(s) Class II
- 3951 Clipping of aneurysm Class II
- 3952 Other repair of aneurysm Class II
- 3953 Repair of arteriovenous fistula Class II
- 3955 Reimplantation of aberrant renal vessel Class II
- 3956 Repair of blood vessel with tissue patch graft Class II
- 3957 Repair of blood vessel with synthetic patch graft Class II
- 3958 Repair of blood vessel with unspecified type of patch graft Class II
- 3959 Other repair of vessel Class II
- 3971 Endovascular implantation of graft in abdominal aorta Class I
- 3973 Endovascular implantation of graft in thoracic aorta Class II
- 3979 Other endovascular repair (of aneurysm) of other vessels Class II
- 398 Operations on carotid body, carotid sinus and other vascular bodies Class
II
- 3990 Insertion of non-drug -eluting peripheral vessel stent(s) Class II
- 3991 Freeing of vessel Class II
- 3993 Insertion of vessel-to-vessel cannula Class II
- 3994 Replacement of vessel-to-vessel cannula Class II
- 3998 Control of hemorrhage, not otherwise specified Class II
- 3999 Other operations on vessels Class II
- 4444 Transcatheter embolization for gastric or duodenal bleeding Class II
136
137
I-1-30 PROSEDUR PENGGANTIAN

ALAT DEFIBRILATOR DAN
PACEMAKER JANTUNG
- 0053 Implantation or replacement of cardiac resynchronization pacemaker
pulse generator only (CRT-P) Class II
- 0054 Implantation or replacement of cardiac resynchronization defibrillation
pulse generator device only (CRT-D) Class II
Class II
Class II
Class II
138
I-1-40 PROSEDUR
KARDIOVASKULAR PERKUTAN
- 3541 Enlargement of existing atrial septal defect Class II
- 3604 Intracoronary artery thrombolytic infusion Class II
Class II
- 3606 Insertion of non-drug -eluting coronary artery stent(s) Class II
- 3607 Insertion of drug-eluting coronary artery stent(s) Class II
- 3609 Other specified removal of coronary artery obstruction Class II
- 3727 Cardiac mapping Class II
- 3734 Excision or destruction of lesion or tissue of heart, other approach Class
II
139
I-2-11 PEMASANGAN/PENYISIPAN
DEFIBRILATOR JANTUNG & SISTEM
BANTU JANTUNG
- 0051 Implantation of cardiac resynchronization defibrillation, total system
(CRT-D) Class II
- 3767 Implantation of cardiomyostimulation system Class II
- 3794 Implantation or replacement of automatic cardioverter/ defibrillator, total
system (AICD) Class II
Class II
Class II
140
I-2-12 PROSEDUR BESAR PADA

PEMBULUH DARAH TORASIK
- 3805 Incision of other thoracic vessels Class II
- 3814 Endarterectomy of aorta Class II
- 3815 Endarterectomy of other thoracic vessels Class II
- 3835 Resection of other thoracic vessels with anastomosis Class II
- 3855 Ligation and stripping of varicose veins, thoracic vessels Class II
- 3865 Other excision of vessels, thoracic vessels Class II
141
I-2-13 PROSEDUR BESAR PADA

PEMBULUH DARAH ABDOMEN
- 3806 Incision of abdominal arteries Class II
- 3807 Incision of abdominal veins Class II
- 3816 Endarterectomy of abdominal arteries Class II
- 3836 Resection of abdominal arteries with anastomosis Class II
- 3837 Resection of abdominal veins with anastomosis Class II
- 3846 Resection of vessel with replacement ,abdominal arteries Class II
- 3847 Resection of vessel with replacement, abdominal veins Class II
- 3866 Other excision of vessels, abdominal arteries Class II
- 3867 Other excision of vessels, abdominal veins Class II
- 3925 Aorta-iliac-femoral bypass Class II
142
I-2-14 PROSEDUR
PEMASANGAN/PENYISIPAN ALAT
PACU PERMANEN PADA JANTUNG
- 0050 Implantation of cardiac resynchronization pacemaker without mention of
defibrillation, total system (CRT-P) Class II
Class II
Class II
Class II
Class II
143
I-2-15 PROSEDUR KATETERISASI

JANTUNG
144
I-2-16 PROSEDUR REVISI

DEFIBRILATOR DAN ALAT PACU
JANTUNG TIDAK TERMASUK
PENGGANTIAN ALAT
- 0052 Implantation or replacement of transvenous lead (electrode) into left
ventricular coronary venous system Class II
Class II
Class II
- 3775 Revision of lead (electrode) Class II
Class II
- 3777 Removal of lead(s) (electrodes) without replacement Class II
- 3779 Revision or relocation of pacemaker pocket Class II
- 3789 Revision or removal of pacemaker device Class II
145
I-2-17 PROSEDUR LIGASI DAN

STRIPPING PEMBULUH DARAH VENA
- 3809 Incision of lower limb veins Class II
- 3839 Resection of lower limb veins with anastomosis Class II
- 3849 Resection of vessel with replacement, lower limb veins Class II
- 3850 Ligation and stripping of varicose veins, unspecified site Class II
- 3853 Ligation and stripping of varicose veins , upper limb vessels Class II
- 3859 Ligation and stripping of varicose veins ,lower limb varicose veins Class II
- 3869 Other excision of vessels, lower limb veins Class II
- 3889 Other surgical occlusion of vessels, lower limb veins Class II
- 3932 Suture of vein Class II
- 3992 Injection of sclerosing agent into vein Class II
146
I-2-21 ANGIOGRAFI ARTERI BUKAN

JANTUNG
- 0055 Insertion of drug-eluting peripheral vessels stent(s) Class II
- 3950 Angioplasty or atherectomy of other non-coronary vessel(s) Class II
- 3973 Endovascular implantation of graft in thoracic aorta Class II
- 3979 Other endovascular repair (of aneurysm) of other vessels Class II
- 3990 Insertion of non-drug -eluting peripheral vessel stent(s) Class II
- 4444 Transcatheter embolization for gastric or duodenal bleeding Class II
147
I-2-22 PROSEDUR SEDANG PADA

PEMBULUH DARAH
- 3764 Removal of external heart assist system(s) or device (s) Class II
- 3810 Endarterectomy, unspecified site Class II
- 3813 Endarterectomy of upper limb vessels Class II
- 3818 Endarterectomy of lower limb arteries Class II
- 3830 Resection of vessel with anastomosis, unspecified site Class II
- 3833 Resection of upper limb vessels with anastomosis Class II
- 3838 Resection of lower limb arteries with anastomosis Class II
- 3840 Resection of vessel with replacement, unspecified site Class II
- 3843 Resection of vessel with replacement, upper limb vessels Class II
- 3848 Resection of vessel with replacement, lower limb arteries Class II
- 387 Interruption of the vena cava Class II
- 3885 Other surgical occlusion of vessels, other thoracic vessels Class II
- 3886 Other surgical occlusion of vessels, abdominal arteries Class II
- 3929 Other (peripheral) vascular shunt or bypass Class II
- 3949 Other revision of vascular procedure Class II
- 3951 Clipping of aneurysm Class II
- 3952 Other repair of aneurysm Class II
- 3953 Repair of arteriovenous fistula Class II
- 3955 Reimplantation of aberrant renal vessel Class II
- 3956 Repair of blood vessel with tissue patch graft Class II
- 3957 Repair of blood vessel with synthetic patch graft Class II
- 3958 Repair of blood vessel with unspecified type of patch graft Class II
- 3959 Other repair of vessel Class II
- 398 Operations on carotid body, carotid sinus and other vascular bodies Class
II
148
149
I-2-23 PROSEDUR KECIL PADA

PEMBULUH DARAH
- 3800 Incision of vessel, unspecified site Class II
- 3803 Incision of upper limb vessels Class II
- 3808 Incision of lower limb arteries Class II
- 3821 Biopsy of blood vessel Class II
- 3829 Other diagnostic procedures on blood vessels Class II
- 3857 Ligation and stripping of varicose veins ,abdominal varicose veins Class
II
- 3860 Other excision of vessels, unspecified site Class II
- 3863 Other excision of vessels, upper limb vessels Class II
- 3868 Other excision of vessels, lower limb arteries Class II
- 3880 Other surgical occlusion of vessels, unspecified site Class II
- 3883 Other surgical occlusion of vessels, upper limb vessels Class II
- 3887 Other surgical occlusion of vessels, abdominal veins Class II
- 3888 Other surgical occlusion of vessels, lower limb arteries Class II
- 3930 Suture of unspecified blood vessel Class II
- 3931 Suture of artery Class II
- 3941 Control of hemorrhage following vascular surgery Class II
- 3991 Freeing of vessel Class II
- 3993 Insertion of vessel-to-vessel cannula Class II
- 3994 Replacement of vessel-to-vessel cannula Class II
- 3998 Control of hemorrhage, not otherwise specified Class II
- 3999 Other operations on vessels Class II
150
I-2-31 PEMASANGAN ATAU

PENGGANTIAN ALAT DEFIBRILATOR
JANTUNG
- 0054 Implantation or replacement of cardiac resynchronization defibrillation
pulse generator device only (CRT-D) Class II
Class II
Class II
151
I-2-32 PEMASANGAN ATAU

PENGGANTIAN ALAT PACU JANTUNG
- 0053 Implantation or replacement of cardiac resynchronization pacemaker
pulse generator only (CRT-P) Class II
Class II
152
I-2-41 PROSEDUR
ELEKTROFISIOLOGIK
- 3727 Cardiac mapping Class II
- 3734 Excision or destruction of lesion or tissue of heart, other approach Class
II
153
I-2-42 PROSEDUR ANGIOPLASTI

PEMBULUH DARAH KORONER DAN
KARDIOVASKULAR PERKUTAN LAIN
- 3541 Enlargement of existing atrial septal defect Class II
- 3604 Intracoronary artery thrombolytic infusion Class II
Class II
- 3606 Insertion of non-drug -eluting coronary artery stent(s) Class II
- 3607 Insertion of drug-eluting coronary artery stent(s) Class II
- 3609 Other specified removal of coronary artery obstruction Class II
154
I-3-10 PROSEDUR RESUSITASI

- 9960 Cardiopulmonary resuscitation, not otherwise specified Class V
- 9962 Other electric countershock of heart Class III
- 9963 Closed chest cardiac massage Class V
155
I-3-11 PROSEDUR KARDIOVERSI

- 9961 Atrial cardioversion Class III
- 9969 Other conversion of cardiac rhythm Class III
156
I-3-12 PROSEDUR KECIL LAIN-LAIN

PADA JANTUNG
- 0001 Therapeutic ultrasound of vessels of head and neck Class III
- 0002 Therapeutic ultrasound of heart Class III
- 0003 Therapeutic ultrasound of peripheral vascular vessels Class III
- 370 Pericardiocentesis Class III
- 3725 Biopsy of heart Class III
- 3729 Other diagnostic procedures on heart and pericardium Class III
- 3778 Insertion of temporary transvenous pacemaker system Class III
- 3792 Injection of therapeutic substance into heart Class III
- 3793 Injection of therapeutic substance into pericardium Class III
- 3822 Percutaneous angioscopy Class III
- 3891 Arterial catheterization Class III
- 3892 Umbilical vein catheterization Class III
- 3894 Venous cutdown Class III
- 9744 Nonoperative removal of heart assist system Class III
157
I-3-13 PROSEDUR
EKOKARDIOGRAFI
- 8872 Diagnostic ultrasound of heart Class III
- 8955 Phonocardiogram with ECG lead Class III
- 8957 Apexcardiogram (with ECG lead) Class III
158
I-3-14 PROSEDUR STRESS TESTING

- 8941 Cardiovascular stress test using treadmill Class III
- 8942 Masters\ two-step stress test Class III
- 8943 Cardiovascular stress test using bicycle ergometer Class III
159
I-3-15 PROSEDUR PENGAWASAN

FUNGSI KARDIOVASKULAR
- 8910 Intracarotid amobarbitral test Class III
- 8945 Artificial pacemaker rate check Class III
- 8946 Artificial pacemaker artifact wave form check Class III
- 8947 Artificial pacemaker electrode impedance check Class III
- 8948 Artificial pacemaker voltage or amperage threshold check Class III
- 8949 Automatic implantable cardioverter / defibrillator (AICD) check Class III
- 8950 Ambulatory cardiac monitoring Class III
- 8953 Vectorcardiogram (with ecg) Class III
- 8954 Electrographic monitoring Class III
- 8956 Carotid pulse tracing with ECG lead Class III
- 8958 Plethysmogram Class III
- 8959 Other nonoperative cardiac and vascular measurements Class III
- 8961 Systemic arterial pressure monitoring Class III
- 8962 Central venous pressure monitoring Class III
- 8963 Pulmonary artery pressure monitoring Class III
- 8964 Pulmonary artery wedge monitoring Class III
- 8965 Measurement of systemic arterial blood gases Class V
- 8966 Measurement of mixed venous blood gases Class III
- 8967 Monitoring of cardiac output by oxygen consumption technique Class III
- 8968 Monitoring of cardiac output by other technique Class III
- 8969 Monitoring of coronary blood flow Class III
160
J-1-01 PROSEDUR VENTILASI

MEKANIKAL LONG TERM DENGAN
TRAKEOSTOMI
- 311 Temporary tracheostomy Class II
- 3121 Mediastinal tracheostomy Class II
- 3129 Other permanent tracheostomy Class II
- 9672 Continuous invasive mechanical ventilation for 96 consecutive hours or
more Class I
161

MEKANIKAL LONG TERM TANPA
TRAKEOSTOMI
- 9672 Continuous invasive mechanical ventilation for 96 consecutive hours or
more Class I
162
J-1-10 PROSEDUR SISTEM

PERNAFASAN KOMPLEKS
- 3173 Closure of other fistula of trachea Class II
- 3175 Reconstruction of trachea and construction of artificial larynx Class II
- 3179 Other repair and plastic operations on trachea Class II
- 321 Other excision of bronchus Class II
- 3222 Lung volume reduction surgery Class II
- 323 Segmental resection of lung Class I
- 3241 Thoracoscopic lobectomy of lung Class I
- 3249 Other lobectomy of lung Class I
- 324 Lobectomy of lung Class I
- 325 Pneumonectomy Class I
- 326 Radical dissection of thoracic structures Class I
- 3334 Thoracoplasty Class I
- 3341 Suture of laceration of bronchus Class II
- 3342 Closure of bronchial fistula Class II
- 3343 Closure of laceration of lung Class I
- 3348 Other repair and plastic operations on bronchus Class II
- 3349 Other repair and plastic operations on lung Class I
- 3392 Ligation of bronchus Class II
- 3398 Other operations on bronchus Class II
- 3451 Decortication of lung Class I
- 3474 Repair of pectus deformity Class II
- 9397 Decompression chamber Class I
163

PERNAFASAN NON KOMPLEKS
- 313 Other incision of larynx or trachea Class II
- 3145 Open biopsy of larynx or trachea Class II
- 315 Local excision or destruction of lesion or tissue of trachea Class II
- 3171 Suture of laceration of trachea Class II
- 3172 Closure of external fistula of trachea Class II
- 3174 Revision of tracheostomy Class II
- 3192 Lysis of adhesions of trachea or larynx Class II
- 3199 Other operations on trachea Class II
- 344 Excision or destruction of lesion of chest wall Class II
- 3472 Closure of thoracostomy Class II
- 9604 Insertion of endotracheal tube Class II
- 9670 Continuous invasive mechanical ventilation of unspecified duration Class
II
- 9671 Continuous invasive mechanical ventilation for less than 96 consecutive
hours Class II
164

PERNAFASAN MODERAT KOMPLEKS
- 3195 Tracheoesophageal fistulization Class II
- 3209 Other local excision or destruction of lesion or tissue of bronchus Class II
- 3221 Plication of emphysematous bleb Class II
- 3229 Other local excision or destruction of lesion or tissue of lung Class II
- 329 Other excision of lung Class II
- 330 Incision of bronchus Class II
- 331 Incision of lung Class II
- 3325 Open biopsy of bronchus Class II
- 3328 Open biopsy of lung Class II
- 3329 Other diagnostic procedures on lung or bronchus Class II
- 3339 Other surgical collapse of lung Class II
- 3393 Puncture of lung Class II
- 3399 Other operations on lung Class II
- 3402 Exploratory thoracotomy Class II
- 3403 Reopening of recent thoracotomy site Class II
- 341 Incision of mediastinum Class II
- 3421 Transpleural thoracoscopy Class II
- 3422 Mediastinoscopy Class II
- 3426 Open mediastinum biopsy Class II
- 3427 Biopsy of diaphragm Class II
- 3428 Other diagnostic procedures on chest wall, pleura, and diaphragm Class
II
- 3429 Other diagnostic procedures on mediastinum Class II
- 343 Excision or destruction of lesion or tissue of mediastinum Class II
- 3459 Other excision of pleura Class II
165
- 346 Scarification of pleura Class II

- 3473 Closure of other fistula of thorax Class II
- 3479 Other repair of chest wall Class II
- 3481 Excision of lesion or tissue of diaphragm Class II
- 3482 Suture of laceration of diaphragm Class II
- 3483 Closure of fistula of diaphragm Class II
- 3484 Other repair of diaphragm Class II
- 3485 Implantation of diaphragmatic pacemaker Class II
- 3489 Other operations on diaphragm Class II
- 3493 Repair of pleura Class II
- 3499 Other operations on thorax Class II
- 4061 Cannulation of thoracic duct Class II
- 4062 Fistulization of thoracic duct Class II
- 4063 Closure of fistula of thoracic duct Class II
- 4064 Ligation of thoracic duct Class II
- 4069 Other operations on thoracic duct Class II
- 537 Repair of diaphragmatic hernia, abdominal approach Class II
- 5380 Repair of diaphragmatic hernia with thoracic approach, not otherwise
specified Class II
- 5381 Plication of the diaphragm Class II
- 5382 Repair of parasternal hernia Class II
- 7701 Sequestrectomy of scapula, clavicle, and thorax (ribs and sternum) Class
II
- 7711 Other incision of bone without division, scapula, clavicle, and thorax (ribs
and sternum) Class II
- 7721 Wedge osteotomy of scapula, clavicle, and thorax (ribs and sternum)
Class II
- 7731 Other division of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7761 Local excision of lesion or tissue of scapula, clavicle, and thorax (ribs and
sternum) Class II
166
- 7771 Excision of bone for graft, scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7781 Other partial ostectomy of scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7791 Total ostectomy of scapula, clavicle, and thorax (ribs and sternum) Class
II
- 7801 Bone graft of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7811 Application of external fixation device, scapula, clavicle, and thorax (ribs
- 7841 Other repair or plastic operations on scapula, clavicle, and thorax (ribs
- 7851 Internal fixation of bone without fracture reduction on scapula, clavicle,
and thorax (ribs and sternum) Class II
- 7861 Removal of implanted device from scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7871 Osteoclasis of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7881 Diagnostic procedures on scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7891 Insertion of bone growth stimulator into scapula, clavicle, and thorax
(ribs and sternum) Class II
167
J-2-10 PROSEDUR BESAR PADA

SISTEM SALURAN PERNAFASAN
- 3173 Closure of other fistula of trachea Class II
- 3175 Reconstruction of trachea and construction of artificial larynx Class II
- 3179 Other repair and plastic operations on trachea Class II
- 321 Other excision of bronchus Class II
- 3222 Lung volume reduction surgery Class II
- 3341 Suture of laceration of bronchus Class II
- 3342 Closure of bronchial fistula Class II
- 3348 Other repair and plastic operations on bronchus Class II
- 3392 Ligation of bronchus Class II
- 3398 Other operations on bronchus Class II
- 3474 Repair of pectus deformity Class II
168

MEKANIKAL JANGKA PENDEK
- 9604 Insertion of endotracheal tube Class II
- 9670 Continuous invasive mechanical ventilation of unspecified duration Class
II
- 9671 Continuous invasive mechanical ventilation for less than 96 consecutive
hours Class II
169
J-2-22 PROSEDUR PADA LARING

DAN TRAKEA
- 313 Other incision of larynx or trachea Class II
- 3145 Open biopsy of larynx or trachea Class II
- 315 Local excision or destruction of lesion or tissue of trachea Class II
- 3171 Suture of laceration of trachea Class II
- 3172 Closure of external fistula of trachea Class II
- 3174 Revision of tracheostomy Class II
- 3192 Lysis of adhesions of trachea or larynx Class II
- 3199 Other operations on trachea Class II
- 344 Excision or destruction of lesion of chest wall Class II
- 3472 Closure of thoracostomy Class II
170
J-2-31 PROSEDUR
THORAKOSKOPI/MEDIASTINOSKOPI
- 3421 Transpleural thoracoscopy Class II
- 3422 Mediastinoscopy Class II
171
J-2-32 PROSEDUR DADA

INTERMEDIATE
- 3195 Tracheoesophageal fistulization Class II
- 3209 Other local excision or destruction of lesion or tissue of bronchus Class II
- 3221 Plication of emphysematous bleb Class II
- 3229 Other local excision or destruction of lesion or tissue of lung Class II
- 329 Other excision of lung Class II
- 330 Incision of bronchus Class II
- 331 Incision of lung Class II
- 3325 Open biopsy of bronchus Class II
- 3328 Open biopsy of lung Class II
- 3329 Other diagnostic procedures on lung or bronchus Class II
- 3339 Other surgical collapse of lung Class II
- 3393 Puncture of lung Class II
- 3399 Other operations on lung Class II
- 3402 Exploratory thoracotomy Class II
- 3403 Reopening of recent thoracotomy site Class II
- 341 Incision of mediastinum Class II
- 3426 Open mediastinum biopsy Class II
- 3427 Biopsy of diaphragm Class II
- 3428 Other diagnostic procedures on chest wall, pleura, and diaphragm Class
II
- 3429 Other diagnostic procedures on mediastinum Class II
- 343 Excision or destruction of lesion or tissue of mediastinum Class II
- 3459 Other excision of pleura Class II
- 346 Scarification of pleura Class II
- 3473 Closure of other fistula of thorax Class II
172
- 3479 Other repair of chest wall Class II

- 3481 Excision of lesion or tissue of diaphragm Class II
- 3482 Suture of laceration of diaphragm Class II
- 3483 Closure of fistula of diaphragm Class II
- 3484 Other repair of diaphragm Class II
- 3485 Implantation of diaphragmatic pacemaker Class II
- 3489 Other operations on diaphragm Class II
- 3493 Repair of pleura Class II
- 3499 Other operations on thorax Class II
- 4061 Cannulation of thoracic duct Class II
- 4062 Fistulization of thoracic duct Class II
- 4063 Closure of fistula of thoracic duct Class II
- 4064 Ligation of thoracic duct Class II
- 4069 Other operations on thoracic duct Class II
- 537 Repair of diaphragmatic hernia, abdominal approach Class II
- 5380 Repair of diaphragmatic hernia with thoracic approach, not otherwise
specified Class II
- 5381 Plication of the diaphragm Class II
- 5382 Repair of parasternal hernia Class II
- 7701 Sequestrectomy of scapula, clavicle, and thorax (ribs and sternum) Class
II
- 7711 Other incision of bone without division, scapula, clavicle, and thorax (ribs
- 7721 Wedge osteotomy of scapula, clavicle, and thorax (ribs and sternum)
Class II
- 7731 Other division of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7761 Local excision of lesion or tissue of scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7771 Excision of bone for graft, scapula, clavicle, and thorax (ribs and
sternum) Class II
173
- 7781 Other partial ostectomy of scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7791 Total ostectomy of scapula, clavicle, and thorax (ribs and sternum) Class
II
- 7801 Bone graft of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7811 Application of external fixation device, scapula, clavicle, and thorax (ribs
- 7841 Other repair or plastic operations on scapula, clavicle, and thorax (ribs
- 7851 Internal fixation of bone without fracture reduction on scapula, clavicle,
and thorax (ribs and sternum) Class II
- 7861 Removal of implanted device from scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7871 Osteoclasis of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7881 Diagnostic procedures on scapula, clavicle, and thorax (ribs and
sternum) Class II
- 7891 Insertion of bone growth stimulator into scapula, clavicle, and thorax
(ribs and sternum) Class II
174
J-3-10 PROSEDUR PADA DINDING

DADA
- 3331 Destruction of phrenic nerve for collapse of lung Class III
- 3401 Incision of chest wall Class III
- 3409 Other incision of pleura Class III
- 3423 Biopsy of chest wall Class III
- 3471 Suture of laceration of chest wall Class III
175
J-3-11 PROSEDUR
PEMASANGAN/PENYISIPAN TUBE
PADA DADA
- 3404 Insertion of intercostal catheter for drainage Class III
- 3405 Creation of pleuroperitoneal shunt Class III
176
J-3-12 PROSEDUR THORACENTESIS

- 3491 Thoracentesis Class III
177
J-3-13 PROSEDUR TERAPI SALURAN

PERNAFASAN
- 3194 Injection of locally acting therapeutic substance into trachea Class III
- 9390 Non-invasive mechanical ventilation Class III
- 9391 Intermittent positive pressure breathing (IPPB) Class III
- 9393 Nonmechanical methods of resuscitation Class III
- 9394 Respiratory medication administered by nebulizer Class III
- 9395 Hyperbaric oxygenation Class III
- 9396 Other oxygen enrichment Class III
- 9398 Other control of atmospheric pressure and composition Class III
- 9399 Other respiratory procedures Class III
178
J-3-14 PROSEDUR BIOPSI

PERKUTAN DAN ASPIRASI
- 3149 Other diagnostic procedures on trachea Class III
- 3326 Closed (percutaneous)(needle) biopsy of lung Class III
- 3332 Artificial pneumothorax for collapse of lung Class III
- 3333 Pneumoperitoneum for collapse of lung Class III
- 3424 Other pleural biopsy Class III
- 3425 Closed (percutaneous) (needle) biopsy of mediastinum Class III
179
J-3-15 PROSEDUR BRONKOSKOPI

- 3141 Tracheoscopy through artificial stoma Class III
- 3142 Laryngoscopy and other tracheoscopy Class III
- 3144 Closed (endoscopic) biopsy of trachea Class III
- 3193 Replacement of laryngeal or tracheal stent Class III
- 3201 Endoscopic excision or destruction of lesion or tissue of bronchus Class
III
- 3228 Endoscopic excision or destruction of lesion or tissue of lung Class III
- 3321 Bronchoscopy through artificial stoma Class III
- 3322 Fiber-optic bronchoscopy Class III
- 3323 Other bronchoscopy Class III
- 3324 Closed (endoscopic) biopsy of bronchus Class III
- 3327 Endoscopic biopsy of lung (closed) Class III
- 3391 Bronchial dilation Class III
180
J-3-16 PROSEDUR UJI FUNGSI PARU

- 8937 Vital capacity determination Class III
- 8938 Other nonoperative respiratory measurements Class III
181
J-3-17 PROSEDUR LAIN-LAIN PADA

SISTEM SALURAN PERNAFASAN
- 3492 Injection into thoracic cavity Class III
- 9601 Insertion of nasopharyngeal airway Class III
- 9602 Insertion of oropharyngeal airway Class III
- 9603 Insertion of esophageal obturator airway Class III
- 9605 Other intubation of respiratory tract Class III
- 9655 Tracheostomy toilette Class III
- 9656 Other lavage of bronchus and trachea Class III
- 9723 Replacement of tracheostomy tube Class III
- 9737 Removal of tracheostomy tube Class III
- 9741 Removal of thoracotomy tube or pleural cavity drain Class III
- 9742 Removal of mediastinal drain Class III
- 9743 Removal of sutures from thorax Class III
- 9749 Removal of other device from thorax Class III
- 9815 Removal of intraluminal foreign body from trachea and bronchus without
incision Class III
- 9825 Removal of other foreign body without incision from trunk except
scrotum,penis, or vulva Class III
182
K-1-10 PROSEDUR NON KOMPLEKS

USUS HALUS & USUS BESAR
- 4500 Incision of intestine, not otherwise specified Class II
- 4502 Other incision of small intestine Class II
- 4503 Incision of large intestine Class II
- 4511 Transabdominal endoscopy of small intestine Class II
- 4515 Open biopsy of small intestine Class II
- 4521 Transabdominal endoscopy of large intestine Class II
- 4526 Open biopsy of large intestine Class II
- 4533 Local excision of lesion or tissue of small intestine, except duodenum
Class II
- 4534 Other destruction of lesion of small intestine, except duodenum Class II
- 4541 Excision of lesion or tissue of large intestine Class II
- 4549 Other destruction of lesion of large intestine Class II
- 4621 Temporary ileostomy Class II
- 4639 Other enterostomy Class II
- 4640 Revision of intestinal stoma, not otherwise specified Class II
- 4641 Revision of stoma of small intestine Class II
- 4642 Repair of pericolostomy hernia Class II
- 4643 Other revision of stoma of large intestine Class II
- 4650 Closure of intestinal stoma, not otherwise specified Class II
- 4651 Closure of stoma of small intestine Class II
- 4652 Closure of stoma of large intestine Class II
- 4660 Fixation of intestine, not otherwise specified Class II
- 4661 Fixation of small intestine to abdominal wall Class II
- 4662 Other fixation of small intestine Class II
- 4663 Fixation of large intestine to abdominal wall Class II
183
- 4664 Other fixation of large intestine Class II

- 4673 Suture of laceration of small intestine, except duodenum Class II
- 4674 Closure of fistula of small intestine, except duodenum Class II
- 4679 Other repair of intestine Class II
- 4680 Intra-abdominal manipulation of intestine, not otherwise specified Class
II
- 4681 Intra-abdominal manipulation of small intestine Class II
- 4682 Intra-abdominal manipulation of large intestine Class II
- 4691 Myotomy of sigmoid colon Class II
- 4692 Myotomy of other parts of colon Class II
- 4699 Other operations on intestines Class II
- 480 Proctotomy Class II
- 481 Proctostomy Class II
- 4821 Transabdominal proctosigmoidoscopy Class II
- 4872 Closure of proctostomy Class II
- 7072 Repair of colovaginal fistula Class II
- 7074 Repair of other vaginoenteric fistula Class II
184
K-1-11 PROSEDUR ADHESIOLISIS

PERITONEAL
- 5451 Laparoscopic lysis of peritoneal adhesions Class II
- 5459 Other lysis of peritoneal adhesions Class II
- 545 Lysis of peritoneal adhesions Class II
185
K-1-12 PROSEDUR HERNIA TIDAK

TERMASUK INGUINAL & FEMORAL
- 5341 Laparoscopic repair of umbilical hernia with graft or prosthesis Class II
- 5349 Other open umbilical herniorrhaphy Class II
- 5351 Incisional hernia repair Class II
- 5359 Repair of other hernia of anterior abdominal wall Class II
- 5361 Other open incisional hernia repair with graft or prosthesis Class II
- 5369 Other open repair of other hernia of anterior abdominal wall with graft or
prosthesis Class II
- 539 Other hernia repair Class II
- 5472 Other repair of abdominal wall Class II
186
K-1-13 PROSEDUR APPENDIK

- 4701 Laparascopic appendectomy Class II
- 4709 Other appendectomy Class II
- 470 Appendectomy Class II
- 4711 Laposcopic incidental appendectomy Class II
- 4719 other incidental appendectomy Class II
- 471 Incidental appendectomy Class II
- 472 Drainage of appendiceal abscess Class II
- 4791 Appendicostomy Class II
- 4792 Closure of appendiceal fistula Class II
- 4799 Other operations on appendix Class II
187
K-1-14 PROSEDUR HERNIA

INGUINAL DAN FEMORAL
- 5300 Unilateral repair of inguinal hernia, not otherwise specified Class II
- 5301 Other and open repair of direct inguinal hernia Class II
- 5302 Other and open repair of indirect inguinal hernia Class II
- 5303 Other and open repair of direct inguinal hernia with graft or prosthesis
Class II
- 5304 Other and open repair of indirect inguinal hernia with graft or prosthesis
Class II
- 5305 Repair of inguinal hernia with graft or prosthesis, not otherwise specified
Class II
- 5310 Bilateral repair of inguinal hernia, not otherwise specified Class II
- 5311 Other and open bilateral repair of direct inguinal hernia Class II
- 5312 Other and open bilateral repair of indirect inguinal hernia Class II
- 5313 Other and open bilateral repair of inguinal hernia, one direct and one
indirect Class II
- 5314 Other and open bilateral repair of direct inguinal hernia with graft or
prosthesis Class II
- 5315 Other and open bilateral repair of indirect inguinal hernia with graft or
prosthesis Class II
indirect, with graft or prosthesis Class II
- 5317 Bilateral inguinal hernia repair with graft or prosthesis, not otherwise
specified Class II
- 5321 Unilateral repair of femoral hernia with graft or prosthesis Class II
- 5329 Other unilateral femoral herniorrhaphy Class II
- 5331 Bilateral repair of femoral hernia with graft or prosthesis Class II
- 5339 Other bilateral femoral herniorrhaphy Class II
188
K-1-20 PROSEDUR INTESTINAL

KOMPLEKS
- 4240 Esophagectomy, not otherwise specified Class I
- 4241 Partial esophagectomy Class I
- 4242 Total esophagectomy Class I
- 4251 Intrathoracic esophagoesophagostomy Class I
- 4252 Intrathoracic esophagogastrostomy Class I
- 4253 Intrathoracic esophageal anastomosis with interposition of small bowel
Class I
- 4254 Other intrathoracic esophagoenterostomy Class I
- 4255 Intrathoracic esophageal anastomosis with interposition of colon Class I
- 4256 Other intrathoracic esophagocolostomy Class I
- 4258 Intrathoracic esophageal anastomosis with other interposition Class I
- 4259 Other intrathoracic anastomosis of esophagus Class I
- 4261 Antesternal esophagoesophagostomy Class I
- 4262 Antesternal esophagogastrostomy Class I
- 4263 Antesternal esophageal anastomosis with interposition of small bowel
Class I
- 4264 Other antesternal esophagoenterostomy Class I
- 4265 Antesternal esophageal anastomosis with interposition of colon Class I
- 4266 Other antesternal esophagocolostomy Class I
- 4268 Other antesternal esophageal anastomosis with interposition Class I
- 4269 Other antesternal anastomosis of esophagus Class I
- 427 Esophagomyotomy Class II
- 4282 Suture of laceration of esophagus Class II
- 4284 Repair of esophageal fistula, not elsewhere classified Class II
- 4285 Repair of esophageal stricture Class II
- 4287 Other graft of esophagus Class I
189
- 4289 Other repair of esophagus Class II

- 4291 Ligation of esophageal varices Class II
- 435 Partial gastrectomy with anastomosis to esophagus Class I
- 436 Partial gastrectomy with anastomosis to duodenum Class I
- 437 Partial gastrectomy with anastomosis to jejunum Class I
- 4381 Partial gastrectomy with jejunal transposition Class I
- 4389 Other partial gastrectomy Class I
- 4391 Total gastrectomy with intestinal interposition Class I
- 4399 Other total gastrectomy Class I
- 4431 High gastric bypass Class I
- 4439 Other gastroenterostomy Class II
- 4440 Suture of peptic ulcer, not otherwise specified Class I
- 4441 Suture of gastric ulcer site Class I
- 4442 Suture of duodenal ulcer site Class I
- 445 Revision of gastric anastomosis Class I
- 4461 Suture of laceration of stomach Class I
- 4463 Closure of other gastric fistula Class II
- 4465 Esophagogastroplasty Class II
- 4466 Other procedures for creation of esophagogastric sphincteric
competence Class II
- 4469 Other repair of stomach Class II
- 4491 Ligation of gastric varices Class II
- 4531 Other local excision of lesion of duodenum Class II
- 4550 Isolation of intestinal segment, not otherwise specified Class I
- 4551 Isolation of segment of small intestine Class I
- 4552 Isolation of segment of large intestine Class I
- 4561 Multiple segmental resection of small intestine Class I
- 4562 Other partial resection of small intestine Class I
- 4563 Total removal of small intestine Class I
190
- 4571 Open and other multiple segmental resection of large intestine Class I
- 4572 Open and other Cecectomy Class I
- 4573 Open and other Right hemicolectomy Class I
- 4574 Open and other Resection of transverse colon Class I
- 4575 Open and other Left hemicolectomy Class I
- 4576 Open and other Sigmoidectomy Class I
- 4579 Other and unspecified partial excision of large intestine Class I
- 458 Total intra-abdominal colectomy Class I
- 4590 Intestinal anastomosis, not otherwise specified Class I
- 4591 Small-to-small intestinal anastomosis Class I
- 4592 Anastomosis of small intestine to rectal stump Class I
- 4593 Other small-to-large intestinal anastomosis Class I
- 4594 Large-to-large intestinal anastomosis Class I
- 4595 Anastomosis to anus Class I
- 4601 Exteriorization of small intestine Class II
- 4602 Resection of exteriorized segment of small intestine Class II
- 4603 Exteriorization of large intestine Class II
- 4604 Resection of exteriorized segment of large intestine Class II
- 4610 Colostomy, not otherwise specified Class II
- 4611 Temporary colostomy Class II
- 4613 Permanent colostomy Class II
- 4620 Ileostomy, not otherwise specified Class II
- 4622 Continent ileostomy Class II
- 4623 Other permanent ileostomy Class II
- 4671 Suture of laceration of duodenum Class I
- 4672 Closure of fistula of duodenum Class II
- 4675 Suture of laceration of large intestine Class I
- 4676 Closure of fistula of large intestine Class II
191
- 4693 Revision of anastomosis of small intestine Class II

- 4694 Revision of anastomosis of large intestine Class II
- 4697 Transplant of intestine Class I
- 4841 Soave submucosal resection of rectum Class I
- 4849 Other pull-through resection of rectum Class I
- 485 Abdominoperineal resection of rectum Class I
- 4861 Transsacral rectosigmoidectomy Class I
- 4862 Anterior resection of rectum with synchronous colostomy Class I
- 4863 Other anterior resection of rectum Class I
- 4864 Posterior resection of rectum Class I
- 4865 Duhamel resection of rectum Class I
- 4869 Other resection of rectum Class I
- 4874 Rectorectostomy Class I
- 4875 Abdominal proctopexy Class I
- 5471 Repair of gastroschisis Class II
192
K-1-30 PROSEDUR DUODENUM,

ESOFAGUS & LAMBUNG NON
KOMPLEKS
- 4201 Incision of esophageal web Class II
- 4209 Other incision of esophagus Class II
- 4210 Esophagostomy, not otherwise specified Class II
- 4211 Cervical esophagostomy Class II
- 4212 Exteriorization of esophageal pouch Class II
- 4219 Other external fistulization of esophagus Class II
- 4221 Operative esophagoscopy by incision Class II
- 4225 Open biopsy of esophagus Class II
- 4231 Local excision of esophageal diverticulum Class II
- 4232 Local excision of other lesion or tissue of esophagus Class II
- 4239 Other destruction of lesion or tissue of esophagus Class II
- 4283 Closure of esophagostomy Class II
- 4286 Production of subcutaneous tunnel without esophageal anastomosis
Class II
- 430 Gastrotomy Class II
- 4319 Other gastrostomy Class II
- 433 Pyloromyotomy Class II
- 4342 Local excision of other lesion or tissue of stomach Class II
- 4349 Other destruction of lesion or tissue of stomach Class II
- 4411 Transabdominal gastroscopy Class II
- 4415 Open biopsy of stomach Class II
- 4421 Dilation of pylorus by incision Class II
- 4429 Other pyloroplasty Class II
- 4432 Percutaneous (endoscopic) gastojejunostomy Class II
193
- 4449 Other control of hemorrhage of stomach or duodenum Class II

- 4462 Closure of gastrostomy Class II
- 4464 Gastropexy Class II
- 4492 Intraoperative manipulation of stomach Class II
- 4499 Other operations on stomach Class II
- 4501 Incision of duodenum Class II
- 4532 Other destruction of lesion of duodenum Class II
- 540 Incision of abdominal wall Class II
- 5429 Other diagnostic procedures on abdominal region Class II
194
K-1-40 PROSEDUR SISTEM

PENCERNAAN LAIN-LAIN
- 5411 Exploratory laparotomy Class II
- 5412 Reopening of recent laparotomy site Class II
- 5419 Other laparotomy Class II
- 5421 Laparoscopy Class II
- 5423 Biopsy of peritoneum Class II
- 543 Excision or destruction of lesion or tissue of abdominal wall or umbilicus
Class II
- 544 Excision or destruction of peritoneal tissue Class II
- 5461 Reclosure of postoperative disruption of abdominal wall Class II
- 5462 Delayed closure of granulating abdominal wound Class II
- 5463 Other suture of abdominal wall Class II
- 5464 Suture of peritoneum Class II
- 5473 Other repair of peritoneum Class II
- 5474 Other repair of omentum Class II
- 5475 Other repair of mesentery Class II
- 5492 Removal of foreign body from peritoneal cavity Class II
- 5493 Creation of cutaneoperitoneal fistula Class II
- 5494 Creation of peritoneovascular shunt Class II
- 5495 Incision of peritoneum Class II
195
K-1-50 PROSEDUR ANAL

- 4825 Open biopsy of rectum Class II
- 4826 Biopsy of perirectal tissue Class II
- 4831 Radical electrocoagulation of rectal lesion or tissue Class II
- 4832 Other electrocoagulation of rectal lesion or tissue Class II
- 4833 Destruction of rectal lesion or tissue by laser Class II
- 4834 Destruction of rectal lesion or tissue by cryosurgery Class II
- 4835 Local excision of rectal lesion or tissue Class II
- 4836 (Endoscopic) polypectomy of rectum Class II
- 4871 Suture of laceration of rectum Class II
- 4873 Closure of other rectal fistula Class II
- 4876 Other proctopexy Class II
- 4879 Other repair of rectum Class II
- 4881 Incision of perirectal tissue Class II
- 4882 Excision of perirectal tissue Class II
- 4891 Incision of rectal stricture Class II
- 4892 Anorectal myectomy Class II
- 4893 Repair of perirectal fistula Class II
- 4899 Other operations on rectum and perirectal tissue Class II
- 4901 Incision of perianal abscess Class II
- 4902 Other incision of perianal tissue Class II
- 4904 Other excision of perianal tissue Class II
- 4911 Anal fistulotomy Class II
- 4912 Anal fistulectomy Class II
- 4922 Biopsy of perianal tissue Class II
- 4923 Biopsy of anus Class II
- 4939 Other local excision or destruction of lesion or tissue of anus Class II
196
- 4944 Destruction of hemorrhoids by cryotherapy Class II

- 4945 Ligation of hemorrhoids Class II
- 4946 Excision of hemorrhoids Class II
- 4949 Other procedures on hemorrhoids Class II
- 4951 Left lateral anal sphincterotomy Class II
- 4952 Posterior anal sphincterotomy Class II
- 4959 Other anal sphincterotomy Class II
- 496 Excision of anus Class II
- 4971 Suture of laceration of anus Class II
- 4972 Anal cerclage Class II
- 4973 Closure of anal fistula Class II
- 4974 Gracilis muscle transplant for anal incontinence Class II
- 4975 Implantation or revision of artificial anal sphincter Class II
- 4976 Removal of artificial anal sphincter Class II
- 4979 Other repair of anal sphincter Class II
- 4991 Incision of anal septum Class II
- 4992 Insertion of subcutaneous electrical anal stimulator Class II
- 4993 Other incision of anus Class II
- 4994 Reduction of anal prolapse Class II
- 4995 Control of (postoperative) hemorrhage of anus Class II
- 4999 Other operations on anus Class II
- 7073 Repair of rectovaginal fistula Class II
197
K-2-10 PROSEDUR KECIL PADA

USUS BESAR DAN KECIL
- 4500 Incision of intestine, not otherwise specified Class II
- 4502 Other incision of small intestine Class II
- 4503 Incision of large intestine Class II
- 4511 Transabdominal endoscopy of small intestine Class II
- 4515 Open biopsy of small intestine Class II
- 4521 Transabdominal endoscopy of large intestine Class II
- 4526 Open biopsy of large intestine Class II
- 4533 Local excision of lesion or tissue of small intestine, except duodenum
Class II
- 4534 Other destruction of lesion of small intestine, except duodenum Class II
- 4541 Excision of lesion or tissue of large intestine Class II
- 4549 Other destruction of lesion of large intestine Class II
- 4621 Temporary ileostomy Class II
- 4639 Other enterostomy Class II
- 4640 Revision of intestinal stoma, not otherwise specified Class II
- 4641 Revision of stoma of small intestine Class II
- 4642 Repair of pericolostomy hernia Class II
- 4643 Other revision of stoma of large intestine Class II
- 4650 Closure of intestinal stoma, not otherwise specified Class II
- 4651 Closure of stoma of small intestine Class II
- 4652 Closure of stoma of large intestine Class II
- 4660 Fixation of intestine, not otherwise specified Class II
- 4661 Fixation of small intestine to abdominal wall Class II
- 4662 Other fixation of small intestine Class II
- 4663 Fixation of large intestine to abdominal wall Class II
198
- 4664 Other fixation of large intestine Class II

- 4673 Suture of laceration of small intestine, except duodenum Class II
- 4674 Closure of fistula of small intestine, except duodenum Class II
- 4679 Other repair of intestine Class II
- 4680 Intra-abdominal manipulation of intestine, not otherwise specified Class
II
- 4681 Intra-abdominal manipulation of small intestine Class II
- 4682 Intra-abdominal manipulation of large intestine Class II
- 4691 Myotomy of sigmoid colon Class II
- 4692 Myotomy of other parts of colon Class II
- 4699 Other operations on intestines Class II
- 480 Proctotomy Class II
- 481 Proctostomy Class II
- 4821 Transabdominal proctosigmoidoscopy Class II
- 4872 Closure of proctostomy Class II
- 7072 Repair of colovaginal fistula Class II
- 7074 Repair of other vaginoenteric fistula Class II
199
K-2-11 PROSEDUR ADHESIOLYSIS

PADA PERITONEUM
- 5451 Laparoscopic lysis of peritoneal adhesions Class II
- 5459 Other lysis of peritoneal adhesions Class II
- 545 Lysis of peritoneal adhesions Class II
200
K-2-12 PROSEDUR PADA HERNIA

TIDAK TERMASUK HERNIA
INGUINALIS DAN FEMORALIS
- 5341 Laparoscopic repair of umbilical hernia with graft or prosthesis Class II
- 5349 Other open umbilical herniorrhaphy Class II
- 5351 Incisional hernia repair Class II
- 5359 Repair of other hernia of anterior abdominal wall Class II
- 5361 Other open incisional hernia repair with graft or prosthesis Class II
- 5369 Other open repair of other hernia of anterior abdominal wall with graft or
prosthesis Class II
- 539 Other hernia repair Class II
201
K-2-13 PROSEDUR PADA USUS

BUNTU
- 4701 Laparascopic appendectomy Class II
- 4709 Other appendectomy Class II
- 470 Appendectomy Class II
- 4711 Laposcopic incidental appendectomy Class II
- 4719 other incidental appendectomy Class II
- 471 Incidental appendectomy Class II
- 472 Drainage of appendiceal abscess Class II
- 4791 Appendicostomy Class II
- 4792 Closure of appendiceal fistula Class II
- 4799 Other operations on appendix Class II
202
K-2-14 PROSEDUR PADA HERNIA

INGUINALIS DAN FEMORALIS
- 5300 Unilateral repair of inguinal hernia, not otherwise specified Class II
- 5301 Other and open repair of direct inguinal hernia Class II
- 5302 Other and open repair of indirect inguinal hernia Class II
- 5303 Other and open repair of direct inguinal hernia with graft or prosthesis
Class II
- 5304 Other and open repair of indirect inguinal hernia with graft or prosthesis
Class II
- 5305 Repair of inguinal hernia with graft or prosthesis, not otherwise specified
Class II
- 5310 Bilateral repair of inguinal hernia, not otherwise specified Class II
- 5311 Other and open bilateral repair of direct inguinal hernia Class II
- 5312 Other and open bilateral repair of indirect inguinal hernia Class II
indirect Class II
- 5314 Other and open bilateral repair of direct inguinal hernia with graft or
prosthesis Class II
- 5315 Other and open bilateral repair of indirect inguinal hernia with graft or
prosthesis Class II
indirect, with graft or prosthesis Class II
- 5317 Bilateral inguinal hernia repair with graft or prosthesis, not otherwise
specified Class II
- 5321 Unilateral repair of femoral hernia with graft or prosthesis Class II
- 5329 Other unilateral femoral herniorrhaphy Class II
- 5331 Bilateral repair of femoral hernia with graft or prosthesis Class II
- 5339 Other bilateral femoral herniorrhaphy Class II
203
K-2-21 PROSEDUR BESAR PADA

USUS HALUS DAN USUS BESAR
- 4531 Other local excision of lesion of duodenum Class II
- 4601 Exteriorization of small intestine Class II
- 4602 Resection of exteriorized segment of small intestine Class II
- 4603 Exteriorization of large intestine Class II
- 4604 Resection of exteriorized segment of large intestine Class II
- 4610 Colostomy, not otherwise specified Class II
- 4611 Temporary colostomy Class II
- 4613 Permanent colostomy Class II
- 4620 Ileostomy, not otherwise specified Class II
- 4622 Continent ileostomy Class II
- 4623 Other permanent ileostomy Class II
- 4672 Closure of fistula of duodenum Class II
- 4676 Closure of fistula of large intestine Class II
- 4693 Revision of anastomosis of small intestine Class II
- 4694 Revision of anastomosis of large intestine Class II
204
K-2-22 PROSEDUR BESAR PADA

GASTROINTESTINAL ATAS
- 427 Esophagomyotomy Class II
- 4282 Suture of laceration of esophagus Class II
- 4284 Repair of esophageal fistula, not elsewhere classified Class II
- 4285 Repair of esophageal stricture Class II
- 4289 Other repair of esophagus Class II
- 4291 Ligation of esophageal varices Class II
- 4439 Other gastroenterostomy Class II
- 4463 Closure of other gastric fistula Class II
- 4465 Esophagogastroplasty Class II
- 4466 Other procedures for creation of esophagogastric sphincteric
competence Class II
- 4469 Other repair of stomach Class II
- 4491 Ligation of gastric varices Class II
205
K-2-31 PROSEDUR SEDANG PADA

- 4201 Incision of esophageal web Class II
- 4209 Other incision of esophagus Class II
- 4210 Esophagostomy, not otherwise specified Class II
- 4211 Cervical esophagostomy Class II
- 4212 Exteriorization of esophageal pouch Class II
- 4219 Other external fistulization of esophagus Class II
- 4221 Operative esophagoscopy by incision Class II
- 4225 Open biopsy of esophagus Class II
- 4231 Local excision of esophageal diverticulum Class II
- 4232 Local excision of other lesion or tissue of esophagus Class II
- 4239 Other destruction of lesion or tissue of esophagus Class II
- 4283 Closure of esophagostomy Class II
- 4286 Production of subcutaneous tunnel without esophageal anastomosis
Class II
- 4415 Open biopsy of stomach Class II
- 4421 Dilation of pylorus by incision Class II
- 4429 Other pyloroplasty Class II
- 4449 Other control of hemorrhage of stomach or duodenum Class II
- 4464 Gastropexy Class II
- 4532 Other destruction of lesion of duodenum Class II
206
K-2-32 PROSEDUR LAIN-LAIN PADA

- 430 Gastrotomy Class II
- 4319 Other gastrostomy Class II
- 433 Pyloromyotomy Class II
- 4342 Local excision of other lesion or tissue of stomach Class II
- 4349 Other destruction of lesion or tissue of stomach Class II
- 4411 Transabdominal gastroscopy Class II
- 4432 Percutaneous (endoscopic) gastojejunostomy Class II
- 4462 Closure of gastrostomy Class II
- 4492 Intraoperative manipulation of stomach Class II
- 4499 Other operations on stomach Class II
- 4501 Incision of duodenum Class II
- 540 Incision of abdominal wall Class II
- 5429 Other diagnostic procedures on abdominal region Class II
207
K-2-41 PROSEDUR LAPAROSKOPI

- 5421 Laparoscopy Class II
208
K-2-42 PROSEDUR LAPAROTOMI &

GASTROINTESTINAL LAINNYA
- 5411 Exploratory laparotomy Class II
- 5412 Reopening of recent laparotomy site Class II
- 5419 Other laparotomy Class II
- 5423 Biopsy of peritoneum Class II
- 543 Excision or destruction of lesion or tissue of abdominal wall or umbilicus
Class II
- 544 Excision or destruction of peritoneal tissue Class II
- 5461 Reclosure of postoperative disruption of abdominal wall Class II
- 5462 Delayed closure of granulating abdominal wound Class II
- 5463 Other suture of abdominal wall Class II
- 5464 Suture of peritoneum Class II
209
K-2-51 PROSEDUR UNTUK WASIR

- 4944 Destruction of hemorrhoids by cryotherapy Class II
- 4945 Ligation of hemorrhoids Class II
- 4946 Excision of hemorrhoids Class II
- 4949 Other procedures on hemorrhoids Class II
210
K-2-52 PROSEDUR SEDANG PADA

ANUS & REKTUM
- 4825 Open biopsy of rectum Class II
- 4835 Local excision of rectal lesion or tissue Class II
- 4871 Suture of laceration of rectum Class II
- 4873 Closure of other rectal fistula Class II
- 4876 Other proctopexy Class II
- 4879 Other repair of rectum Class II
- 4881 Incision of perirectal tissue Class II
- 4882 Excision of perirectal tissue Class II
- 4891 Incision of rectal stricture Class II
- 4892 Anorectal myectomy Class II
- 4893 Repair of perirectal fistula Class II
- 4911 Anal fistulotomy Class II
- 4912 Anal fistulectomy Class II
- 496 Excision of anus Class II
- 4972 Anal cerclage Class II
- 4973 Closure of anal fistula Class II
- 4974 Gracilis muscle transplant for anal incontinence Class II
- 4975 Implantation or revision of artificial anal sphincter Class II
- 4979 Other repair of anal sphincter Class II
- 7073 Repair of rectovaginal fistula Class II
211

ANUS & REKTUM
- 4826 Biopsy of perirectal tissue Class II
- 4831 Radical electrocoagulation of rectal lesion or tissue Class II
- 4832 Other electrocoagulation of rectal lesion or tissue Class II
- 4833 Destruction of rectal lesion or tissue by laser Class II
- 4834 Destruction of rectal lesion or tissue by cryosurgery Class II
- 4836 (Endoscopic) polypectomy of rectum Class II
- 4899 Other operations on rectum and perirectal tissue Class II
- 4901 Incision of perianal abscess Class II
- 4902 Other incision of perianal tissue Class II
- 4904 Other excision of perianal tissue Class II
- 4922 Biopsy of perianal tissue Class II
- 4923 Biopsy of anus Class II
- 4939 Other local excision or destruction of lesion or tissue of anus Class II
- 4951 Left lateral anal sphincterotomy Class II
- 4952 Posterior anal sphincterotomy Class II
- 4959 Other anal sphincterotomy Class II
- 4971 Suture of laceration of anus Class II
- 4976 Removal of artificial anal sphincter Class II
- 4991 Incision of anal septum Class II
- 4992 Insertion of subcutaneous electrical anal stimulator Class II
- 4993 Other incision of anus Class II
- 4994 Reduction of anal prolapse Class II
- 4995 Control of (postoperative) hemorrhage of anus Class II
- 4999 Other operations on anus Class II
212
K-3-10 PROSEDUR KECIL LAIN-LAIN

PADA GASTROINTESTINAL
- 4229 Other diagnostic procedures on esophagus Class III
- 4292 Dilation of esophagus Class III
- 4299 Other operations on esophagus Class III
- 4419 Other diagnostic procedures on stomach Class III
- 4519 Other diagnostic procedures on small intestine Class III
- 4527 Intestinal biopsy, site unspecified Class III
- 4528 Other diagnostic procedures on large intestine Class III
- 4529 Other diagnostic procedures on intestine, site unspecified Class III
- 4614 Delayed opening of colostomy Class III
- 4624 Delayed opening of ileostomy Class III
- 4631 Delayed opening of other enterostomy Class III
- 4685 Dilation of intestine Class III
- 5422 Biopsy of abdominal wall or umbilicus Class III
- 5424 Closed [percutaneous] [needle] biopsy of intra-abdominal mass Class III
- 5425 Peritoneal lavage Class III
- 5491 Percutaneous abdominal drainage Class III
- 5496 Injection of air into peritoneal cavity Class III
- 5497 Injection of locally-acting therapeutic substance into peritoneal cavity
Class III
- 5499 Other operations of abdominal region Class III
- 8932 Esophageal manometry Class III
- 9606 Insertion of Sengstaken tube Class III
- 9607 Insertion of other (naso-)gastric tube Class III
- 9608 Insertion of (naso-)intestinal tube Class III
- 9609 Insertion of rectal tube Class III
213
- 9627 Manual reduction of hernia Class III

- 9628 Manual reduction of enterostomy prolapse Class III
- 9629 Reduction of intussusception of alimentary tract Class III
- 9631 Gastric cooling Class III
- 9632 Gastric freezing Class III
- 9633 Gastric lavage Class III
- 9635 Gastric gavage Class III
- 9637 Proctoclysis Class III
- 9638 Removal of impacted feces Class III
- 9639 Other transanal enema Class III
- 9643 Digestive tract instillation, except gastric gavage Class III
214

ANUS & REKTUM
- 4829 Other diagnostic procedures on rectum, rectosigmoid, and perirectal
Class III
- 4903 Excision of perianal skin tags Class III
- 4921 Anoscopy Class III
- 4929 Other diagnostic procedures on anus and perianal tissue Class III
- 4931 Endoscopic excision or destruction of lesion or tissue of anus Class III
- 4941 Reduction of hemorrhoids Class III
- 4942 Injection of hemorrhoids Class III
- 4943 Cauterization of hemorrhoids Class III
- 4947 Evacuation of thrombosed hemorrhoids Class III
- 9619 Rectal packing Class III
- 9622 Dilation of rectum Class III
- 9623 Dilation of anal sphincter Class III
- 9624 Dilation and manipulation of enterostomy stoma Class III
- 9626 Manual reduction of rectal prolapse Class III
- 9805 Removal of intraluminal foreign body from rectum and anus without
incision Class III
215
K-3-12 PROSEDUR SIGMOIDOSKOPI

DAN ANOSKOPI
- 4524 Flexible sigmoidoscopy Class III
- 4822 Proctosigmoidoscopy through artificial stoma Class III
- 4823 Rigid proctosigmoidoscopy Class III
- 4824 Closed (endoscopic) biopsy of rectum Class III
216
K-3-13 PROSEDUR KOLONOSKOPI

- 4522 Endoscopy of large intestine through artificial stoma Class III
- 4523 Colonoscopy Class III
- 4525 Closed (endoscopic) biopsy of large intestine Class III
- 4542 Endoscopic polypectomy of large intestine Class III
- 4543 Endoscopic excision or destruction of other lesion or tissue of large
intestine Class III
- 9804 Removal of intraluminal foreign body from large intestine without
incision Class III
217
K-3-14 PROSEDUR ENDOSKOPI

BESAR PADA GASTROINTESTINAL
ATAS
- 4233 Endoscopic excision or destruction of lesion or tissue of esophagus Class
III
- 4281 Insertion of permanent tube into esophagus Class III
- 4311 Percutaneous (endoscopic) gastrostomy (PEG) Class III
- 4341 Endoscopic excision or destruction of lesion or tissue of stomach Class III
- 4422 Endoscopic dilation of pylorus Class III
- 4443 Endoscopic control of gastric or duodenal bleeding Class III
- 4632 Percutaneous (endoscopic) jejunostomy (PEJ) Class III
218
K-3-15 PROSEDUR ENDOSKOPI

KECIL PADA GASTROINTESTINAL
ATAS
- 4222 Esophagoscopy through artificial stoma Class III
- 4223 Other esophagoscopy Class III
- 4224 Closed (endoscopic) biopsy of esophagus Class III
- 4412 Gastroscopy through artificial stoma Class III
- 4413 Other gastroscopy Class III
- 4414 Closed biopsy of stomach (endoscopic) Class III
- 4493 Insertion of gastric bubble (balloon) Class III
- 4512 Endoscopy of small intestine through artificial stoma Class III
- 4513 Other endoscopy of small intestine Class III
- 4514 Closed biopsy of small intestine (endoscopic) Class III
- 4516 Esophagogastroduodenoscopy (EGD) with closed biopsy Class III
- 4530 Endoscopic excision or destruction of lesion of duodenum Class III
- 9802 Removal of intraluminal foreign body from esophagus without incision
Class III
- 9803 Removal of intraluminal foreign body from stomach and small intestine
without incision Class III
219
K-3-16 PROSEDUR LAIN-LAIN PADA

GASTROINTESTINAL
- 4494 Removal of gastric bubble (balloon) Class III
- 9634 Other irrigation of (naso-)gastric tube Class III
- 9636 Irrigation of gastrostomy or enterostomy Class III
- 9701 Replacement of (naso-)gastric or esophagostomy tube Class III
- 9702 Replacement of gastrostomy tube Class III
- 9703 Replacement of tube or enterostomy device of small intestine Class III
- 9704 Replacement of tube or enterostomy device of large intestine Class III
- 9751 Removal of gastrostomy tube Class III
- 9752 Removal of tube from small intestine Class III
- 9753 Removal of tube from large intestine or appendix Class III
- 9759 Removal of other device from digestive system Class III
- 9781 Removal of retroperitoneal drainage device Class III
- 9782 Removal of peritoneal drainage device Class III
- 9783 Removal of abdominal wall sutures Class III
- 9784 Removal of sutures from trunk, not elsewhere classified Class III
- 9785 Removal of packing from trunk, not elsewhere classified Class III
- 9786 Removal of other device from abdomen Class III
- 9787 Removal of other device from trunk Class III
- 9818 Removal of intraluminal foreign body from artificial stoma without
incision Class III
- 9820 Removal of foreign body, not otherwise specified Class III
- 9993 Rectal massage (for levator spasm) Class III
220
L-1-20 PROSEDUR PEMINDAHAN

KULIT PADA LUKA BAKAR
- 8582 Split-thickness graft to breast Class II
- 8583 Full-thickness graft to breast Class II
- 8584 Pedicle graft to breast Class II
- 8585 Muscle flap graft to breast Class II
- 8660 Free skin graft, not otherwise specified Class II
- 8661 Full-thickness skin graft to hand Class II
- 8662 Other skin graft to hand Class II
- 8663 Full-thickness skin graft to other sites Class II
- 8665 Heterograft to skin Class II
- 8666 Homograft to skin Class II
- 8667 Dermal regenerative graft Class II
- 8669 Other skin graft to other sites Class II
- 8670 Pedicle or flap graft, not otherwise specified Class II
- 8671 Cutting and preparation of pedicle grafts or flaps Class II
- 8672 Advancement of pedicle graft Class II
- 8673 Attachment of pedicle or flap graft to hand Class II
- 8674 Attachment of pedicle or flap graft to other sites Class II
- 8675 Revision of pedicle or flap graft Class II
- 8691 Excision of skin for graft Class II
- 8693 Insertion of tissue expander Class II
221
L-1-30 PROSEDUR PEMINDAHAN

KULIT TANPA LUKA BAKAR
222
L-1-40 PROSEDUR PADA KULIT,

JARINGAN BAWAH KULIT DAN
PAYUDARA
- 8606 Insertion of totally implantable infusion pump Class II
- 8607 Insertion of totally implantable vascular access device (vad) Class II
- 8609 Other incision of skin and subcutaneous tissue Class II
- 8621 Excision of pilonidal cyst or sinus Class II
- 863 Other local excision or destruction of lesion or tissue of skin and Class II
- 8681 Repair for facial weakness Class II
- 8682 Facial rhytidectomy Class II
- 8683 Size reduction plastic operation Class II
- 8684 Relaxation of scar or web contracture of skin Class II
- 8686 Onychoplasty Class II
- 8689 Other repair and reconstruction of skin and subcutaneous tissue Class II
223
L-1-50 PROSEDUR PADA PAYUDARA

- 850 Mastotomy Class II
- 8512 Open biopsy of breast Class II
- 8520 Excision or destruction of breast tissue, not otherwise specified Class II
- 8521 Local excision of lesion of breast Class II
- 8522 Resection of quadrant of breast Class II
- 8523 Subtotal mastectomy Class II
- 8524 Excision of ectopic breast tissue Class II
- 8525 Excision of nipple Class II
- 8531 Unilateral reduction mammoplasty Class II
- 8532 Bilateral reduction mammoplasty Class II
- 8533 Unilateral subcutaneous mammectomy with synchronous implant Class II
- 8534 Other unilateral subcutaneous mammectomy Class II
- 8535 Bilateral subcutaneous mammectomy with synchronous implant Class II
- 8536 Other bilateral subcutaneous mammectomy Class II
- 8541 Unilateral simple mastectomy Class II
- 8542 Bilateral simple mastectomy Class II
- 8543 Unilateral extended simple mastectomy Class II
- 8544 Bilateral extended simple mastectomy Class II
- 8545 Unilateral radical mastectomy Class II
- 8546 Bilateral radical mastectomy Class II
- 8547 Unilateral extended radical mastectomy Class II
- 8548 Bilateral extended radical mastectomy Class II
- 8550 Augmentation mammoplasty, not otherwise specified Class II
- 8553 Unilateral breast implant Class II
- 8554 Bilateral breast implant Class II
- 856 Mastopexy Class II
224
- 857 Total reconstruction of breast Class II

- 8586 Transposition of nipple Class II
- 8587 Other repair or reconstruction of nipple Class II
- 8589 Other mammoplasty Class II
- 8593 Revision of implant of breast Class II
- 8594 Removal of implant of breast Class II
- 8595 Insertion of breast tissue expander Class II
- 8596 Removal of breast tissue expander (s) Class II
- 8599 Other operations on the breast Class II
225
L-2-21 PROSEDUR BESAR

PEMINDAHAN KULIT PADA LUKA
BAKAR
226
L-2-22 PROSEDUR KECIL

PEMINDAHAN KULIT PADA LUKA
BAKAR
227
L-2-31 PROSEDUR BESAR

PEMINDAHAN KULIT TANPA LUKA
BAKAR
228
L-2-32 PROSEDUR KECIL

PEMINDAHAN KULIT TANPA LUKA
BAKAR
229
L-2-41 PROSEDUR BEDAH PLASTIK

- 8606 Insertion of totally implantable infusion pump Class II
- 8681 Repair for facial weakness Class II
- 8682 Facial rhytidectomy Class II
- 8683 Size reduction plastic operation Class II
230
L-2-42 PROSEDUR LAIN-LAIN PADA

KULIT DAN JARINGAN BAWAH KULIT
- 8607 Insertion of totally implantable vascular access device (vad) Class II
- 8609 Other incision of skin and subcutaneous tissue Class II
- 8621 Excision of pilonidal cyst or sinus Class II
- 863 Other local excision or destruction of lesion or tissue of skin and Class II
- 8684 Relaxation of scar or web contracture of skin Class II
- 8686 Onychoplasty Class II
- 8689 Other repair and reconstruction of skin and subcutaneous tissue Class II
231
L-2-51 PROSEDUR PENGANGKATAN

PAYUDARA
- 8523 Subtotal mastectomy Class II
- 8533 Unilateral subcutaneous mammectomy with synchronous implant Class II
- 8534 Other unilateral subcutaneous mammectomy Class II
- 8535 Bilateral subcutaneous mammectomy with synchronous implant Class II
- 8536 Other bilateral subcutaneous mammectomy Class II
- 8541 Unilateral simple mastectomy Class II
- 8542 Bilateral simple mastectomy Class II
- 8543 Unilateral extended simple mastectomy Class II
- 8544 Bilateral extended simple mastectomy Class II
- 8545 Unilateral radical mastectomy Class II
- 8546 Bilateral radical mastectomy Class II
- 8547 Unilateral extended radical mastectomy Class II
- 8548 Bilateral extended radical mastectomy Class II
232
L-2-52 PROSEDUR BESAR PADA

PAYUDARA TANPA PENGANGKATAN
PAYUDARA
- 8522 Resection of quadrant of breast Class II
- 8531 Unilateral reduction mammoplasty Class II
- 8532 Bilateral reduction mammoplasty Class II
- 8550 Augmentation mammoplasty, not otherwise specified Class II
- 8553 Unilateral breast implant Class II
- 8554 Bilateral breast implant Class II
- 856 Mastopexy Class II
- 857 Total reconstruction of breast Class II
- 8587 Other repair or reconstruction of nipple Class II
- 8589 Other mammoplasty Class II
- 8595 Insertion of breast tissue expander Class II
233
L-2-53 PROSEDUR KECIL PADA

PAYUDARA TANPA PENGANGKATAN
PAYUDARA
- 850 Mastotomy Class II
- 8512 Open biopsy of breast Class II
- 8520 Excision or destruction of breast tissue, not otherwise specified Class II
- 8521 Local excision of lesion of breast Class II
- 8524 Excision of ectopic breast tissue Class II
- 8525 Excision of nipple Class II
- 8586 Transposition of nipple Class II
- 8593 Revision of implant of breast Class II
- 8594 Removal of implant of breast Class II
- 8596 Removal of breast tissue expander (s) Class II
- 8599 Other operations on the breast Class II
234
L-3-10 PROSEDUR KECIL LAIN-LAIN

PADA PAYUDARA
- 8511 Closed (percutaneous) (needle) biopsy of breast Class III
- 8519 Other diagnostic procedures on breast Class III
- 8551 Unilateral injection into breast for augmentation Class III
- 8552 Bilateral injection into breast for augmentation Class III
- 8581 Suture of laceration of breast Class III
- 8591 Aspiration of breast Class III
- 8592 Injection of therapeutic agent into breast Class III
235
L-3-11 PROSEDUR BESAR PADA

KULIT
- 8622 Excisional debridement of wound, infection, or burn Class III
- 8651 Replantation of scalp Class III
- 8664 Hair transplant Class III
236
L-3-12 PROSEDUR KECIL PADA

KULIT
- 8601 Aspiration of skin and subcutaneous tissue Class III
- 8602 Injection or tattooing of skin lesion or defect Class III
- 8603 Incision of pilonidal sinus or cyst Class III
- 8604 Other incision with drainage of skin and subcutaneous tissue Class III
- 8605 Incision with removal of foreign body from skin and subcutaneous tissue
Class III
- 8611 Biopsy of skin and subcutaneous tissue Class III
- 8619 Other diagnostic procedures on skin and subcutaneous tissue Class III
- 8623 Removal of nail, nailbed, or nail fold Class III
- 8624 Chemosurgery of skin Class III
- 8625 Dermabrasion Class III
- 8626 Ligation of dermal appendage Class III
- 8627 Debridement of nail, nail bed, or nail fold Class III
- 8628 Nonexcisional debridement of wound, infection, or burn Class III
- 8659 Suture of skin and subcutaneous tissue of other sites Class III
- 8692 Electrolysis and other epilation of skin Class III
- 8699 Other operations on skin and subcutaneous tissue Class III
- 9822 Removal of other foreign body without incision from head and neck Class
III
237
M-1-01 PROSEDUR BILATERAL DAN

MULTIPLE SENDI ANGGOTA TUBUH
BAWAH MAYOR
- 8151 Total hip replacement Class I
- 8152 Partial hip replacement Class I
- 8153 Revision of hip replacement, NEC Class I
- 8154 Total knee replacement Class I
- 8155 Revision of knee replacement, NEC Class I
- 8156 Total ankle replacement Class I
- 8162 Fusion or refusion of 2-3 vertebrae Class I
- 8164 Fusion or refusion of 9 or more vertebrae Class I
238
M-1-02 PROSEDUR AMPUTASI

- 8400 Upper limb amputation, not otherwise specified Class I
- 8403 Amputation through hand Class I
- 8404 Disarticulation of wrist Class I
- 8405 Amputation through forearm Class I
- 8406 Disarticulation of elbow Class I
- 8407 Amputation through humerus Class I
- 8408 Disarticulation of shoulder Class I
- 8409 Interthoracoscapular amputation Class I
- 8410 Lower limb amputation, not otherwise specified Class I
- 8412 Amputation through foot Class I
- 8413 Disarticulation of ankle Class I
- 8414 Amputation of ankle through malleoli of tibia and fibula Class I
- 8415 Other amputation below knee Class I
- 8416 Disarticulation of knee Class I
- 8417 Amputation above knee Class I
- 8418 Disarticulation of hip Class I
- 8419 Abdominopelvic amputation Class I
- 8491 Amputation, not otherwise specified Class I
239
M-1-03 PROSEDUR FUSI TULANG

BELAKANG PADA LENGKUNGAN
TULANG BELAKANG
- 8100 Spinal fusion, not otherwise specified Class I
- 8101 Atlas-axis spinal fusion Class I
- 8102 Other cervical fusion, anterior technique Class I
- 8103 Other cervical fusion, posterior technique Class I
- 8104 Dorsal and dorsolumbar fusion, anterior technique Class I
- 8105 Dorsal and dorsolumbar fusion, posterior technique Class I
- 8106 Lumbar and lumbosacral fusion, anterior technique Class I
- 8107 Lumbar and lumbosacral fusion, lateral transverse process technique
Class I
- 8108 Lumbar and lumbosacral fusion, posterior technique Class I
- 8130 Refusion of spine,not otherwise specified Class I
- 8131 Refusion of atlas-axis spine Class I
- 8132 Refuison of other cervical spine, anterior technique Class I
- 8133 Refuison of other cervical spine, posterior technique Class I
- 8134 Refuison of dorsal and dorolumbarspine, anterior technique Class I
- 8135 Refuison of dorsal and dorolumbarspine, posterior technique Class I
- 8136 Refuison of lumbar and lumbosacral spine, anterior technique Class I
- 8137 Refuison of lumbar and lumbosacral spine, lateral transverse technique
Class I
- 8138 Refuison of lumbar and lumbosacral spine, posterior technique Class I
- 8139 Refusion of spine, NEC Class I
- 8451 Insertion of interbody spinal fusion device Class I
240
M-1-04 PROSEDUR PADA SENDI

TUNGKAI/ANGGOTA TUBUH BAGIAN
BAWAH MAYOR
- 8151 Total hip replacement Class I
- 8152 Partial hip replacement Class I
- 8153 Revision of hip replacement, NEC Class I
- 8154 Total knee replacement Class I
- 8155 Revision of knee replacement, NEC Class I
- 8156 Total ankle replacement Class I
- 8164 Fusion or refusion of 9 or more vertebrae Class I
- 8426 Foot reattachment Class I
- 8427 Lower leg or ankle reattachment Class I
- 8428 Thigh reattachment Class I
241
M-1-05 PROSEDUR PADA SENDI

LENGAN/ANGGOTA TUBUH BAGIAN
BAWAH MAYOR
- 8173 Total wrist replacement Class I
- 8180 Total shoulder replacement Class I
- 8181 Partial shoulder replacement Class I
- 8184 Total elbow replacement Class I
- 8423 Forearm, wrist, or hand reattachment Class I
- 8424 Upper arm reattachment Class I
242
M-1-10 PROSEDUR KRANIAL DAN

REKONSTRUKSI TULANG WAJAH
- 7639 Partial ostectomy of other facial bone Class II
- 7641 Total mandibulectomy with synchronous reconstruction Class II
- 7643 Other reconstruction of mandible Class II
- 7644 Total ostectomy of other facial bone with synchronous reconstruction
Class II
- 7645 Other total ostectomy of other facial bone Class II
- 7646 Other reconstruction of other facial bone Class II
- 7661 Closed osteoplasty (osteotomy) of mandibular ramus Class II
- 7662 Open osteoplasty (osteotomy) of mandibular ramus Class II
- 7663 Osteoplasty (osteotomy) of body of mandible Class II
- 7664 Other orthognathic surgery on mandible Class II
- 7665 Segmental osteoplasty (osteotomy) of maxilla Class II
- 7666 Total osteoplasty (osteotomy) of maxilla Class II
- 7667 Reduction genioplasty Class II
- 7668 Augmentation genioplasty Class II
243
M-1-20 PROSEDUR PAHA DAN

SENDI PANGGUL SELAIN SENDI
MAYOR
- 7705 Sequestrectomy of femur Class II
- 7725 Wedge osteotomy of femur Class II
- 7735 Other division of femur Class II
- 7785 Other partial ostectomy of femur Class II
- 7795 Total ostectomy of femur Class II
- 7805 Bone graft of femur Class II
- 7815 Application of external fixation device, femur Class II
- 7825 Limb shortening procedures, femur Class II
- 7835 Limb lengthening procedures, femur Class II
- 7845 Other repair or plastic operations on femur Class II
- 7855 Internal fixation of bone without fracture reduction on femur Class II
- 7875 Osteoclasis of femur Class II
- 7895 Insertion of bone growth stimulator into femur Class II
- 7915 Closed reduction of fracture with internal fixation, femur Class II
- 7925 Open reduction of fracture without internal fixation, femur Class II
- 7935 Open reduction of fracture with internal fixation, femur Class II
- 7945 Closed reduction of separated epiphysis of femur Class II
- 7955 Open reduction of separated epiphysis of femur Class II
- 7965 Debridement of open fracture of femur Class II
- 7985 Open reduction of dislocation of hip Class II
- 7995 Unspecified operation on bone injury of femur Class II
- 8005 Arthrotomy for removal of prosthesis of hip Class I
- 8015 Other arthrotomy of hip Class II
- 8045 Division of joint capsule, ligament, or cartilage of hip Class II
244
- 8075 Synovectomy of hip Class II

- 8095 Other excision of hip joint Class II
- 8121 Arthrodesis of hip Class II
- 8140 Repair of hip, not elsewhere classified Class II
- 8312 Adductor tenotomy of hip Class II
245
M-1-30 PROSEDUR KAKI

- 0444 Release of tarsal tunnel Class II
- 7708 Sequestrectomy of tarsals and metatarsals Class II
- 7718 Other incision of bone without division, tarsals and metatarsals Class II
- 7728 Wedge osteotomy of tarsals and metatarsals Class II
- 7738 Other division of tarsals and metatarsals Class II
- 7751 Bunionectomy with soft tissue correction and osteotomy of the first
metatarsal Class II
- 7752 Bunionectomy with soft tissue correction and arthrodesis Class II
- 7753 Other bunionectomy with soft tissue correction Class II
- 7754 Excision or correction of bunionette Class II
- 7756 Repair of hammer toe Class II
- 7757 Repair of claw toe Class II
- 7758 Other excision, fusion, and repair of toes Class II
- 7759 Other bunionectomy Class II
- 7768 Local excision of lesion or tissue of tarsals and metatarsals Class II
- 7778 Excision of bone for graft, tarsals and metatarsals Class II
- 7788 Other partial ostectomy of tarsals and metatarsals Class II
- 7798 Total ostectomy of tarsals and metatarsals Class II
- 7808 Bone graft of tarsals and metatarsals Class II
- 7818 Application of external fixation device, tarsals and metatarsals Class II
- 7828 Limb shortening procedures, tarsals and metatarsals Class II
- 7838 Limb lengthening procedures, tarsals and metatarsals Class II
- 7848 Other repair or plastic operations on tarsals and metatarsals Class II
- 7858 Internal fixation of bone without fracture reduction on tarsals and
metatarsals Class II
- 7878 Osteoclasis of tarsals and metatarsals Class II
246
- 7888 Diagnostic procedures on tarsals and metatarsals, not elsewhere

classified Class II
- 7898 Insertion of bone growth stimulator into tarsals and metatarsals Class II
- 7917 Closed reduction of fracture with internal fixation, tarsals and
- 7918 Closed reduction of fracture with internal fixation, phalanges of foot
Class II
- 7927 Open reduction of fracture without internal fixation, tarsals and
- 7928 Open reduction of fracture without internal fixation, phalanges of foot
Class II
- 7937 Open reduction of fracture with internal fixation, tarsals and metatarsals
Class II
- 7938 Open reduction of fracture with internal fixation, phalanges of foot Class
II
- 7967 Debridement of open fracture of tarsals and metatarsals Class II
- 7968 Debridement of open fracture of phalanges of foot Class II
- 7988 Open reduction of dislocation of foot and toe Class II
- 7998 Unspecified operation on bone injury of phalanges of foot Class II
- 8018 Other arthrotomy of foot and toe Class II
- 8048 Division of joint capsule, ligament, or cartilage of foot and toe Class II
- 8078 Synovectomy of foot and toe Class II
- 8088 Other local excision or destruction of lesion of joint of foot and toe Class
II
- 8098 Other excision of joint of foot and toe Class II
- 8113 Subtalar fusion Class II
- 8114 Midtarsal fusion Class II
- 8115 Tarsometatarsal fusion Class II
- 8116 Metatarsophalangeal fusion Class II
- 8117 Other fusion of foot Class II
- 8157 Replacement of joint of foot and toe Class II
247
- 8194 Suture of capsule or ligament of ankle and foot Class II

- 8311 Achillotenotomy Class II
- 8384 Release of clubfoot, not elsewhere classified Class II
- 8411 Amputation of toe Class II
- 8425 Toe reattachment Class II
248
M-1-40 PROSEDUR EKSISI LOKAL

DAN PENGANGKATAN ALAT FIKSASI
INTERNAL
- 7710 Other incision of bone without division, unspecified site Class II
- 7712 Other incision of bone without division, humerus Class II
- 7713 Other incision of bone without division, radius and ulna Class II
- 7715 Other incision of bone without division, femur Class II
- 7716 Other incision of bone without division, patella Class II
- 7717 Other incision of bone without division, tibia and fibula Class II
- 7719 Other incision of bone without division, other specified bone Class II
- 7760 Local excision of lesion or tissue of bone, unspecified site Class II
- 7762 Local excision of lesion or tissue of humerus Class II
- 7763 Local excision of lesion or tissue of radius and ulna Class II
- 7765 Local excision of lesion or tissue of femur Class II
- 7766 Local excision of lesion or tissue of patella Class II
- 7767 Local excision of lesion or tissue of tibia and fibula Class II
- 7769 Local excision of lesion or tissue of other specified bone Class II
- 7770 Excision of bone for graft, unspecified site Class II
- 7772 Excision of bone for graft, humerus Class II
- 7773 Excision of bone for graft, radius and ulna Class II
- 7775 Excision of bone for graft, femur Class II
- 7776 Excision of bone for graft, patella Class II
- 7777 Excision of bone for graft, tibia and fibula Class II
- 7779 Excision of bone for graft, other specified bone Class II
- 7860 Removal of implanted device, unspecified site Class II
- 7862 Removal of implanted device from humerus Class II
- 7863 Removal of implanted device from radius and ulna Class II
249
- 7864 Removal of implanted device from carpals and metacarpals Class II

- 7865 Removal of implanted device from femur Class II
- 7866 Removal of implanted device from patella Class II
- 7867 Removal of implanted device from tibia and fibula Class II
- 7868 Removal of implanted device from tarsal and metatarsals Class II
- 7869 Removal of implanted device from other bone, except facial bone Class II
- 8000 Arthrotomy for removal of prosthesis, unspecified site Class II
- 8001 Arthrotomy for removal of prosthesis of shoulder Class II
- 8002 Arthrotomy for removal of prosthesis of elbow Class II
- 8003 Arthrotomy for removal of prosthesis of wrist Class II
- 8004 Arthrotomy for removal of prosthesis of hand and finger Class II
- 8006 Arthrotomy for removal of prosthesis of knee Class II
- 8007 Arthrotomy for removal of prosthesis of ankle Class II
- 8008 Arthrotomy for removal of prosthesis of foot and toe Class II
- 8009 Arthrotomy for removal of prosthesis of other specified site Class II
- 8080 Other local excision or destruction of lesion of joint, unspecified Class II
- 8081 Other local excision or destruction of lesion of shoulder joint Class II
- 8082 Other local excision or destruction of lesion of elbow joint Class II
- 8085 Other local excision or destruction of lesion of hip joint Class II
- 8086 Other local excision or destruction of lesion of knee joint Class II
- 8089 Other local excision or destruction of lesion of joint of other specified site
Class II
250
M-1-50 PROSEDUR JARINGAN

LUNAK
- 8070 Synovectomy, unspecified site Class II
- 8079 Synovectomy of other specified site Class II
- 8195 Suture of capsule or ligament of other lower extremity Class II
- 8301 Exploration of tendon sheath Class II
- 8302 Myotomy Class II
- 8303 Bursotomy Class II
- 8309 Other incision of soft tissue Class II
- 8313 Other tenotomy Class II
- 8314 Fasciotomy Class II
- 8319 Other division of soft tissue Class II
- 8329 Other diagnostic procedures on muscle, tendon, fascia, and bursa,
including that of hand Class II
- 8331 Excision of lesion of tendon sheath Class II
- 8332 Excision of lesion of muscle Class II
- 8339 Excision of lesion of other soft tissue Class II
- 8341 Excision of tendon for graft Class II
- 8342 Other tenonectomy Class II
- 8343 Excision of muscle or fascia for graft Class II
- 8344 Other fasciectomy Class II
- 8345 Other myectomy Class II
- 8349 Other excision of soft tissue Class II
- 835 Bursectomy Class II
- 8361 Suture of tendon sheath Class II
- 8362 Delayed suture of tendon Class II
- 8364 Other suture of tendon Class II
251
- 8365 Other suture of muscle or fascia Class II

- 8371 Advancement of tendon Class II
- 8372 Recession of tendon Class II
- 8373 Reattachment of tendon Class II
- 8374 Reattachment of muscle Class II
- 8375 Tendon transfer or transplantation Class II
- 8376 Other tendon transposition Class II
- 8377 Muscle transfer or transplantation Class II
- 8379 Other muscle transposition Class II
- 8381 Tendon graft Class II
- 8382 Graft of muscle or fascia Class II
- 8383 Tendon pulley reconstruction Class II
- 8385 Other change in muscle or tendon length Class II
- 8386 Quadricepsplasty Class II
- 8387 Other plastic operations on muscle Class II
- 8388 Other plastic operations on tendon Class II
- 8389 Other plastic operations on fascia Class II
- 8391 Lysis of adhesions of muscle, tendon, fascia, and bursa Class II
- 8392 Insertion or replacement of skeletal muscle stimulator Class II
- 8393 Removal of skeletal muscle stimulator Class II
- 8399 Other operations on muscle, tendon, fascia, and bursa Class II
- 843 Revision of amputation stump Class II
- 864 Radical excision of skin lesion Class II
252
M-1-60 PROSEDUR SISTEM

MUSKULOSKLETAL & JARINGAN
PENGHUBUNG LAIN-LAIN
- 0115 Biopsy of skull Class II
- 0119 Other diagnostic procedures on skull Class II
- 0353 Repair of vertebral fracture Class II
- 7601 Sequestrectomy of facial bone Class II
- 7609 Other incision of facial bone Class II
- 7611 Biopsy of facial bone Class II
- 7619 Other diagnostic procedures on facial bones and joints Class II
- 762 Local excision or destruction of lesion of facial bone Class II
- 7631 Partial mandibulectomy Class II
- 7642 Other total mandibulectomy Class II
- 765 Temporomandibular arthroplasty Class II
- 7669 Other facial bone repair Class II
- 7670 Reduction of facial fracture, not otherwise specified Class II
- 7672 Open reduction of malar and zygomatic fracture Class II
- 7674 Open reduction of maxillary fracture Class II
- 7676 Open reduction of mandibular fracture Class II
- 7677 Open reduction of alveolar fracture Class II
- 7679 Other open reduction of facial fracture Class II
- 7691 Bone graft to facial bone Class II
- 7692 Insertion of synthetic implant in facial bone Class II
- 7694 Open reduction of temporomandibular dislocation Class II
- 7697 Removal of internal fixation device from facial bone Class II
- 7699 Other operations on facial bones and joints Class II
- 7700 Sequestrectomy, unspecified site Class II
253
- 7709 Sequestrectomy of other bone Class II

- 7720 Wedge osteotomy, unspecified site Class II
- 7729 Wedge osteotomy of other bone Class II
- 7730 Other division of bone, unspecified site Class II
- 7739 Other division of other bone Class II
- 7740 Biopsy of bone, unspecified site Class II
- 7741 Biopsy of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7742 Biopsy of humerus Class II
- 7743 Biopsy of radius and ulna Class II
- 7744 Biopsy of carpals and metacarpals Class II
- 7745 Biopsy of femur Class II
- 7746 Biopsy of patella Class II
- 7747 Biopsy of tibia and fibula Class II
- 7748 Biopsy of tarsals and metatarsals Class II
- 7749 Biopsy of other bone Class II
- 7780 Other partial ostectomy, unspecified site Class II
- 7789 Other partial ostectomy of other bone Class II
- 7790 Total ostectomy, unspecified site Class II
- 7799 Total ostectomy of other bone Class II
- 7800 Bone graft, unspecified site Class II
- 7809 Bone graft of other bone except facial bones Class II
- 7810 Application of external fixation device, unspecified site Class II
- 7819 Application of external fixation device, other bone except facial bones
Class II
- 7820 Limb shortening procedures, unspecified site Class II
- 7829 Limb shortening procedures, other bone except facial bones Class II
- 7830 Limb lengthening procedures, unspecified site Class II
- 7839 Limb lengthening procedures, other bone except facial bones Class II
- 7840 Other repair or plastic operations on bone, unspecified site Class II
254
- 7849 Other repair or plastic operations on other bone, except facial bone Class
II
- 7850 Internal fixation of bone without fracture reduction, unspecified site
Class II
- 7859 Internal fixation of bone without fracture reduction on other bone, except
facial bone Class II
- 7870 Osteoclasis, unspecified site Class II
- 7879 Osteoclasis of other bone, except facial bone Class II
- 7880 Diagnostic procedures on bone, not elsewhere classified, unspecified site
Class II
- 7882 Diagnostic procedures on humerus, not elsewhere classified Class II
- 7883 Diagnostic procedures on radius and ulna, not elsewhere classified Class
II
- 7885 Diagnostic procedures on femur, not elsewhere classified Class II
- 7886 Diagnostic procedures on patella, not elsewhere classified Class II
- 7887 Diagnostic procedures on tibia and fibula, not elsewhere classified Class
II
- 7889 Diagnostic procedures on other bone, not elsewhere classified Class II
- 7890 Insertion of bone growth stimulator, unspecified site Class II
- 7899 Insertion of bone growth stimulator into other bone, except facial bone
Class II
- 7910 Closed reduction of fracture with internal fixation, unspecified site Class
II
- 7919 Closed reduction of fracture with internal fixation, other specified bone
Class II
- 7920 Open reduction of fracture without internal fixation, unspecified site
Class II
- 7929 Open reduction of fracture without internal fixation, other specified bone
Class II
- 7930 Open reduction of fracture with internal fixation, unspecified site Class II
- 7939 Open reduction of fracture with internal fixation, other specified bone
Class II
- 7940 Closed reduction of separated epiphysis, unspecified site Class II
255
- 7949 Closed reduction of separated epiphysis of other specified bone Class II

- 7950 Open reduction of separated epiphysis, unspecified site Class II
- 7959 Open reduction of separated epiphysis of other specified bone Class II
- 7960 Debridement of open fracture, unspecified site Class II
- 7969 Debridement of open fracture of other specified bone Class II
- 7980 Open reduction of dislocation of unspecified site Class II
- 7989 Open reduction of dislocation of other specified site, except tempor Class
II
- 7990 Unspecified operation on bone injury, unspecified site Class II
- 7999 Unspecified operation on bone injury of other specified bone Class II
- 8010 Other arthrotomy, unspecified site Class II
- 8019 Other arthrotomy of other specified site Class II
- 8020 Arthroscopy, unspecified site Class II
- 8021 Arthroscopy of shoulder Class II
- 8022 Arthroscopy of elbow Class II
- 8023 Arthroscopy of wrist Class II
- 8024 Arthroscopy of hand and finger Class II
- 8025 Arthroscopy of hip Class II
- 8026 Arthroscopy of knee Class II
- 8027 Arthroscopy of ankle Class II
- 8028 Arthroscopy of foot and toe Class II
- 8029 Arthroscopy of other specified site Class II
- 8040 Division of joint capsule, ligament, or cartilage, unspecified site Class II
- 8049 Division of joint capsule, ligament, or cartilage of other specified Class II
- 8050 Excision or destruction of intervertebral disc, unspecified Class II
- 8051 Excision of intervertebral disc Class II
- 8059 Other destruction of intervertebral disc Class II
- 8090 Other excision of joint, unspecified site Class II
- 8120 Arthrodesis of unspecified joint Class II
256
- 8129 Arthrodesis of other specified joint Class II

- 8159 Revision of joint replacement of lower extremity, not elsewhere classified
Class II
- 8196 Other repair of joint Class II
- 8197 Revision of joint replacement of upper extremity Class II
- 8198 Other diagnostic procedures on joint structures Class II
- 8199 Other operations on joint structures Class II
- 8429 Other reattachment of extremity Class II
- 8440 Implantation or fitting of prosthetic limb device, not otherwise specified
Class II
- 8492 Separation of equal conjoined twins Class I
- 8493 Separation of unequal conjoined twins Class I
- 8499 Other operations on musculoskeletal system Class II
257
M-1-70 PROSEDUR LUTUT DAN

TUNGKAI BAWAH SELAIN KAKI
- 7706 Sequestrectomy of patella Class II
- 7707 Sequestrectomy of tibia and fibula Class II
- 7726 Wedge osteotomy of patella Class II
- 7727 Wedge osteotomy of tibia and fibula Class II
- 7736 Other division of patella Class II
- 7737 Other division of tibia and fibula Class II
- 7786 Other partial ostectomy of patella Class II
- 7787 Other partial ostectomy of tibia and fibula Class II
- 7796 Total ostectomy of patella Class II
- 7797 Total ostectomy of tibia and fibula Class II
- 7806 Bone graft of patella Class II
- 7807 Bone graft of tibia and fibula Class II
- 7816 Application of external fixation device, patella Class II
- 7817 Application of external fixation device, tibia and fibula Class II
- 7827 Limb shortening procedures, tibia and fibula Class II
- 7837 Limb lengthening procedures, tibia and fibula Class II
- 7846 Other repair or plastic operations on patella Class II
- 7847 Other repair or plastic operations on tibia and fibula Class II
- 7856 Internal fixation of bone without fracture reduction on patella Class II
- 7857 Internal fixation of bone without fracture reduction on tibia and fibula
Class II
- 7876 Osteoclasis of patella Class II
- 7877 Osteoclasis of tibia and fibula Class II
- 7896 Insertion of bone growth stimulator into patella Class II
- 7897 Insertion of bone growth stimulator into tibia and fibula Class II
258
- 7916 Closed reduction of fracture with internal fixation, tibia and fibula Class II
- 7926 Open reduction of fracture without internal fixation, tibia and fibula Class
II
- 7936 Open reduction of fracture with internal fixation, tibia and fibula Class II
- 7946 Closed reduction of separated epiphysis of tibia and fibula Class II
- 7956 Open reduction of separated epiphysis of tibia and fibula Class II
- 7966 Debridement of open fracture of tibia and fibula Class II
- 7986 Open reduction of dislocation of knee Class II
- 7987 Open reduction of dislocation of ankle Class II
- 7996 Unspecified operation on bone injury of tibia and fibula Class II
- 7997 Unspecified operation on bone injury of tarsals and metatarsals Class II
- 8016 Other arthrotomy of knee Class II
- 8017 Other arthrotomy of ankle Class II
- 8046 Division of joint capsule, ligament, or cartilage of knee Class II
- 8047 Division of joint capsule, ligament, or cartilage of ankle Class II
- 806 Excision of semilunar cartilage of knee Class II
- 8076 Synovectomy of knee Class II
- 8077 Synovectomy of ankle Class II
- 8087 Other local excision or destruction of lesion of ankle joint Class II
- 8096 Other excision of knee joint Class II
- 8097 Other excision of ankle joint Class II
- 8099 Other excision of joint of other specified site Class II
- 8111 Ankle fusion Class II
- 8112 Triple arthrodesis Class II
- 8122 Arthrodesis of knee Class II
- 8142 Five-in-one repair of knee Class II
- 8143 Triad knee repair Class II
- 8144 Patellar stabilization Class II
- 8145 Other repair of the cruciate ligaments Class II
259
- 8146 Other repair of the collateral ligaments Class II

- 8147 Other repair of knee Class II
- 8149 Other repair of ankle Class II
- 8448 Implantation of prosthetic device of leg Class II
260
M-1-80 PROSEDUR ANGGOTA

TUBUH ATAS
- 7702 Sequestrectomy of humerus Class II
- 7703 Sequestrectomy of radius and ulna Class II
- 7704 Sequestrectomy of carpals and metacarpals Class II
- 7714 Other incision of bone without division, carpus and metacarpus Class II
- 7722 Wedge osteotomy of humerus Class II
- 7723 Wedge osteotomy of radius and ulna Class II
- 7724 Wedge osteotomy of carpals and metacarpals Class II
- 7732 Other division of humerus Class II
- 7733 Other division of radius and ulna Class II
- 7734 Other division of carpals and metacarpals Class II
- 7764 Local excision of lesion or tissue of carpals and metacarpals Class II
- 7774 Excision of bone for graft, carpus and metacarpus Class II
- 7782 Other partial ostectomy of humerus Class II
- 7783 Other partial ostectomy of radius and ulna Class II
- 7784 Other partial ostectomy of carpals and metacarpals Class II
- 7792 Total ostectomy of humerus Class II
- 7793 Total ostectomy of radius and ulna Class II
- 7794 Total ostectomy of carpals and metacarpals Class II
- 7802 Bone graft of humerus Class II
- 7803 Bone graft of radius and ulna Class II
- 7804 Bone graft of carpals and metacarpals Class II
- 7812 Application of external fixation device, humerus Class II
- 7813 Application of external fixation device, radius and ulna Class II
- 7814 Application of external fixation device, carpals and metacarpals Class II
- 7822 Limb shortening procedures, humerus Class II
261
- 7823 Limb shortening procedures, radius and ulna Class II

- 7824 Limb shortening procedures, carpals and metacarpals Class II
- 7832 Limb lengthening procedures, humerus Class II
- 7833 Limb lengthening procedures, radius and ulna Class II
- 7834 Limb lengthening procedures, carpals and metacarpals Class II
- 7842 Other repair or plastic operation on humerus Class II
- 7843 Other repair or plastic operations on radius and ulna Class II
- 7844 Other repair or plastic operations on carpals and metacarpals Class II
- 7852 Internal fixation of bone without fracture reduction on humerus Class II
- 7853 Internal fixation of bone without fracture reduction on radius and ulna
Class II
- 7854 Internal fixation of bone without fracture reductionon carpals and
metacarpals Class II
- 7872 Osteoclasis of humerus Class II
- 7873 Osteoclasis of radius and ulna Class II
- 7874 Osteoclasis of carpals and metacarpals Class II
- 7884 Diagnostic procedures on carpals and metacarpals, not elsewhere
classified Class II
- 7892 Insertion of bone growth stimulator into humerus Class II
- 7893 Insertion of bone growth stimulator into radius and ulna Class II
- 7894 Insertion of bone growth stimulator into carpals and metacarpals Class II
- 7911 Closed reduction of fracture with internal fixation, humerus Class II
- 7912 Closed reduction of fracture with internal fixation, radius and ulna Class
II
- 7913 Closed reduction of fracture with internal fixation, carpals and
- 7914 Closed reduction of fracture with internal fixation,phalanges of hand
Class II
- 7921 Open reduction of fracture without internal fixation, humerus Class II
- 7922 Open reduction of fracture without internal fixation, radius and ulna
Class II
262
- 7923 Open reduction of fracture without internal fixation, carpals and

- 7924 Open reduction of fracture without internal fixation, phalanges of hand
Class II
- 7931 Open reduction of fracture with internal fixation, humerus Class II
- 7932 Open reduction of fracture with internal fixation, radius and ulna Class II
- 7933 Open reduction of fracture with internal fixation, carpals and
- 7934 Open reduction of fracture with internal fixation, phalanges of hand Class
II
- 7941 Closed reduction of separated epiphysis of humerus Class II
- 7942 Closed reduction of separated epiphysis of radius and ulna Class II
- 7951 Open reduction of separated epiphysis of humerus Class II
- 7952 Open reduction of separated epiphysis of radius and ulna Class II
- 7961 Debridement of open fracture of humerus Class II
- 7962 Debridement of open fracture of radius and ulna Class II
- 7963 Debridement of open fracture of carpals and metacarpals Class II
- 7964 Debridement of open fracture of phalanges of hand Class II
- 7981 Open reduction of dislocation of shoulder Class II
- 7982 Open reduction of dislocation of elbow Class II
- 7983 Open reduction of dislocation of wrist Class II
- 7984 Open reduction of dislocation of hand and finger Class II
- 7991 Unspecified operation on bone injury of humerus Class II
- 7992 Unspecified operation on bone injury of radius and ulna Class II
- 7993 Unspecified operation on bone injury of carpals and metacarpals Class II
- 7994 Unspecified operation on bone injury of phalanges of hand Class II
- 8011 Other arthrotomy of shoulder Class II
- 8012 Other arthrotomy of elbow Class II
- 8013 Other arthrotomy of wrist Class II
- 8014 Other arthrotomy of hand and finger Class II
263
- 8041 Division of joint capsule, ligament, or cartilage of shoulder Class II

- 8042 Division of joint capsule, ligament, or cartilage of elbow Class II
- 8043 Division of joint capsule, ligament, or cartilage of wrist Class II
- 8044 Division of joint capsule, ligament, or cartilage of hand and finger Class II
- 8071 Synovectomy of shoulder Class II
- 8072 Synovectomy of elbow Class II
- 8073 Synovectomy of wrist Class II
- 8074 Synovectomy of hand and finger Class II
- 8083 Other local excision or destruction of lesion of wrist joint Class II
- 8084 Other local excision or destruction of lesion of joint of hand and finger
Class II
- 8091 Other excision of shoulder joint Class II
- 8092 Other excision of elbow joint Class II
- 8093 Other excision of wrist joint Class II
- 8094 Other excision of joint of hand and finger Class II
- 8123 Arthrodesis of shoulder Class II
- 8124 Arthrodesis of elbow Class II
- 8125 Carporadial fusion Class II
- 8126 Metacarpocarpal fusion Class II
- 8127 Metacarpophalangeal fusion Class II
- 8128 Interphalangeal fusion Class II
- 8171 Arthroplasty of metacarpophalangeal and interphalangeal joint with
implant Class II
- 8172 Arthroplasty of metacarpophalangeal and interphalangeal joint without
implant Class II
- 8174 Arthroplasty of carpocarpal or carpometacarpal joint with implant Class II
- 8175 Arthroplasty of carpocarpal or carpometacarpal joint without implant
Class II
- 8179 Other repair of hand, fingers, and wrist Class II
- 8182 Repair of recurrent dislocation of shoulder Class II
264
- 8183 Other repair of shoulder Class II

- 8185 Other repair of elbow Class II
- 8193 Suture of capsule or ligament of upper extremity Class II
- 8201 Exploration of tendon sheath of hand Class II
- 8202 Myotomy of hand Class II
- 8203 Bursotomy of hand Class II
- 8209 Other incision of soft tissue of hand Class II
- 8211 Tenotomy of hand Class II
- 8212 Fasciotomy of hand Class II
- 8219 Other division of soft tissue of hand Class II
- 8221 Excision of lesion of tendon sheath of hand Class II
- 8222 Excision of lesion of muscle of hand Class II
- 8229 Excision of other lesion of soft tissue of hand Class II
- 8231 Bursectomy of hand Class II
- 8232 Excision of tendon of hand for graft Class II
- 8233 Other tenonectomy of hand Class II
- 8234 Excision of muscle or fascia of hand for graft Class II
- 8235 Other fasciectomy of hand Class II
- 8236 Other myectomy of hand Class II
- 8239 Other excision of soft tissue of hand Class II
- 8241 Suture of tendon sheath of hand Class II
- 8242 Delayed suture of flexor tendon of hand Class II
- 8243 Delayed suture of other tendon of hand Class II
- 8244 Other suture of flexor tendon of hand Class II
- 8245 Other suture of other tendon of hand Class II
- 8246 Suture of muscle or fascia of hand Class II
- 8251 Advancement of tendon of hand Class II
- 8252 Recession of tendon of hand Class II
265
- 8253 Reattachment of tendon of hand Class II

- 8254 Reattachment of muscle of hand Class II
- 8255 Other change in muscle or tendon length of hand Class II
- 8256 Other hand tendon transfer or transplantation Class II
- 8257 Other hand tendon transposition Class II
- 8258 Other hand muscle transfer or transplantation Class II
- 8259 Other hand muscle transposition Class II
- 8261 Pollicization operation carrying over nerves and blood supply Class II
- 8269 Other reconstruction of thumb Class II
- 8272 Plastic operation on hand with graft of muscle or fascia Class II
- 8279 Plastic operation on hand with other graft or implant Class II
- 8281 Transfer of finger, except thumb Class II
- 8282 Repair of cleft hand Class II
- 8283 Repair of macrodactyly Class II
- 8284 Repair of mallet finger Class II
- 8285 Other tenodesis of hand Class II
- 8286 Other tenoplasty of hand Class II
- 8289 Other plastic operations on hand Class II
- 8291 Lysis of adhesions of hand Class II
- 8299 Other operations on muscle, tendon, and fascia of hand Class II
- 8363 Rotator cuff repair Class II
- 8401 Amputation and disarticulation of finger Class II
- 8402 Amputation and disarticulation of thumb Class II
- 8421 Thumb reattachment Class II
- 8422 Finger reattachment Class II
- 8444 Implantation of prosthetic device of arm Class II
- 8685 Correction of syndactyly Class II
266
267
M-2-10 PROSEDUR REKONTRUKSI

TULANG KRANIAL DAN WAJAH
- 7639 Partial ostectomy of other facial bone Class II
- 7641 Total mandibulectomy with synchronous reconstruction Class II
- 7643 Other reconstruction of mandible Class II
- 7644 Total ostectomy of other facial bone with synchronous reconstruction
Class II
- 7645 Other total ostectomy of other facial bone Class II
- 7646 Other reconstruction of other facial bone Class II
- 7661 Closed osteoplasty (osteotomy) of mandibular ramus Class II
- 7662 Open osteoplasty (osteotomy) of mandibular ramus Class II
- 7663 Osteoplasty (osteotomy) of body of mandible Class II
- 7664 Other orthognathic surgery on mandible Class II
- 7665 Segmental osteoplasty (osteotomy) of maxilla Class II
- 7666 Total osteoplasty (osteotomy) of maxilla Class II
- 7667 Reduction genioplasty Class II
- 7668 Augmentation genioplasty Class II
268
M-2-21 PROSEDUR BESAR PADA

SENDI PANGGUL DAN PAHA
- 7805 Bone graft of femur Class II
- 7825 Limb shortening procedures, femur Class II
- 7835 Limb lengthening procedures, femur Class II
- 7855 Internal fixation of bone without fracture reduction on femur Class II
- 7925 Open reduction of fracture without internal fixation, femur Class II
- 7935 Open reduction of fracture with internal fixation, femur Class II
- 7955 Open reduction of separated epiphysis of femur Class II
- 7965 Debridement of open fracture of femur Class II
- 7985 Open reduction of dislocation of hip Class II
- 8015 Other arthrotomy of hip Class II
269
M-2-22 PROSEDUR KECIL PADA

SENDI PANGGUL DAN PAHA
- 7705 Sequestrectomy of femur Class II
- 7725 Wedge osteotomy of femur Class II
- 7735 Other division of femur Class II
- 7785 Other partial ostectomy of femur Class II
- 7795 Total ostectomy of femur Class II
- 7815 Application of external fixation device, femur Class II
- 7845 Other repair or plastic operations on femur Class II
- 7875 Osteoclasis of femur Class II
- 7895 Insertion of bone growth stimulator into femur Class II
- 7915 Closed reduction of fracture with internal fixation, femur Class II
- 7945 Closed reduction of separated epiphysis of femur Class II
- 7995 Unspecified operation on bone injury of femur Class II
- 8045 Division of joint capsule, ligament, or cartilage of hip Class II
- 8075 Synovectomy of hip Class II
- 8095 Other excision of hip joint Class II
- 8121 Arthrodesis of hip Class II
- 8140 Repair of hip, not elsewhere classified Class II
- 8312 Adductor tenotomy of hip Class II
270
M-2-31 PROSEDUR BUNION

- 7751 Bunionectomy with soft tissue correction and osteotomy of the first
metatarsal Class II
- 7752 Bunionectomy with soft tissue correction and arthrodesis Class II
- 7753 Other bunionectomy with soft tissue correction Class II
- 7754 Excision or correction of bunionette Class II
- 7756 Repair of hammer toe Class II
- 7757 Repair of claw toe Class II
- 7758 Other excision, fusion, and repair of toes Class II
- 7759 Other bunionectomy Class II
271
M-2-32 PROSEDUR LAIN-LAIN PADA

KAKI
- 0444 Release of tarsal tunnel Class II
- 7708 Sequestrectomy of tarsals and metatarsals Class II
- 7718 Other incision of bone without division, tarsals and metatarsals Class II
- 7728 Wedge osteotomy of tarsals and metatarsals Class II
- 7738 Other division of tarsals and metatarsals Class II
- 7768 Local excision of lesion or tissue of tarsals and metatarsals Class II
- 7778 Excision of bone for graft, tarsals and metatarsals Class II
- 7788 Other partial ostectomy of tarsals and metatarsals Class II
- 7798 Total ostectomy of tarsals and metatarsals Class II
- 7808 Bone graft of tarsals and metatarsals Class II
- 7818 Application of external fixation device, tarsals and metatarsals Class II
- 7828 Limb shortening procedures, tarsals and metatarsals Class II
- 7838 Limb lengthening procedures, tarsals and metatarsals Class II
- 7848 Other repair or plastic operations on tarsals and metatarsals Class II
- 7858 Internal fixation of bone without fracture reduction on tarsals and
- 7878 Osteoclasis of tarsals and metatarsals Class II
- 7888 Diagnostic procedures on tarsals and metatarsals, not elsewhere
classified Class II
- 7898 Insertion of bone growth stimulator into tarsals and metatarsals Class II
- 7917 Closed reduction of fracture with internal fixation, tarsals and
- 7918 Closed reduction of fracture with internal fixation, phalanges of foot
Class II
- 7927 Open reduction of fracture without internal fixation, tarsals and
272
- 7928 Open reduction of fracture without internal fixation, phalanges of foot

Class II
- 7937 Open reduction of fracture with internal fixation, tarsals and metatarsals
Class II
- 7938 Open reduction of fracture with internal fixation, phalanges of foot Class
II
- 7967 Debridement of open fracture of tarsals and metatarsals Class II
- 7968 Debridement of open fracture of phalanges of foot Class II
- 7988 Open reduction of dislocation of foot and toe Class II
- 7998 Unspecified operation on bone injury of phalanges of foot Class II
- 8018 Other arthrotomy of foot and toe Class II
- 8048 Division of joint capsule, ligament, or cartilage of foot and toe Class II
- 8078 Synovectomy of foot and toe Class II
- 8088 Other local excision or destruction of lesion of joint of foot and toe Class
II
- 8098 Other excision of joint of foot and toe Class II
- 8113 Subtalar fusion Class II
- 8114 Midtarsal fusion Class II
- 8115 Tarsometatarsal fusion Class II
- 8116 Metatarsophalangeal fusion Class II
- 8117 Other fusion of foot Class II
- 8157 Replacement of joint of foot and toe Class II
- 8194 Suture of capsule or ligament of ankle and foot Class II
- 8311 Achillotenotomy Class II
- 8384 Release of clubfoot, not elsewhere classified Class II
- 8411 Amputation of toe Class II
- 8425 Toe reattachment Class II
273
M-2-41 PROSEDUR EKSISI, INSISI

DAN ARTHROTOMI TULANG
- 7710 Other incision of bone without division, unspecified site Class II
- 7712 Other incision of bone without division, humerus Class II
- 7713 Other incision of bone without division, radius and ulna Class II
- 7715 Other incision of bone without division, femur Class II
- 7716 Other incision of bone without division, patella Class II
- 7717 Other incision of bone without division, tibia and fibula Class II
- 7719 Other incision of bone without division, other specified bone Class II
- 7760 Local excision of lesion or tissue of bone, unspecified site Class II
- 7762 Local excision of lesion or tissue of humerus Class II
- 7763 Local excision of lesion or tissue of radius and ulna Class II
- 7765 Local excision of lesion or tissue of femur Class II
- 7766 Local excision of lesion or tissue of patella Class II
- 7767 Local excision of lesion or tissue of tibia and fibula Class II
- 7769 Local excision of lesion or tissue of other specified bone Class II
- 7770 Excision of bone for graft, unspecified site Class II
- 7772 Excision of bone for graft, humerus Class II
- 7773 Excision of bone for graft, radius and ulna Class II
- 7775 Excision of bone for graft, femur Class II
- 7776 Excision of bone for graft, patella Class II
- 7777 Excision of bone for graft, tibia and fibula Class II
- 7779 Excision of bone for graft, other specified bone Class II
- 8000 Arthrotomy for removal of prosthesis, unspecified site Class II
- 8001 Arthrotomy for removal of prosthesis of shoulder Class II
- 8002 Arthrotomy for removal of prosthesis of elbow Class II
- 8003 Arthrotomy for removal of prosthesis of wrist Class II
274
- 8004 Arthrotomy for removal of prosthesis of hand and finger Class II

- 8006 Arthrotomy for removal of prosthesis of knee Class II
- 8007 Arthrotomy for removal of prosthesis of ankle Class II
- 8008 Arthrotomy for removal of prosthesis of foot and toe Class II
- 8009 Arthrotomy for removal of prosthesis of other specified site Class II
- 8080 Other local excision or destruction of lesion of joint, unspecified Class II
- 8081 Other local excision or destruction of lesion of shoulder joint Class II
- 8082 Other local excision or destruction of lesion of elbow joint Class II
- 8085 Other local excision or destruction of lesion of hip joint Class II
- 8086 Other local excision or destruction of lesion of knee joint Class II
- 8089 Other local excision or destruction of lesion of joint of other specified site
Class II
275
M-2-42 PROSEDUR PEMINDAHAN

ALAT IMPLAN
- 7860 Removal of implanted device, unspecified site Class II
- 7862 Removal of implanted device from humerus Class II
- 7863 Removal of implanted device from radius and ulna Class II
- 7864 Removal of implanted device from carpals and metacarpals Class II
- 7865 Removal of implanted device from femur Class II
- 7866 Removal of implanted device from patella Class II
- 7867 Removal of implanted device from tibia and fibula Class II
- 7868 Removal of implanted device from tarsal and metatarsals Class II
- 7869 Removal of implanted device from other bone, except facial bone Class II
276

JARINGAN LUNAK
- 8371 Advancement of tendon Class II
- 8372 Recession of tendon Class II
- 8373 Reattachment of tendon Class II
- 8374 Reattachment of muscle Class II
- 8375 Tendon transfer or transplantation Class II
- 8376 Other tendon transposition Class II
- 8377 Muscle transfer or transplantation Class II
- 8379 Other muscle transposition Class II
- 8381 Tendon graft Class II
- 8382 Graft of muscle or fascia Class II
- 8385 Other change in muscle or tendon length Class II
- 8386 Quadricepsplasty Class II
- 8387 Other plastic operations on muscle Class II
- 8388 Other plastic operations on tendon Class II
- 8389 Other plastic operations on fascia Class II
- 843 Revision of amputation stump Class II
- 864 Radical excision of skin lesion Class II
277

JARINGAN LUNAK
- 8070 Synovectomy, unspecified site Class II
- 8079 Synovectomy of other specified site Class II
- 8195 Suture of capsule or ligament of other lower extremity Class II
- 8301 Exploration of tendon sheath Class II
- 8302 Myotomy Class II
- 8303 Bursotomy Class II
- 8309 Other incision of soft tissue Class II
- 8313 Other tenotomy Class II
- 8314 Fasciotomy Class II
- 8319 Other division of soft tissue Class II
- 8329 Other diagnostic procedures on muscle, tendon, fascia, and bursa,
including that of hand Class II
- 8331 Excision of lesion of tendon sheath Class II
- 8332 Excision of lesion of muscle Class II
- 8339 Excision of lesion of other soft tissue Class II
- 8341 Excision of tendon for graft Class II
- 8342 Other tenonectomy Class II
- 8343 Excision of muscle or fascia for graft Class II
- 8344 Other fasciectomy Class II
- 8345 Other myectomy Class II
- 8349 Other excision of soft tissue Class II
- 835 Bursectomy Class II
- 8361 Suture of tendon sheath Class II
- 8362 Delayed suture of tendon Class II
- 8364 Other suture of tendon Class II
278
- 8365 Other suture of muscle or fascia Class II

- 8391 Lysis of adhesions of muscle, tendon, fascia, and bursa Class II
- 8392 Insertion or replacement of skeletal muscle stimulator Class II
- 8393 Removal of skeletal muscle stimulator Class II
- 8399 Other operations on muscle, tendon, fascia, and bursa Class II
279
M-2-61 PROSEDUR ARTROSKOPI

- 8020 Arthroscopy, unspecified site Class II
- 8021 Arthroscopy of shoulder Class II
- 8022 Arthroscopy of elbow Class II
- 8023 Arthroscopy of wrist Class II
- 8024 Arthroscopy of hand and finger Class II
- 8025 Arthroscopy of hip Class II
- 8026 Arthroscopy of knee Class II
- 8027 Arthroscopy of ankle Class II
- 8028 Arthroscopy of foot and toe Class II
- 8029 Arthroscopy of other specified site Class II
280
M-2-62 PROSEDUR LAIN-LAIN PADA

SENDI & TULANG
- 0353 Repair of vertebral fracture Class II
- 7820 Limb shortening procedures, unspecified site Class II
- 7829 Limb shortening procedures, other bone except facial bones Class II
- 7830 Limb lengthening procedures, unspecified site Class II
- 7839 Limb lengthening procedures, other bone except facial bones Class II
- 7840 Other repair or plastic operations on bone, unspecified site Class II
- 7849 Other repair or plastic operations on other bone, except facial bone Class
II
- 7850 Internal fixation of bone without fracture reduction, unspecified site
Class II
- 7859 Internal fixation of bone without fracture reduction on other bone, except
facial bone Class II
- 7870 Osteoclasis, unspecified site Class II
- 7879 Osteoclasis of other bone, except facial bone Class II
- 7910 Closed reduction of fracture with internal fixation, unspecified site Class
II
- 7919 Closed reduction of fracture with internal fixation, other specified bone
Class II
- 7920 Open reduction of fracture without internal fixation, unspecified site
Class II
- 7929 Open reduction of fracture without internal fixation, other specified bone
Class II
- 7930 Open reduction of fracture with internal fixation, unspecified site Class II
- 7939 Open reduction of fracture with internal fixation, other specified bone
Class II
- 7940 Closed reduction of separated epiphysis, unspecified site Class II
- 7949 Closed reduction of separated epiphysis of other specified bone Class II
- 7950 Open reduction of separated epiphysis, unspecified site Class II
281
- 7959 Open reduction of separated epiphysis of other specified bone Class II

- 7960 Debridement of open fracture, unspecified site Class II
- 7969 Debridement of open fracture of other specified bone Class II
- 7980 Open reduction of dislocation of unspecified site Class II
- 7989 Open reduction of dislocation of other specified site, except tempor Class
II
- 7990 Unspecified operation on bone injury, unspecified site Class II
- 7999 Unspecified operation on bone injury of other specified bone Class II
- 8010 Other arthrotomy, unspecified site Class II
- 8019 Other arthrotomy of other specified site Class II
- 8040 Division of joint capsule, ligament, or cartilage, unspecified site Class II
- 8049 Division of joint capsule, ligament, or cartilage of other specified Class II
- 8050 Excision or destruction of intervertebral disc, unspecified Class II
- 8051 Excision of intervertebral disc Class II
- 8059 Other destruction of intervertebral disc Class II
- 8090 Other excision of joint, unspecified site Class II
- 8120 Arthrodesis of unspecified joint Class II
- 8129 Arthrodesis of other specified joint Class II
- 8159 Revision of joint replacement of lower extremity, not elsewhere classified
Class II
- 8196 Other repair of joint Class II
- 8197 Revision of joint replacement of upper extremity Class II
- 8198 Other diagnostic procedures on joint structures Class II
- 8199 Other operations on joint structures Class II
- 8429 Other reattachment of extremity Class II
282
M-2-63 PROSEDUR INSISI, BIOPSI

DAN GRAFT PADA TULANG
- 7700 Sequestrectomy, unspecified site Class II
- 7709 Sequestrectomy of other bone Class II
- 7720 Wedge osteotomy, unspecified site Class II
- 7729 Wedge osteotomy of other bone Class II
- 7730 Other division of bone, unspecified site Class II
- 7739 Other division of other bone Class II
- 7740 Biopsy of bone, unspecified site Class II
- 7741 Biopsy of scapula, clavicle, and thorax (ribs and sternum) Class II
- 7742 Biopsy of humerus Class II
- 7743 Biopsy of radius and ulna Class II
- 7744 Biopsy of carpals and metacarpals Class II
- 7745 Biopsy of femur Class II
- 7746 Biopsy of patella Class II
- 7747 Biopsy of tibia and fibula Class II
- 7748 Biopsy of tarsals and metatarsals Class II
- 7749 Biopsy of other bone Class II
- 7780 Other partial ostectomy, unspecified site Class II
- 7789 Other partial ostectomy of other bone Class II
- 7790 Total ostectomy, unspecified site Class II
- 7799 Total ostectomy of other bone Class II
- 7800 Bone graft, unspecified site Class II
- 7809 Bone graft of other bone except facial bones Class II
- 7810 Application of external fixation device, unspecified site Class II
- 7819 Application of external fixation device, other bone except facial bones
Class II
283
- 7880 Diagnostic procedures on bone, not elsewhere classified, unspecified site

Class II
- 7882 Diagnostic procedures on humerus, not elsewhere classified Class II
- 7883 Diagnostic procedures on radius and ulna, not elsewhere classified Class
II
- 7885 Diagnostic procedures on femur, not elsewhere classified Class II
- 7886 Diagnostic procedures on patella, not elsewhere classified Class II
- 7887 Diagnostic procedures on tibia and fibula, not elsewhere classified Class
II
- 7889 Diagnostic procedures on other bone, not elsewhere classified Class II
- 7890 Insertion of bone growth stimulator, unspecified site Class II
- 7899 Insertion of bone growth stimulator into other bone, except facial bone
Class II
- 8440 Implantation or fitting of prosthetic limb device, not otherwise specified
Class II
- 8499 Other operations on musculoskeletal system Class II
284

TULANG KEPALA & WAJAH
- 7631 Partial mandibulectomy Class II
- 7642 Other total mandibulectomy Class II
- 765 Temporomandibular arthroplasty Class II
- 7672 Open reduction of malar and zygomatic fracture Class II
- 7674 Open reduction of maxillary fracture Class II
- 7676 Open reduction of mandibular fracture Class II
- 7679 Other open reduction of facial fracture Class II
- 7691 Bone graft to facial bone Class II
- 7692 Insertion of synthetic implant in facial bone Class II
- 7694 Open reduction of temporomandibular dislocation Class II
285

TULANG KEPALA & WAJAH
- 0115 Biopsy of skull Class II
- 0119 Other diagnostic procedures on skull Class II
- 7601 Sequestrectomy of facial bone Class II
- 7609 Other incision of facial bone Class II
- 7611 Biopsy of facial bone Class II
- 7619 Other diagnostic procedures on facial bones and joints Class II
- 762 Local excision or destruction of lesion of facial bone Class II
- 7669 Other facial bone repair Class II
- 7670 Reduction of facial fracture, not otherwise specified Class II
- 7677 Open reduction of alveolar fracture Class II
- 7697 Removal of internal fixation device from facial bone Class II
- 7699 Other operations on facial bones and joints Class II
286

LUTUT & TUNGKAI BAWAH
- 7726 Wedge osteotomy of patella Class II
- 7727 Wedge osteotomy of tibia and fibula Class II
- 7737 Other division of tibia and fibula Class II
- 7786 Other partial ostectomy of patella Class II
- 7787 Other partial ostectomy of tibia and fibula Class II
- 7796 Total ostectomy of patella Class II
- 7797 Total ostectomy of tibia and fibula Class II
- 7806 Bone graft of patella Class II
- 7807 Bone graft of tibia and fibula Class II
- 7827 Limb shortening procedures, tibia and fibula Class II
- 7837 Limb lengthening procedures, tibia and fibula Class II
- 7846 Other repair or plastic operations on patella Class II
- 7847 Other repair or plastic operations on tibia and fibula Class II
- 7856 Internal fixation of bone without fracture reduction on patella Class II
- 7857 Internal fixation of bone without fracture reduction on tibia and fibula
Class II
- 7876 Osteoclasis of patella Class II
- 7877 Osteoclasis of tibia and fibula Class II
- 7926 Open reduction of fracture without internal fixation, tibia and fibula Class
II
- 7936 Open reduction of fracture with internal fixation, tibia and fibula Class II
- 7946 Closed reduction of separated epiphysis of tibia and fibula Class II
- 7956 Open reduction of separated epiphysis of tibia and fibula Class II
- 7966 Debridement of open fracture of tibia and fibula Class II
- 7986 Open reduction of dislocation of knee Class II
- 7987 Open reduction of dislocation of ankle Class II
287
- 8016 Other arthrotomy of knee Class II

- 8017 Other arthrotomy of ankle Class II
- 806 Excision of semilunar cartilage of knee Class II
- 8076 Synovectomy of knee Class II
- 8077 Synovectomy of ankle Class II
- 8096 Other excision of knee joint Class II
- 8097 Other excision of ankle joint Class II
- 8099 Other excision of joint of other specified site Class II
- 8111 Ankle fusion Class II
- 8112 Triple arthrodesis Class II
- 8122 Arthrodesis of knee Class II
- 8142 Five-in-one repair of knee Class II
- 8143 Triad knee repair Class II
- 8144 Patellar stabilization Class II
- 8145 Other repair of the cruciate ligaments Class II
- 8146 Other repair of the collateral ligaments Class II
- 8147 Other repair of knee Class II
- 8149 Other repair of ankle Class II
288

LUTUT & TUNGKAI BAWAH
- 7706 Sequestrectomy of patella Class II
- 7707 Sequestrectomy of tibia and fibula Class II
- 7736 Other division of patella Class II
- 7816 Application of external fixation device, patella Class II
- 7817 Application of external fixation device, tibia and fibula Class II
- 7896 Insertion of bone growth stimulator into patella Class II
- 7897 Insertion of bone growth stimulator into tibia and fibula Class II
- 7916 Closed reduction of fracture with internal fixation, tibia and fibula Class II
- 7996 Unspecified operation on bone injury of tibia and fibula Class II
- 7997 Unspecified operation on bone injury of tarsals and metatarsals Class II
- 8046 Division of joint capsule, ligament, or cartilage of knee Class II
- 8047 Division of joint capsule, ligament, or cartilage of ankle Class II
- 8087 Other local excision or destruction of lesion of ankle joint Class II
- 8448 Implantation of prosthetic device of leg Class II
289

LENGAN, SIKU & BAHU
- 7782 Other partial ostectomy of humerus Class II
- 7783 Other partial ostectomy of radius and ulna Class II
- 7792 Total ostectomy of humerus Class II
- 7793 Total ostectomy of radius and ulna Class II
- 7802 Bone graft of humerus Class II
- 7803 Bone graft of radius and ulna Class II
- 7822 Limb shortening procedures, humerus Class II
- 7823 Limb shortening procedures, radius and ulna Class II
- 7832 Limb lengthening procedures, humerus Class II
- 7833 Limb lengthening procedures, radius and ulna Class II
- 7842 Other repair or plastic operation on humerus Class II
- 7843 Other repair or plastic operations on radius and ulna Class II
- 7852 Internal fixation of bone without fracture reduction on humerus Class II
- 7853 Internal fixation of bone without fracture reduction on radius and ulna
Class II
- 7921 Open reduction of fracture without internal fixation, humerus Class II
- 7922 Open reduction of fracture without internal fixation, radius and ulna
Class II
- 7931 Open reduction of fracture with internal fixation, humerus Class II
- 7932 Open reduction of fracture with internal fixation, radius and ulna Class II
- 7951 Open reduction of separated epiphysis of humerus Class II
- 7952 Open reduction of separated epiphysis of radius and ulna Class II
- 7961 Debridement of open fracture of humerus Class II
- 7962 Debridement of open fracture of radius and ulna Class II
- 8091 Other excision of shoulder joint Class II
- 8092 Other excision of elbow joint Class II
290
- 8123 Arthrodesis of shoulder Class II

- 8124 Arthrodesis of elbow Class II
- 8182 Repair of recurrent dislocation of shoulder Class II
- 8183 Other repair of shoulder Class II
- 8185 Other repair of elbow Class II
- 8363 Rotator cuff repair Class II
291

LENGAN, SIKU & BAHU
- 7702 Sequestrectomy of humerus Class II
- 7703 Sequestrectomy of radius and ulna Class II
- 7722 Wedge osteotomy of humerus Class II
- 7723 Wedge osteotomy of radius and ulna Class II
- 7732 Other division of humerus Class II
- 7733 Other division of radius and ulna Class II
- 7812 Application of external fixation device, humerus Class II
- 7813 Application of external fixation device, radius and ulna Class II
- 7872 Osteoclasis of humerus Class II
- 7873 Osteoclasis of radius and ulna Class II
- 7892 Insertion of bone growth stimulator into humerus Class II
- 7893 Insertion of bone growth stimulator into radius and ulna Class II
- 7911 Closed reduction of fracture with internal fixation, humerus Class II
- 7912 Closed reduction of fracture with internal fixation, radius and ulna Class
II
- 7924 Open reduction of fracture without internal fixation, phalanges of hand
Class II
- 7941 Closed reduction of separated epiphysis of humerus Class II
- 7942 Closed reduction of separated epiphysis of radius and ulna Class II
- 7981 Open reduction of dislocation of shoulder Class II
- 7982 Open reduction of dislocation of elbow Class II
- 7991 Unspecified operation on bone injury of humerus Class II
- 7992 Unspecified operation on bone injury of radius and ulna Class II
- 8011 Other arthrotomy of shoulder Class II
- 8012 Other arthrotomy of elbow Class II
- 8041 Division of joint capsule, ligament, or cartilage of shoulder Class II
292
- 8042 Division of joint capsule, ligament, or cartilage of elbow Class II

- 8071 Synovectomy of shoulder Class II
- 8072 Synovectomy of elbow Class II
- 8193 Suture of capsule or ligament of upper extremity Class II
- 8444 Implantation of prosthetic device of arm Class II
293

TANGAN & PERGELANGAN TANGAN
- 7784 Other partial ostectomy of carpals and metacarpals Class II
- 7794 Total ostectomy of carpals and metacarpals Class II
- 7804 Bone graft of carpals and metacarpals Class II
- 7834 Limb lengthening procedures, carpals and metacarpals Class II
- 7844 Other repair or plastic operations on carpals and metacarpals Class II
- 7854 Internal fixation of bone without fracture reductionon carpals and
- 7923 Open reduction of fracture without internal fixation, carpals and
- 7933 Open reduction of fracture with internal fixation, carpals and
- 7963 Debridement of open fracture of carpals and metacarpals Class II
- 7964 Debridement of open fracture of phalanges of hand Class II
- 7983 Open reduction of dislocation of wrist Class II
- 8093 Other excision of wrist joint Class II
- 8094 Other excision of joint of hand and finger Class II
- 8125 Carporadial fusion Class II
- 8126 Metacarpocarpal fusion Class II
- 8127 Metacarpophalangeal fusion Class II
- 8171 Arthroplasty of metacarpophalangeal and interphalangeal joint with
implant Class II
- 8174 Arthroplasty of carpocarpal or carpometacarpal joint with implant Class II
- 8175 Arthroplasty of carpocarpal or carpometacarpal joint without implant
Class II
- 8229 Excision of other lesion of soft tissue of hand Class II
- 8234 Excision of muscle or fascia of hand for graft Class II
- 8242 Delayed suture of flexor tendon of hand Class II
294
- 8243 Delayed suture of other tendon of hand Class II

- 8253 Reattachment of tendon of hand Class II
- 8254 Reattachment of muscle of hand Class II
- 8256 Other hand tendon transfer or transplantation Class II
- 8261 Pollicization operation carrying over nerves and blood supply Class II
- 8269 Other reconstruction of thumb Class II
- 8272 Plastic operation on hand with graft of muscle or fascia Class II
- 8279 Plastic operation on hand with other graft or implant Class II
- 8281 Transfer of finger, except thumb Class II
- 8282 Repair of cleft hand Class II
- 8283 Repair of macrodactyly Class II
- 8289 Other plastic operations on hand Class II
- 8291 Lysis of adhesions of hand Class II
- 8401 Amputation and disarticulation of finger Class II
- 8421 Thumb reattachment Class II
- 8422 Finger reattachment Class II
- 8685 Correction of syndactyly Class II
295

TANGAN & PERGELANGAN TANGAN
- 7704 Sequestrectomy of carpals and metacarpals Class II
- 7714 Other incision of bone without division, carpus and metacarpus Class II
- 7724 Wedge osteotomy of carpals and metacarpals Class II
- 7734 Other division of carpals and metacarpals Class II
- 7764 Local excision of lesion or tissue of carpals and metacarpals Class II
- 7774 Excision of bone for graft, carpus and metacarpus Class II
- 7814 Application of external fixation device, carpals and metacarpals Class II
- 7824 Limb shortening procedures, carpals and metacarpals Class II
- 7874 Osteoclasis of carpals and metacarpals Class II
- 7884 Diagnostic procedures on carpals and metacarpals, not elsewhere
classified Class II
- 7894 Insertion of bone growth stimulator into carpals and metacarpals Class II
- 7913 Closed reduction of fracture with internal fixation, carpals and
- 7914 Closed reduction of fracture with internal fixation,phalanges of hand
Class II
- 7934 Open reduction of fracture with internal fixation, phalanges of hand Class
II
- 7984 Open reduction of dislocation of hand and finger Class II
- 7993 Unspecified operation on bone injury of carpals and metacarpals Class II
- 7994 Unspecified operation on bone injury of phalanges of hand Class II
- 8013 Other arthrotomy of wrist Class II
- 8014 Other arthrotomy of hand and finger Class II
- 8043 Division of joint capsule, ligament, or cartilage of wrist Class II
- 8044 Division of joint capsule, ligament, or cartilage of hand and finger Class II
- 8073 Synovectomy of wrist Class II
- 8074 Synovectomy of hand and finger Class II
296
- 8083 Other local excision or destruction of lesion of wrist joint Class II

- 8084 Other local excision or destruction of lesion of joint of hand and finger
Class II
- 8128 Interphalangeal fusion Class II
- 8172 Arthroplasty of metacarpophalangeal and interphalangeal joint without
implant Class II
- 8179 Other repair of hand, fingers, and wrist Class II
- 8201 Exploration of tendon sheath of hand Class II
- 8202 Myotomy of hand Class II
- 8203 Bursotomy of hand Class II
- 8209 Other incision of soft tissue of hand Class II
- 8211 Tenotomy of hand Class II
- 8212 Fasciotomy of hand Class II
- 8219 Other division of soft tissue of hand Class II
- 8221 Excision of lesion of tendon sheath of hand Class II
- 8222 Excision of lesion of muscle of hand Class II
- 8231 Bursectomy of hand Class II
- 8232 Excision of tendon of hand for graft Class II
- 8233 Other tenonectomy of hand Class II
- 8235 Other fasciectomy of hand Class II
- 8236 Other myectomy of hand Class II
- 8239 Other excision of soft tissue of hand Class II
- 8241 Suture of tendon sheath of hand Class II
- 8244 Other suture of flexor tendon of hand Class II
- 8245 Other suture of other tendon of hand Class II
- 8246 Suture of muscle or fascia of hand Class II
- 8251 Advancement of tendon of hand Class II
- 8252 Recession of tendon of hand Class II
- 8255 Other change in muscle or tendon length of hand Class II
297
- 8257 Other hand tendon transposition Class II

- 8258 Other hand muscle transfer or transplantation Class II
- 8259 Other hand muscle transposition Class II
- 8284 Repair of mallet finger Class II
- 8285 Other tenodesis of hand Class II
- 8286 Other tenoplasty of hand Class II
- 8299 Other operations on muscle, tendon, and fascia of hand Class II
- 8402 Amputation and disarticulation of thumb Class II
298
M-3-10 PROSEDUR MANIPULATIVE

OSTEOPATHIC
- 9361 Osteopathic manipulative treatment for general mobilization Class III
- 9362 Osteopathic manipulative treatment using high-velocity, low-amplitude
forces Class III
- 9363 Osteopathic manipulative treatment using low- velocity, high-amplitude
forces Class III
- 9364 Osteopathic manipulative treatment using isotonic, isometric forces
Class III
- 9365 Osteopathic manipulative treatment using indirect forces Class III
- 9366 Osteopathic manipulative treatment to move tissue fluids Class III
- 9367 Other specified osteopathic manipulative treatment Class III
299
M-3-11 PROSEDUR DIAGNOSTIK

DAN TERAPEUTIK
MUSKULOSKELETAL
- 7696 Injection of therapeutic substance into temporomandibular joint Class III
- 8052 Intervertebral chemonucleolysis Class III
- 8191 Arthrocentesis Class III
- 8192 Injection of therapeutic substance into joint or ligament Class III
- 8204 Incision and drainage of palmar or thenar space Class III
- 8292 Aspiration of bursa of hand Class III
- 8293 Aspiration of other soft tissue of hand Class III
- 8294 Injection of therapeutic substance into bursa of hand Class III
- 8295 Injection of therapeutic substance into tendon of hand Class III
- 8296 Other injection of locally-acting therapeutic substance into soft ti Class III
- 8321 Biopsy of soft tissue Class III
- 8394 Aspiration of bursa Class III
- 8395 Aspiration of other soft tissue Class III
- 8396 Injection of therapeutic substance into bursa Class III
- 8397 Injection of therapeutic substance into tendon Class III
- 8398 Injection of locally acting therapeutic substance into other soft tissue
Class III
- 9788 Removal of external immobilization device Class III
- 9789 Removal of other therapeutic device Class V
300
M-3-12 PROSEDUR BIOPSI SENDI

DAN TRAKSI SKELETAL
- 8030 Biopsy of joint structure, unspecified site Class III
- 8031 Biopsy of joint structure of shoulder Class III
- 8032 Biopsy of joint structure of elbow Class III
- 8033 Biopsy of joint structure of wrist Class III
- 8034 Biopsy of joint structure of hand and finger Class III
- 8035 Biopsy of joint structure of hip Class III
- 8036 Biopsy of joint structure of knee Class III
- 8037 Biopsy of joint structure of ankle Class III
- 8038 Biopsy of joint structure of foot and toe Class III
- 8039 Biopsy of joint structure of other specified site Class III
- 9341 Spinal traction using skull device Class III
- 9342 Other spinal traction Class III
- 9343 Intermittent skeletal traction Class III
- 9344 Other skeletal traction Class III
- 9345 Thomas\ splint traction Class III
- 9346 Other skin traction of limbs Class III
301
M-3-13 PROSEDUR REDUKSI

FRAKTUR TERTUTUP
- 7900 Closed reduction of fracture without internal fixation, unspecified site
Class III
- 7901 Closed reduction of fracture without internal fixation, humerus Class III
- 7902 Closed reduction of fracture without internal fixation, radius and ulna
Class III
- 7903 Closed reduction of fracture without internal fixation, carpals and
metacarpals Class III
- 7904 Closed reduction of fracture without internal fixation, phalanges of hand
Class III
- 7905 Closed reduction of fracture without internal fixation, femur Class III
- 7906 Closed reduction of fracture without internal fixation, tibia and fibula
Class III
- 7907 Closed reduction of fracture without internal fixation, tarsals and
metatarsals Class III
- 7908 Closed reduction of fracture without internal fixation, phalanges of foot
Class III
- 7909 Closed reduction of fracture without internal fixation, other specified
bone Class III
- 7970 Closed reduction of dislocation of unspecified site Class III
- 7971 Closed reduction of dislocation of shoulder Class III
- 7972 Closed reduction of dislocation of elbow Class III
- 7973 Closed reduction of dislocation of wrist Class III
- 7974 Closed reduction of dislocation of hand and finger Class III
- 7975 Closed reduction of dislocation of hip Class III
- 7976 Closed reduction of dislocation of knee Class III
- 7977 Closed reduction of dislocation of ankle Class III
- 7978 Closed reduction of dislocation of foot and toe Class III
- 7979 Closed reduction of dislocation of other specified site, except temp Class
III
302
303
M-3-14 PROSEDUR REDUKSI

FRAKTUR WAJAH TERTUTUP
- 7671 Closed reduction of malar and zygomatic fracture Class III
- 7673 Closed reduction of maxillary fracture Class III
- 7675 Closed reduction of mandibular fracture Class III
- 7678 Other closed reduction of facial fracture Class III
- 7693 Closed reduction of temporomandibular dislocation Class III
304
M-3-15 PROSEDUR APLIKASI CASTS

DAN SPLINTS
- 9351 Application of plaster jacket Class III
- 9352 Application of neck support Class III
- 9353 Application of other cast Class III
- 9354 Application of splint Class III
- 9711 Replacement of cast on upper limb Class III
- 9712 Replacement of cast on lower limb Class III
- 9713 Replacement of other cast Class III
- 9714 Replacement of other device for musculoskeletal immobilization Class III
305
M-3-16 PROSEDUR THERAPI FISIK

DAN PROSEDUR KECIL
MUSKULOSKLETAL
- 7695 Other manipulation of temporomandibular joint Class III
- 9301 Functional evaluation Class III
- 9308 Electromyography Class III
- 9309 Other diagnostic physical therapy procedure Class III
- 9312 Other active musculoskeletal exercise Class III
- 9313 Resistive exercise Class III
- 9314 Training in joint movements Class III
- 9315 Mobilization of spine Class III
- 9316 Mobilization of other joints Class III
- 9317 Other passive musculoskeletal exercise Class III
- 9321 Manual and mechanical traction Class III
- 9322 Ambulation and gait training Class III
- 9323 Fitting of orthotic device Class III
- 9324 Training in use of prosthetic or orthotic device Class III
- 9325 Forced extension of limb Class III
- 9326 Manual rupture of joint adhesions Class III
- 9327 Stretching of muscle or tendon Class III
- 9328 Stretching of fascia Class III
- 9329 Other forcible correction of deformity Class III
- 9331 Assisted exercise in pool Class III
- 9332 Whirlpool treatment Class III
- 9333 Other hydrotherapy Class III
- 9334 Diathermy Class III
- 9335 Other heat therapy Class III
306
- 9338 Combined physical therapy without mention of the components Class III
- 9339 Other physical therapy Class III
- 9826 Removal of foreign body from hand without incision Class III
- 9827 Removal of foreign body without incision from upper limb, except hand
Class III
- 9828 Removal of foreign body from foot without incision Class III
- 9829 Removal of foreign body without incision from lower limb, except foot
Class III
- 9986 Non-invasive placement of bone growth stimulator Class V
307
M-3-17 PROSEDUR PEMASANGAN

ALAT PROSTETIK
- 8441 Fitting of prosthesis of upper arm and shoulder Class III
- 8442 Fitting of prosthesis of lower arm and hand Class III
- 8443 Fitting of prosthesis of arm, not otherwise specified Class III
- 8445 Fitting of prosthesis above knee Class III
- 8446 Fitting of prosthesis below knee Class III
- 8447 Fitting of prosthesis of leg, not otherwise specified Class III
- 9302 Orthotic evaluation Class III
- 9303 Prosthetic evaluation Class III
308
N-1-01 PROSEDUR PENCANGKOKAN

GINJAL
- 5569 Other kidney transplantation Class I
309
N-1-11 PROSEDUR KANDUNG

KEMIH KOMPLEK
- 576 Partial cystectomy Class II
- 5771 Radical cystectomy Class I
- 5779 Other total cystectomy Class I
- 5783 Repair of fistula involving bladder and intestine Class II
- 5784 Repair of other fistula of bladder Class II
- 5785 Cystourethroplasty and plastic repair of bladder neck Class II
- 5786 Repair of bladder exstrophy Class II
- 5787 Reconstruction of urinary bladder Class I
- 5788 Other anastomosis of bladder Class II
- 5789 Other repair of bladder Class II
- 5893 Implantation of artificial urinary sphincter (AUS) Class II
310
N-1-12 PROSEDUR MEMBUAT BARU,

MEREVISI DAN MEMINDAHKAN ALAT
DIALISIS
- 3927 Arteriovenostomy for renal dialysis Class II
- 3942 Revision of arteriovenous shunt for renal dialysis Class II
- 3943 Removal of arteriovenous shunt for renal dialysis Class II
311
N-1-20 PROSEDUR SALURAN URIN

ATAS
- 5501 Nephrotomy Class II
- 5502 Nephrostomy Class II
- 5503 Percutaneous nephrostomy without fragmentation Class II
- 5504 Percutaneous nephrostomy with fragmentation Class II
- 5511 Pyelotomy Class II
- 5512 Pyelostomy Class II
- 5524 Open biopsy of kidney Class II
- 5529 Other diagnostic procedures on kidney Class II
- 5531 Marsupialization of kidney lesion Class II
- 5539 Other local destruction or excision of renal lesion or tissue Class II
- 554 Partial nephrectomy Class II
- 5551 Nephroureterectomy Class I
- 5552 Nephrectomy of remaining kidney Class I
- 5553 Removal of transplanted or rejected kidney Class I
- 5554 Bilateral nephrectomy Class I
- 5561 Renal autotransplantation Class I
- 557 Nephropexy Class II
- 5581 Suture of laceration of kidney Class II
- 5582 Closure of nephrostomy and pyelostomy Class II
- 5583 Closure of other fistula of kidney Class II
- 5584 Reduction of torsion of renal pedicle Class II
- 5585 Symphysiotomy for horseshoe kidney Class II
- 5586 Anastomosis of kidney Class II
- 5587 Correction of ureteropelvic junction Class II
- 5589 Other repair of kidney Class II
312
- 5591 Decapsulation of kidney Class II

- 5597 Implantation or replacement of mechanical kidney Class I
- 5598 Removal of mechanical kidney Class II
- 5599 Other operations on kidney Class II
- 561 Ureteral meatotomy Class II
- 562 Ureterotomy Class II
- 5634 Open biopsy of ureter Class II
- 5639 Other diagnostic procedures on ureter Class II
- 5640 Ureterectomy, not otherwise specified Class I
- 5641 Partial ureterectomy Class I
- 5642 Total ureterectomy Class I
- 5651 Formation of cutaneous uretero-ileostomy Class II
- 5652 Revision of cutaneous uretero-ileostomy Class II
- 5661 Formation of other cutaneous ureterostomy Class II
- 5662 Revision of other cutaneous ureterostomy Class II
- 5671 Urinary diversion to intestine Class II
- 5672 Revision of ureterointestinal anastomosis Class II
- 5673 Nephrocystanastomosis, not otherwise specified Class II
- 5674 Ureteroneocystostomy Class II
- 5675 Transureteroureterostomy Class II
- 5679 Other anastomosis or bypass of ureter Class II
- 5681 Lysis of intraluminal adhesions of ureter Class II
- 5682 Suture of laceration of ureter Class II
- 5683 Closure of ureterostomy Class II
- 5684 Closure of other fistula of ureter Class II
- 5685 Ureteropexy Class II
- 5686 Removal of ligature from ureter Class II
- 5689 Other repair of ureter Class II
313
- 5692 Implantation of electronic ureteral stimulator Class II

- 5693 Replacement of electronic ureteral stimulator Class II
- 5694 Removal of electronic ureteral stimulator Class II
- 5695 Ligation of ureter Class II
- 5699 Other operations on ureter Class II
- 5900 Retroperitoneal dissection, not otherwise specified Class II
- 5902 Other lysis of perirenal or periureteral adhesions Class II
- 5903 Laparoscopic lysis of perirenal or periureteral adhesions Class II
- 5909 Other incision of perirenal or periureteral tissue Class II
- 9851 Extracorporeal shockwave lithotripsy (ESWL) of the kidney, ureter and/or
bladder Class II
314
N-1-30 PROSEDUR KANDUNG

KEMIH DAN SALURAN URIN BAWAH
- 5712 Lysis of intraluminal adhesions with incision into bladder Class II
- 5718 Other suprapubic cystostomy Class II
- 5719 Other cystotomy Class II
- 5721 Vesicostomy Class II
- 5722 Revision or closure of vesicostomy Class II
- 5734 Open biopsy of bladder Class II
- 5739 Other diagnostic procedures on bladder Class II
- 5751 Excision of urachus Class II
- 5759 Open excision or destruction of other lesion or tissue of bladder Class II
- 5781 Suture of laceration of bladder Class II
- 5782 Closure of cystostomy Class II
- 5791 Sphincterotomy of bladder Class II
- 5793 Control of (postoperative) hemorrhage of bladder Class II
- 5796 Implantation of electronic bladder stimulator Class II
- 5797 Replacement of electronic bladder stimulator Class II
- 5798 Removal of electronic bladder stimulator Class II
- 5799 Other operations on bladder Class II
- 5911 Other lysis of perivesical adhesions Class II
- 5912 Laparoscopic lysis of perivesical adhesions Class II
- 5919 Other incision of perivesical tissue Class II
- 5921 Biopsy of perirenal or perivesical tissue Class II
- 5929 Other diagnostic procedures on perirenal tissue, perivesical tissue, and
retroperitoneum Class II
- 593 Plication of urethrovesical junction Class II
- 5991 Excision of perirenal or perivesical tissue Class II
315
- 5992 Other operations on perirenal or perivesical tissue Class II

- 5995 Ultrasonic fragmentation of urinary stones Class II
- 7561 Repair of current obstetric laceration of bladder and urethra Class II
316
N-1-40 PROSEDUR PADA URETRA

DAN TRANSURETRA
- 560 Transurethral removal of obstruction from ureter and renal pelvis Class II
- 570 Transurethral clearance of bladder Class II
- 5717 Percutaneous cystostomy Class II
- 5733 Closed [transurethral] biopsy of bladder Class II
- 5741 Transurethral lysis of intraluminal adhesions Class II
- 5749 Other transurethral excision or destruction of lesion or tissue of bladder
Class II
- 580 Urethrotomy Class II
- 581 Urethral meatotomy Class II
- 5823 Biopsy of urethra Class II
- 5824 Biopsy of periurethral tissue Class II
- 5829 Other diagnostic procedures on urethra and periurethral tissue Class II
- 5831 Endoscopic excision or destruction of lesion or tissue of urethra Class II
- 5839 Other local excision or destruction of lesion or tissue of urethra Class II
- 583 Excision or destruction of lesion or tissue of urethra Class II
- 5841 Suture of laceration of urethra Class II
- 5842 Closure of urethrostomy Class II
- 5843 Closure of other fistula of urethra Class II
- 5844 Reanastomosis of urethra Class II
- 5845 Repair of hypospadias or epispadias Class II
- 5846 Other reconstruction of urethra Class II
- 5847 Urethral meatoplasty Class II
- 5849 Other repair of urethra Class II
- 585 Release of urethral stricture Class II
- 5891 Incision of periurethral tissue Class II
317
- 5892 Excision of periurethral tissue Class II

- 5899 Other operations on urethra and periurethral tissue Class II
- 5972 Injection of implant into urethra and/or bladder neck Class II
- 9819 Removal of intraluminal foreign body from urethra without incision Class
II
318
N-2-11 PROSEDUR BESAR PADA

KANDUNG KEMIH
- 576 Partial cystectomy Class II
- 5783 Repair of fistula involving bladder and intestine Class II
- 5784 Repair of other fistula of bladder Class II
- 5785 Cystourethroplasty and plastic repair of bladder neck Class II
- 5786 Repair of bladder exstrophy Class II
- 5788 Other anastomosis of bladder Class II
- 5789 Other repair of bladder Class II
- 5893 Implantation of artificial urinary sphincter (AUS) Class II
319
N-2-12 PROSEDUR MEMBUAT BARU,

MEREVISI DAN MEMINDAHKAN ALAT
DIALISIS
- 3927 Arteriovenostomy for renal dialysis Class II
- 3942 Revision of arteriovenous shunt for renal dialysis Class II
- 3943 Removal of arteriovenous shunt for renal dialysis Class II
320
N-2-21 EXTRACORPOREAL
SHOCKWAVE LITHOTRIPSY ESWL
PADA SALURAN KEMIH
- 9851 Extracorporeal shockwave lithotripsy (ESWL) of the kidney, ureter and/or
bladder Class II
321

GINJAL DAN URETER
- 5501 Nephrotomy Class II
- 5502 Nephrostomy Class II
- 5504 Percutaneous nephrostomy with fragmentation Class II
- 5512 Pyelostomy Class II
- 554 Partial nephrectomy Class II
- 5581 Suture of laceration of kidney Class II
- 5582 Closure of nephrostomy and pyelostomy Class II
- 5583 Closure of other fistula of kidney Class II
- 5585 Symphysiotomy for horseshoe kidney Class II
- 5586 Anastomosis of kidney Class II
- 5587 Correction of ureteropelvic junction Class II
- 5591 Decapsulation of kidney Class II
- 5651 Formation of cutaneous uretero-ileostomy Class II
- 5652 Revision of cutaneous uretero-ileostomy Class II
- 5661 Formation of other cutaneous ureterostomy Class II
- 5662 Revision of other cutaneous ureterostomy Class II
- 5671 Urinary diversion to intestine Class II
- 5672 Revision of ureterointestinal anastomosis Class II
- 5673 Nephrocystanastomosis, not otherwise specified Class II
- 5674 Ureteroneocystostomy Class II
- 5675 Transureteroureterostomy Class II
- 5679 Other anastomosis or bypass of ureter Class II
- 5682 Suture of laceration of ureter Class II
- 5683 Closure of ureterostomy Class II
- 5684 Closure of other fistula of ureter Class II
322
- 5685 Ureteropexy Class II

- 5686 Removal of ligature from ureter Class II
- 5689 Other repair of ureter Class II
- 5900 Retroperitoneal dissection, not otherwise specified Class II
- 5902 Other lysis of perirenal or periureteral adhesions Class II
- 5909 Other incision of perirenal or periureteral tissue Class II
323
N-2-23 PROSEDUR SEDANG PADA

GINJAL DAN URETER
- 5511 Pyelotomy Class II
- 5524 Open biopsy of kidney Class II
- 5531 Marsupialization of kidney lesion Class II
- 5539 Other local destruction or excision of renal lesion or tissue Class II
- 557 Nephropexy Class II
- 5584 Reduction of torsion of renal pedicle Class II
- 5589 Other repair of kidney Class II
- 5598 Removal of mechanical kidney Class II
- 562 Ureterotomy Class II
- 5634 Open biopsy of ureter Class II
- 5681 Lysis of intraluminal adhesions of ureter Class II
- 5695 Ligation of ureter Class II
- 5699 Other operations on ureter Class II
- 5903 Laparoscopic lysis of perirenal or periureteral adhesions Class II
324
N-2-24 PROSEDUR KECIL PADA

GINJAL DAN URETER
- 5503 Percutaneous nephrostomy without fragmentation Class II
- 5529 Other diagnostic procedures on kidney Class II
- 5599 Other operations on kidney Class II
- 561 Ureteral meatotomy Class II
- 5639 Other diagnostic procedures on ureter Class II
- 5692 Implantation of electronic ureteral stimulator Class II
- 5693 Replacement of electronic ureteral stimulator Class II
- 5694 Removal of electronic ureteral stimulator Class II
325

KANDUNG KEMIH DAN URETHRA
- 5721 Vesicostomy Class II
- 5751 Excision of urachus Class II
- 5759 Open excision or destruction of other lesion or tissue of bladder Class II
- 5781 Suture of laceration of bladder Class II
- 5796 Implantation of electronic bladder stimulator Class II
- 5797 Replacement of electronic bladder stimulator Class II
- 5911 Other lysis of perivesical adhesions Class II
- 5912 Laparoscopic lysis of perivesical adhesions Class II
- 5921 Biopsy of perirenal or perivesical tissue Class II
- 5929 Other diagnostic procedures on perirenal tissue, perivesical tissue, and
retroperitoneum Class II
- 5991 Excision of perirenal or perivesical tissue Class II
- 5992 Other operations on perirenal or perivesical tissue Class II
326

KANDUNG KEMIH DAN URETHRA
- 5712 Lysis of intraluminal adhesions with incision into bladder Class II
- 5718 Other suprapubic cystostomy Class II
- 5719 Other cystotomy Class II
- 5722 Revision or closure of vesicostomy Class II
- 5734 Open biopsy of bladder Class II
- 5739 Other diagnostic procedures on bladder Class II
- 5782 Closure of cystostomy Class II
- 5791 Sphincterotomy of bladder Class II
- 5793 Control of (postoperative) hemorrhage of bladder Class II
- 5798 Removal of electronic bladder stimulator Class II
- 5799 Other operations on bladder Class II
- 5919 Other incision of perivesical tissue Class II
- 593 Plication of urethrovesical junction Class II
- 5995 Ultrasonic fragmentation of urinary stones Class II
- 7561 Repair of current obstetric laceration of bladder and urethra Class II
327

URETHRA DAN TRANSURETHRA
- 560 Transurethral removal of obstruction from ureter and renal pelvis Class II
- 5717 Percutaneous cystostomy Class II
- 5741 Transurethral lysis of intraluminal adhesions Class II
- 5749 Other transurethral excision or destruction of lesion or tissue of bladder
Class II
- 5841 Suture of laceration of urethra Class II
- 5842 Closure of urethrostomy Class II
- 5843 Closure of other fistula of urethra Class II
- 5844 Reanastomosis of urethra Class II
- 5845 Repair of hypospadias or epispadias Class II
- 5846 Other reconstruction of urethra Class II
- 5847 Urethral meatoplasty Class II
- 5849 Other repair of urethra Class II
- 585 Release of urethral stricture Class II
- 5891 Incision of periurethral tissue Class II
- 5892 Excision of periurethral tissue Class II
- 5899 Other operations on urethra and periurethral tissue Class II
328

URETHRA DAN TRANSURETHRA
- 570 Transurethral clearance of bladder Class II
- 5733 Closed [transurethral] biopsy of bladder Class II
- 580 Urethrotomy Class II
- 581 Urethral meatotomy Class II
- 5823 Biopsy of urethra Class II
- 5824 Biopsy of periurethral tissue Class II
- 5829 Other diagnostic procedures on urethra and periurethral tissue Class II
- 5831 Endoscopic excision or destruction of lesion or tissue of urethra Class II
- 5839 Other local excision or destruction of lesion or tissue of urethra Class II
- 583 Excision or destruction of lesion or tissue of urethra Class II
- 5972 Injection of implant into urethra and/or bladder neck Class II
- 9819 Removal of intraluminal foreign body from urethra without incision Class
II
329
N-3-10 PROSEDUR PADA GINJAL

DAN URETER
- 5523 Closed [percutaneous] [needle] biopsy of kidney Class III
- 5592 Percutaneous aspiration of kidney (pelvis) Class III
- 5595 Local perfusion of kidney Class III
- 5596 Other injection of therapeutic substance into kidney Class III
- 5632 Closed percutaneous biopsy of ureter Class III
- 5691 Dilation of ureteral meatus Class III
- 598 Ureteral catheterization Class III
- 5999 Other operations on urinary system Class III
- 6091 Percutaneous aspiration of prostate Class III
330
N-3-11 PROSEDUR DIAGNOSTIK

LAIN PADA STUDI SALURAN KEMIH
- 8921 Urinary manometry Class III
- 8922 Cystometrogram Class III
- 8923 Urethral sphincter electromyogram Class III
- 8924 Uroflowmetry (UFR) Class III
- 8925 Urethral pressure profile (UPP) Class III
- 8929 Other nonoperative genitourinary system measurements Class III
331
N-3-12 PROSEDUR CYSTOSCOPI &

PROSEDUR KECIL ENDOSKOPI
SALURAN KEMIH
- 5635 Endoscopy (cystoscopy) (looposcopy) of ileal conduit Class III
- 5731 Cystoscopy through artificial stoma Class III
- 5732 Other cystoscopy Class III
- 5821 Perineal urethroscopy Class III
- 5822 Other urethroscopy Class III
332
N-3-13 PROSEDUR BESAR

ENDOSKOPI PADA SALURAN KEMIH
- 5521 Nephroscopy Class III
- 5522 Pyeloscopy Class III
- 5631 Ureteroscopy Class III
- 5633 Closed endoscopic biopsy of ureter Class III
333
N-3-14 PROSEDUR KECIL

ENDOSKOPI PADA SALURAN KEMIH
- 5593 Replacement of nephrostomy tube Class III
- 5594 Replacement of pyelostomy tube Class III
- 5711 Percutaneous aspiration of bladder Class III
- 5792 Dilation of bladder neck Class III
- 5794 Insertion of indwelling urinary catheter Class III
- 5795 Replacement of indwelling urinary catheter Class III
- 586 Dilation of urethra Class III
- 5993 Replacement of ureterostomy tube Class III
- 5994 Replacement of cystostomy tube Class III
- 9625 Therapeutic distention of bladder Class III
- 9645 Irrigation of nephrostomy and pyelostomy Class III
- 9646 Irrigation of ureterostomy and ureteral catheter Class III
- 9647 Irrigation of cystostomy Class III
- 9648 Irrigation of other indwelling urinary catheter Class III
- 9761 Removal of pyelostomy and nephrostomy tube Class III
- 9762 Removal of ureterostomy tube and ureteral catheter Class III
- 9763 Removal of cystostomy tube Class III
- 9764 Removal of other urinary drainage device Class III
- 9765 Removal of urethral stent Class III
- 9769 Removal of other device from urinary system Class III
334
N-3-15 PROSEDUR DIALISIS

- 3995 Hemodialysis Class III
- 5498 Peritoneal dialysis Class III
335
O-6-10 PROSEDUR OPERASI

PEMBEDAHAN CAESAR
- 740 Classical cesarean section Class II
- 741 Low cervical cesarean section Class II
- 742 Extraperitoneal cesarean section Class II
- 744 Cesarean section of other specified type Class II
- 7499 Other cesarean section of unspecified type Class II
336
O-6-11 PROSEDUR PERSALINAN

VAGINAL DENGAN STERILISASI &/
DILATASI & KURET
- 6621 Bilateral endoscopic ligation and crushing of fallopian tubes Class II
- 6622 Bilateral endoscopic ligation and division of fallopian tubes Class II
- 6629 Other bilateral endoscopic destruction or occlusion of fallopian tubes
Class II
- 6631 Other bilateral ligation and crushing of fallopian tubes Class II
- 6632 Other bilateral ligation and division of fallopian tubes Class II
- 6639 Other bilateral destruction or occlusion of fallopian tubes Class II
- 664 Total unilateral salpingectomy Class II
- 6651 Removal of both fallopian tubes at same operative episode Class II
- 6652 Removal of remaining fallopian tube Class II
- 6663 Bilateral partial salpingectomy, not otherwise specified Class II
- 6669 Other partial salpingectomy Class II
- 6692 Unilateral destruction or occlusion of fallopian tube Class II
- 6697 Burying of fimbriae in uterine wall Class II
- 6902 Dilation and curettage following delivery or abortion Class II
- 6909 Other dilation and curettage of uterus Class II
- 6952 Aspiration curettage following delivery or abortion Class II
337
O-7-10 PROSEDUR PERSALINAN

DENGAN BEDAH CAESAR
- 740 Classical cesarean section Class II
- 741 Low cervical cesarean section Class II
- 742 Extraperitoneal cesarean section Class II
- 744 Cesarean section of other specified type Class II
- 7499 Other cesarean section of unspecified type Class II
338
O-7-11 PERSALINAN VAGINAL

DENGAN STERILISASI DAN ATAU
PELEBARAN DAN KURETASE
Class II
339
P-8-01 PROSEDUR NEONATAL

DENGAN PENCANGKOKAN ORGAN
ATAU OKSIGENASI SELAPUT
EKSTRAKORPORAL
- 3350 Lung Transplantation, not otherwise specified Class I
- 3351 Uniteral lung transplantation Class I
- 3352 Bilateral lung transplantation Class I
- 335 Lung transplant Class I
- 336 Combined heart-lung transplantation Class I
- 3751 Heart transplantation Class I
- 375 Heart transplantation procedure Class I
- 3965 Extracorporeal membrane oxygenation (ECMO) Class I
- 5051 Auxiliary liver transplant Class I
- 5059 Other transplant of liver Class I
- 5569 Other kidney transplantation Class I
340
P-8-07 PROSEDUR NEONATAL,

BERAT BADAN LAHIR GROUP-5
DENGAN PROSEDUR MAYOR
- 3570 Other and unspecified repair of unspecified septal defect of heart Class I
- 3571 Other and unspecified repair of atrial septal defect Class I
341
Q-5-13 MEDICAL CHECK-UP

- 897 General physical examination Class V
342
Q-5-14 RONGENT PLAIN FILM

- 8709 Other soft tissue x-ray of face, head, and neck Class V
- 8711 Full-mouth x-ray of teeth Class V
- 8712 Other dental x-ray Class V
- 8716 Other x-ray of facial bones Class V
- 8717 Other x-ray of skull Class V
- 8723 Other x-ray of thoracic spine Class V
- 8724 Other x-ray of lumbosacral spine Class V
- 8729 Other x-ray of spine Class V
- 8739 Other soft tissue x-ray of chest wall Class V
- 8743 X-ray of ribs, sternum, and clavicle Class V
- 8744 Routine chest x-ray, so described Class V
- 8749 Other chest x-ray Class V
- 8765 Other x-ray of intestine Class V
- 8769 Other digestive tract x-ray Class V
- 8779 Other x-ray of the urinary system Class V
- 8781 X-ray of gravid uterus Class V
- 8785 Other x-ray of fallopian tubes and uterus Class V
- 8795 Other x-ray of epididymis and vas deferens Class V
- 8799 Other x-ray of male genital organs Class V
- 8809 Other soft tissue x-ray of abdominal wall Class V
- 8816 Other retroperitoneal x-ray Class V
- 8819 Other x-ray of abdomen Class V
- 8821 Skeletal x-ray of shoulder and upper arm Class V
- 8822 Skeletal x-ray of elbow and forearm Class V
- 8823 Skeletal x-ray of wrist and hand Class V
- 8824 Skeletal x-ray of upper limb, not otherwise specified Class V
343
- 8825 Pelvimetry Class V

- 8826 Other skeletal x-ray of pelvis and hip Class V
- 8827 Skeletal x-ray of thigh, knee, and lower leg Class V
- 8828 Skeletal x-ray of ankle and foot Class V
- 8829 Skeletal x-ray of lower limb, not otherwise specified Class V
- 8833 Other skeletal x-ray Class V
- 8835 Other soft tissue x-ray of upper limb Class V
- 8837 Other soft tissue x-ray of lower limb Class V
- 8839 X-ray, other and unspecified Class V
344
Q-5-15 ELEKTROKARDIOGRAM ECG

- 8951 Rhythm electrocardiogram Class V
- 8952 Electrocardiogram Class V
345
Q-5-16 VAKSINASI
- 9912 Immunization for allergy Class V
- 9913 Immunization for autoimmune disease Class V
- 9931 Vaccination against cholera Class V
- 9932 Vaccination against typhoid and paratyphoid fever Class V
- 9933 Vaccination against tuberculosis Class V
- 9934 Vaccination against plague Class V
- 9935 Vaccination against tularemia Class V
- 9936 Administration of diphtheria toxoid Class V
- 9937 Vaccination against pertussis Class V
- 9938 Administration of tetanus toxoid Class V
- 9939 Administration of diphtheria-tetanus-pertussis, combined Class V
- 9941 Administration of poliomyelitis vaccine Class V
- 9942 Vaccination against smallpox Class V
- 9943 Vaccination against yellow fever Class V
- 9944 Vaccination against rabies Class V
- 9945 Vaccination against measles Class V
- 9946 Vaccination against mumps Class V
- 9947 Vaccination against rubella Class V
- 9948 Administration of measles-mumps-rubella vaccine Class V
- 9951 Prophylactic vaccination against the common cold Class V
- 9952 Prophylactic vaccination against influenza Class V
- 9953 Prophylactic vaccination against arthropod-borne viral encephalitis Class
V
- 9954 Prophylactic vaccination against other arthropod- borne viral diseases
Class V
- 9955 Prophylactic administration of vaccine against other diseases Class V
- 9956 Administration of tetanus antitoxin Class V
346
- 9957 Administration of botulism antitoxin Class V

- 9958 Administration of other antitoxins Class V
- 9959 Other vaccination and inoculation Class V
347
Q-5-17 PASANG INFUS

- 0011 Infusion of drotrecogin alfa (activated) Class V
- 0013 Injection or infusion of nesiritide Class V
- 0014 Injection or infusion of oxazolidinone class of antibiotics Class V
- 8452 Insertion of recombinant bone morphogenetic protein rhBMP Class V
- 966 Enteral infusion of concentrated nutritional substances Class V
- 9911 Injection of Rh immune globulin Class V
- 9914 Injection or infusion of gamma globulin Class V
- 9915 Parenteral infusion of concentrated nutritional substances Class V
- 9916 Injection of antidote Class V
- 9917 Injection of insulin Class V
- 9918 Injection or infusion of electrolytes Class V
- 9919 Injection of anticoagulant Class V
- 9920 Injection or infusion of platelet inhibitor Class V
- 9921 Injection of antibiotic Class V
- 9922 Injection of other anti-infective Class V
- 9923 Injection of steroid Class V
- 9924 Injection of other hormone Class V
- 9926 Injection of tranquilizer Class V
- 9929 Injection or infusion of other therapeutic or prophylactic substance Class
V
348
Q-5-18 KONSULTASI ATAU

PEMERIKSAAN LAIN-LAIN
- 8913 Neurologic examination Class V
- 8915 Other nonoperative neurologic function tests Class V
- 8926 Gynecological examination Class V
- 8931 Dental examination Class V
349
T-1-10 TERAPI REHABILITASI &/

DETOKSIKASI ALKOHOL & OBAT
- 9461 Alcohol rehabilitation Class II
- 9462 Alcohol detoxification Class II
- 9463 Alcohol rehabilitation and detoxification Class II
- 9464 Drug rehabilitation Class II
- 9465 Drug detoxification Class II
- 9466 Drug rehabilitation and detoxification Class II
- 9467 Combined alcohol and drug rehabilitation Class II
- 9468 Combined alcohol and drug detoxification Class II
- 9469 Combined alcohol and drug rehabilitation and detoxification Class II
350
T-2-10 PEMULIHAN ALKOHOL,

OBAT DAN ATAU TERAPI
DETOKSIKASI
- 9461 Alcohol rehabilitation Class II
- 9462 Alcohol detoxification Class II
- 9463 Alcohol rehabilitation and detoxification Class II
- 9464 Drug rehabilitation Class II
- 9465 Drug detoxification Class II
- 9466 Drug rehabilitation and detoxification Class II
- 9467 Combined alcohol and drug rehabilitation Class II
- 9468 Combined alcohol and drug detoxification Class II
- 9469 Combined alcohol and drug rehabilitation and detoxification Class II
351
U-1-10 PROSEDUR KOMPLEKS

LARING
- 301 Hemilaryngectomy Class II
- 3029 Other partial laryngectomy Class II
- 303 Complete laryngectomy Class II
- 304 Radical laryngectomy Class II
- 3164 Repair of laryngeal fracture Class II
- 3169 Other repair of larynx Class II
352
U-1-11 PROSEDUR KOMPLEK LEHER

DAN KEPALA LAIN-LAIN
- 2095 Implantation of electromagnetic hearing device Class II
- 2096 Implantation or replacement of cochlear prosthetic device, not otherwise
specified Class II
- 2097 Implantation or replacement of cochlear prosthetic device, single
channel Class II
- 2098 Implantation or replacement of cochlear prosthetic device, multiple
channel Class II
- 253 Complete glossectomy Class I
- 254 Radical glossectomy Class I
- 2732 Wide excision or destruction of lesion or tissue of bony palate Class I
- 4040 Radical neck dissection, not otherwise specified Class II
- 4041 Radical neck dissection, unilateral Class II
- 4042 Radical neck dissection, bilateral Class II
353
U-1-12 PROSEDUR MASTOID DAN

SINUS
- 2021 Incision of mastoid Class II
- 2022 Incision of petrous pyramid air cells Class II
- 2041 Simple mastoidectomy Class II
- 2042 Radical mastoidectomy Class I
- 2049 Other mastoidectomy Class II
- 2092 Revision of mastoidectomy Class II
- 2212 Open biopsy of nasal sinus Class II
- 2231 Radical maxillary antrotomy Class I
- 2239 Other external maxillary antrotomy Class I
- 2241 Frontal sinusotomy Class II
- 2242 Frontal sinusectomy Class II
- 2250 Sinusotomy, not otherwise specified Class II
- 2251 Ethmoidotomy Class II
- 2252 Sphenoidotomy Class II
- 2253 Incision of multiple nasal sinuses Class II
- 2260 Sinusectomy, not otherwise specified Class II
- 2261 Excision of lesion of maxillary sinus with caldwell-luc approach Class II
- 2262 Excision of lesion of maxillary sinus with other approach Class II
- 2263 Ethmoidectomy Class II
- 2264 Sphenoidectomy Class II
- 2271 Closure of nasal sinus fistula Class II
- 2279 Other repair of nasal sinus Class II
- 229 Other operations on nasal sinuses Class II
354
U-1-13 PROSEDUR KELENJAR

LUDAH
- 2612 Open biopsy of salivary gland or duct Class II
- 2621 Marsupialization of salivary gland cyst Class II
- 2629 Other excision of salivary gland lesion Class II
- 2630 Sialoadenectomy, not otherwise specified Class II
- 2631 Partial sialoadenectomy Class II
- 2632 Complete sialoadenectomy Class II
- 2641 Suture of laceration of salivary gland Class II
- 2642 Closure of salivary fistula Class II
- 2649 Other repair and plastic operations on salivary gland or duct Class II
- 2699 Other operations on salivary gland or duct Class II
355
U-1-14 PROSEDUR OPERASI BIBIR

SUMBING & LANGIT-LANGIT MULUT
- 2754 Repair of cleft lip Class II
- 2762 Correction of cleft palate Class II
- 2763 Revision of cleft palate repair Class II
- 2769 Other plastic repair of palate Class II
356
U-1-15 PROSEDUR TONSIL &

ADENOID
- 280 Incision and drainage of tonsil and peritonsillar structures Class II
- 2811 Biopsy of tonsils and adenoids Class II
- 2819 Other diagnostic procedures on tonsils and adenoids Class II
- 282 Tonsillectomy without adenoidectomy Class II
- 283 Tonsillectomy with adenoidectomy Class II
- 284 Excision of tonsil tag Class II
- 285 Excision of lingual tonsil Class II
- 286 Adenoidectomy without tonsillectomy Class II
- 287 Control of hemorrhage after tonsillectomy and adenoidectomy Class II
- 2891 Removal of foreign body from tonsil and adenoid by incision Class II
- 2892 Excision of lesion of tonsil and adenoid Class II
- 2899 Other operations on tonsils and adenoids Class II
357
U-1-20 PROSEDUR TENGGOROKAN,

MULUT, HIDUNG DAN TELINGA LAINLAIN
- 1821 Excision of preauricular sinus Class II
- 1831 Radical excision of lesion of external ear Class II
- 1839 Other excision of external ear Class II
- 185 Surgical correction of prominent ear Class II
- 186 Reconstruction of external auditory canal Class II
- 1871 Construction of auricle of ear Class II
- 1872 Reattachment of amputated ear Class II
- 1879 Other plastic repair of external ear Class II
- 189 Other operations on external ear Class II
- 190 Stapes mobilization Class II
- 1911 Stapedectomy with incus replacement Class II
- 1919 Other stapedectomy Class II
- 1921 Revision of stapedectomy with incus replacement Class II
- 1929 Other revision of stapedectomy Class II
- 193 Other operations on ossicular chain Class II
- 194 Myringoplasty Class II
- 1952 Type ii tympanoplasty Class II
- 1953 Type iii tympanoplasty Class II
- 1954 Type iv tympanoplasty Class II
- 1955 Type v tympanoplasty Class II
- 196 Revision of tympanoplasty Class II
- 199 Other repair of middle ear Class II
- 2023 Incision of middle ear Class II
- 2032 Biopsy of middle and inner ear Class II
358
- 2039 Other diagnostic procedures on middle and inner ear Class II

- 2051 Excision of lesion of middle ear Class II
- 2059 Other excision of middle ear Class II
- 2061 Fenestration of inner ear (initial) Class II
- 2062 Revision of fenestration of inner ear Class II
- 2071 Endolymphatic shunt Class II
- 2072 Injection into inner ear Class II
- 2079 Other incision, excision, and destruction of inner ear Class II
- 2091 Tympanosympathectomy Class II
- 2093 Repair of oval and round windows Class II
- 2099 Other operations on middle and inner ear Class II
- 2104 Control of epistaxis by ligation of ethmoidal arteries Class II
- 2105 Control of epistaxis by (transantral) ligation of the maxillary arte Class II
- 2106 Control of epistaxis by ligation of the external carotid artery Class II
- 2107 Control of epistaxis by excision of nasal mucosa and skin grafting o Class
II
- 2109 Control of epistaxis by other means Class II
- 214 Resection of nose Class II
- 215 Submucous resection of nasal septum Class II
- 2161 Turbinectomy by diathermy or cryosurgery Class II
- 2162 Fracture of the turbinates Class II
- 2169 Other turbinectomy Class II
- 2172 Open reduction of nasal fracture Class II
- 2182 Closure of nasal fistula Class II
- 2183 Total nasal reconstruction Class II
- 2184 Revision rhinoplasty Class II
- 2185 Augmentation rhinoplasty Class II
- 2186 Limited rhinoplasty Class II
- 2187 Other rhinoplasty Class II
359
- 2188 Other septoplasty Class II

- 2189 Other repair and plastic operations on nose Class II
- 2199 Other operations on nose Class II
- 290 Pharyngotomy Class II
- 292 Excision of branchial cleft cyst or vestige Class II
- 2931 Cricopharyngeal myotomy Class II
- 2932 Pharyngeal diverticulectomy Class II
- 2933 Pharyngectomy (partial) Class II
- 2939 Other excision or destruction of lesion or tissue of pharynx Class II
- 293 Excision or destruction of lesion or tissue of pharynx Class II
- 294 Plastic operation on pharynx Class II
- 2951 Suture of laceration of pharynx Class II
- 2952 Closure of branchial cleft fistula Class II
- 2953 Closure of other fistula of pharynx Class II
- 2954 Lysis of pharyngeal adhesions Class II
- 2959 Other repair of pharynx Class II
- 2992 Division of glossopharyngeal nerve Class II
- 2999 Other operations on pharynx Class II
- 3001 Marsupialization of laryngeal cyst Class II
- 3009 Other excision or destruction of lesion or tissue of larynx Class II
- 3021 Epiglottidectomy Class II
- 3022 Vocal cordectomy Class II
- 3161 Suture of laceration of larynx Class II
- 3162 Closure of fistula of larynx Class II
- 3163 Revision of laryngostomy Class II
360
- 3191 Division of laryngeal nerve Class II

- 3198 Other operations on larynx Class II
361
U-1-30 PROSEDUR MULUT

- 242 Gingivoplasty Class II
- 244 Excision of dental lesion of jaw Class II
- 245 Alveoloplasty Class II
- 2502 Open biopsy of tongue Class II
- 251 Excision or destruction of lesion or tissue of tongue Class II
- 252 Partial glossectomy Class II
- 2559 Other repair and plastic operations on tongue Class II
- 2594 Other glossotomy Class II
- 2599 Other operations on tongue Class II
- 270 Drainage of face and floor of mouth Class II
- 271 Incision of palate Class II
- 2721 Biopsy of bony palate Class II
- 2722 Biopsy of uvula and soft palate Class II
- 2731 Local excision or destruction of lesion or tissue of bony palate Class II
- 2742 Wide excision of lesion of lip Class II
- 2743 Other excision of lesion or tissue of lip Class II
- 2749 Other excision of mouth Class II
- 2753 Closure of fistula of mouth Class II
- 2755 Full-thickness skin graft to lip and mouth Class II
- 2756 Other skin graft to lip and mouth Class II
- 2757 Attachment of pedicle or flap graft to lip and mouth Class II
- 2759 Other plastic repair of mouth Class II
- 2761 Suture of laceration of palate Class II
- 2771 Incision of uvula Class II
- 2772 Excision of uvula Class II
- 2773 Repair of uvula Class II
362
- 2779 Other operations on uvula Class II

- 2792 Incision of mouth, unspecified structure Class II
- 2799 Other operations on oral cavity Class II
363
U-2-10 PROSEDUR BESAR PADA

LARING
- 301 Hemilaryngectomy Class II
- 3029 Other partial laryngectomy Class II
- 303 Complete laryngectomy Class II
- 304 Radical laryngectomy Class II
- 3164 Repair of laryngeal fracture Class II
- 3169 Other repair of larynx Class II
364
U-2-11 PROSEDUR BESAR LAINLAIN PADA KEPALA & LEHER

- 2095 Implantation of electromagnetic hearing device Class II
- 2096 Implantation or replacement of cochlear prosthetic device, not otherwise
specified Class II
- 2097 Implantation or replacement of cochlear prosthetic device, single
channel Class II
- 2098 Implantation or replacement of cochlear prosthetic device, multiple
channel Class II
- 4040 Radical neck dissection, not otherwise specified Class II
- 4041 Radical neck dissection, unilateral Class II
- 4042 Radical neck dissection, bilateral Class II
365
U-2-12 PROSEDUR PADA SINUS &

MASTOID
- 2021 Incision of mastoid Class II
- 2022 Incision of petrous pyramid air cells Class II
- 2041 Simple mastoidectomy Class II
- 2049 Other mastoidectomy Class II
- 2092 Revision of mastoidectomy Class II
- 2212 Open biopsy of nasal sinus Class II
- 2241 Frontal sinusotomy Class II
- 2242 Frontal sinusectomy Class II
- 2250 Sinusotomy, not otherwise specified Class II
- 2251 Ethmoidotomy Class II
- 2252 Sphenoidotomy Class II
- 2253 Incision of multiple nasal sinuses Class II
- 2260 Sinusectomy, not otherwise specified Class II
- 2261 Excision of lesion of maxillary sinus with caldwell-luc approach Class II
- 2262 Excision of lesion of maxillary sinus with other approach Class II
- 2263 Ethmoidectomy Class II
- 2264 Sphenoidectomy Class II
- 2271 Closure of nasal sinus fistula Class II
- 2279 Other repair of nasal sinus Class II
- 229 Other operations on nasal sinuses Class II
366
U-2-13 PROSEDUR KELENJAR

LUDAH
- 2612 Open biopsy of salivary gland or duct Class II
- 2621 Marsupialization of salivary gland cyst Class II
- 2629 Other excision of salivary gland lesion Class II
- 2630 Sialoadenectomy, not otherwise specified Class II
- 2631 Partial sialoadenectomy Class II
- 2632 Complete sialoadenectomy Class II
- 2641 Suture of laceration of salivary gland Class II
- 2642 Closure of salivary fistula Class II
- 2649 Other repair and plastic operations on salivary gland or duct Class II
- 2699 Other operations on salivary gland or duct Class II
367
U-2-14 PROSEDUR OPERASI BIBIR

SUMBING & LANGIT-LANGIT MULUT
- 2754 Repair of cleft lip Class II
- 2762 Correction of cleft palate Class II
- 2763 Revision of cleft palate repair Class II
- 2769 Other plastic repair of palate Class II
368
U-2-15 PROSEDUR OPERASI TONSIL

& AMANDEL
- 280 Incision and drainage of tonsil and peritonsillar structures Class II
- 2811 Biopsy of tonsils and adenoids Class II
- 2819 Other diagnostic procedures on tonsils and adenoids Class II
- 282 Tonsillectomy without adenoidectomy Class II
- 283 Tonsillectomy with adenoidectomy Class II
- 284 Excision of tonsil tag Class II
- 285 Excision of lingual tonsil Class II
- 286 Adenoidectomy without tonsillectomy Class II
- 287 Control of hemorrhage after tonsillectomy and adenoidectomy Class II
- 2891 Removal of foreign body from tonsil and adenoid by incision Class II
- 2892 Excision of lesion of tonsil and adenoid Class II
- 2899 Other operations on tonsils and adenoids Class II
369

TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN
- 1831 Radical excision of lesion of external ear Class II
- 1839 Other excision of external ear Class II
- 185 Surgical correction of prominent ear Class II
- 186 Reconstruction of external auditory canal Class II
- 1871 Construction of auricle of ear Class II
- 1872 Reattachment of amputated ear Class II
- 1879 Other plastic repair of external ear Class II
- 2104 Control of epistaxis by ligation of ethmoidal arteries Class II
- 2105 Control of epistaxis by (transantral) ligation of the maxillary arte Class II
- 2106 Control of epistaxis by ligation of the external carotid artery Class II
- 2107 Control of epistaxis by excision of nasal mucosa and skin grafting o Class
II
- 214 Resection of nose Class II
- 2182 Closure of nasal fistula Class II
- 292 Excision of branchial cleft cyst or vestige Class II
- 2931 Cricopharyngeal myotomy Class II
- 2933 Pharyngectomy (partial) Class II
- 294 Plastic operation on pharynx Class II
- 2952 Closure of branchial cleft fistula Class II
- 2953 Closure of other fistula of pharynx Class II
- 2992 Division of glossopharyngeal nerve Class II
- 3001 Marsupialization of laryngeal cyst Class II
- 3021 Epiglottidectomy Class II
370

- 3161 Suture of laceration of larynx Class II
- 3162 Closure of fistula of larynx Class II
- 3163 Revision of laryngostomy Class II
- 3191 Division of laryngeal nerve Class II
- 3198 Other operations on larynx Class II
371
U-2-22 PROSEDUR SEDANG PADA

TENGGOROKAN
- 1821 Excision of preauricular sinus Class II
- 189 Other operations on external ear Class II
- 290 Pharyngotomy Class II
- 2932 Pharyngeal diverticulectomy Class II
- 2939 Other excision or destruction of lesion or tissue of pharynx Class II
- 293 Excision or destruction of lesion or tissue of pharynx Class II
- 2951 Suture of laceration of pharynx Class II
- 2954 Lysis of pharyngeal adhesions Class II
- 2959 Other repair of pharynx Class II
- 2999 Other operations on pharynx Class II
- 3009 Other excision or destruction of lesion or tissue of larynx Class II
- 3022 Vocal cordectomy Class II
372
U-2-23 PROSEDUR PERBAIKAN

HIDUNG RHINOPLASTY
- 215 Submucous resection of nasal septum Class II
- 2183 Total nasal reconstruction Class II
- 2184 Revision rhinoplasty Class II
- 2185 Augmentation rhinoplasty Class II
- 2186 Limited rhinoplasty Class II
- 2187 Other rhinoplasty Class II
- 2188 Other septoplasty Class II
373
U-2-24 PROSEDUR KECIL PADA

HIDUNG
- 2109 Control of epistaxis by other means Class II
- 2161 Turbinectomy by diathermy or cryosurgery Class II
- 2162 Fracture of the turbinates Class II
- 2169 Other turbinectomy Class II
- 2172 Open reduction of nasal fracture Class II
- 2189 Other repair and plastic operations on nose Class II
- 2199 Other operations on nose Class II
374
U-2-25 PROSEDUR PADA TELINGA

TENGAH
- 190 Stapes mobilization Class II
- 1911 Stapedectomy with incus replacement Class II
- 1919 Other stapedectomy Class II
- 1921 Revision of stapedectomy with incus replacement Class II
- 1929 Other revision of stapedectomy Class II
- 193 Other operations on ossicular chain Class II
- 194 Myringoplasty Class II
- 1952 Type ii tympanoplasty Class II
- 1953 Type iii tympanoplasty Class II
- 1954 Type iv tympanoplasty Class II
- 1955 Type v tympanoplasty Class II
- 196 Revision of tympanoplasty Class II
- 199 Other repair of middle ear Class II
- 2023 Incision of middle ear Class II
- 2032 Biopsy of middle and inner ear Class II
- 2039 Other diagnostic procedures on middle and inner ear Class II
- 2051 Excision of lesion of middle ear Class II
- 2059 Other excision of middle ear Class II
- 2061 Fenestration of inner ear (initial) Class II
- 2062 Revision of fenestration of inner ear Class II
- 2071 Endolymphatic shunt Class II
- 2072 Injection into inner ear Class II
- 2079 Other incision, excision, and destruction of inner ear Class II
- 2091 Tympanosympathectomy Class II
- 2093 Repair of oval and round windows Class II
375
- 2099 Other operations on middle and inner ear Class II
376

MULUT DAN LIDAH
- 252 Partial glossectomy Class II
- 2559 Other repair and plastic operations on tongue Class II
- 2731 Local excision or destruction of lesion or tissue of bony palate Class II
- 2742 Wide excision of lesion of lip Class II
- 2743 Other excision of lesion or tissue of lip Class II
- 2755 Full-thickness skin graft to lip and mouth Class II
- 2756 Other skin graft to lip and mouth Class II
- 2757 Attachment of pedicle or flap graft to lip and mouth Class II
377
U-2-32 PROSEDUR KECIL PADA

MULUT DAN LIDAH
- 242 Gingivoplasty Class II
- 244 Excision of dental lesion of jaw Class II
- 245 Alveoloplasty Class II
- 2502 Open biopsy of tongue Class II
- 251 Excision or destruction of lesion or tissue of tongue Class II
- 2594 Other glossotomy Class II
- 2599 Other operations on tongue Class II
- 270 Drainage of face and floor of mouth Class II
- 271 Incision of palate Class II
- 2721 Biopsy of bony palate Class II
- 2722 Biopsy of uvula and soft palate Class II
- 2749 Other excision of mouth Class II
- 2753 Closure of fistula of mouth Class II
- 2759 Other plastic repair of mouth Class II
- 2761 Suture of laceration of palate Class II
- 2771 Incision of uvula Class II
- 2772 Excision of uvula Class II
- 2773 Repair of uvula Class II
- 2779 Other operations on uvula Class II
- 2792 Incision of mouth, unspecified structure Class II
- 2799 Other operations on oral cavity Class II
378
U-3-10 PROSEDUR SEDANG LAINLAIN PADA TELINGA, HIDUNG,

MULUT DAN TENGGOROKAN
- 1829 Excision or destruction of other lesion of external ear Class III
- 184 Suture of laceration of external ear Class III
- 2131 Local excision or destruction of intranasal lesion Class III
- 2132 Local excision or destruction of other lesion of nose Class III
- 2181 Suture of laceration of nose Class III
- 2491 Extension or deepening of buccolabial or lingual sulcus Class III
- 2751 Suture of laceration of lip Class III
- 310 Injection of larynx Class III
- 9549 Other nonoperative procedures related to hearing Class III
379
U-3-11 PROSEDUR KECIL LAIN-LAIN

PADA TELINGA, HIDUNG, MULUT
DAN TENGGOROKAN
- 1802 Incision of external auditory canal Class III
- 1809 Other incision of external ear Class III
- 2001 Myringotomy with insertion of tube Class III
- 2009 Other myringotomy Class III
- 208 Operations on eustachian tube Class III
- 211 Incision of nose Class III
- 2130 Excision or destruction of lesion of nose, not otherwise specified Class III
- 2171 Closed reduction of nasal fracture Class III
- 2191 Lysis of adhesions of nose Class III
- 2200 Aspiration and lavage of nasal sinus, not otherwise specified Class III
- 2201 Puncture of nasal sinus for aspiration or lavage Class III
- 2202 Aspiration or lavage of nasal sinus through natural ostium Class III
- 2211 Closed (endoscopic) (needle) biopsy of nasal sinus Class III
- 222 Intranasal antrotomy Class III
- 240 Incision of gum or alveolar bone Class III
- 2431 Excision of lesion or tissue of gum Class III
- 2432 Suture of laceration of gum Class III
- 2439 Other operations on gum Class III
- 2551 Suture of laceration of tongue Class III
- 2591 Lingual frenotomy Class III
- 2592 Lingual frenectomy Class III
- 2593 Lysis of adhesions of tongue Class III
- 260 Incision of salivary gland or duct Class III
- 2611 Closed (needle) biopsy of salivary gland or duct Class III
380
- 2691 Probing of salivary duct Class III

- 2741 Labial frenectomy Class III
- 2752 Suture of laceration of other part of mouth Class III
- 2791 Labial frenotomy Class III
- 2991 Dilation of pharynx Class III
381
U-3-12 PROSEDUR KAUTERISASI &

PACKING PADA RONGGA HIDUNG
- 2100 Control of epistaxis, not otherwise specified Class III
- 2101 Control of epistaxis by anterior nasal packing Class III
- 2102 Control of epistaxis by posterior (and anterior) packing Class III
- 2103 Control of epistaxis by cauterization (and packing) Class III
- 9721 Replacement of nasal packing Class III
382
U-3-13 PROSEDUR DIAGNOSTIK

LAIN-LAIN PADA TELINGA, HIDUNG,
MULUT DAN TENGGOROKAN
- 1812 Biopsy of external ear Class III
- 1819 Other diagnostic procedures on external ear Class III
- 2122 Biopsy of nose Class III
- 2129 Other diagnostic procedures on nose Class III
- 2219 Other diagnostic procedures on nasal sinuses Class III
- 2411 Biopsy of gum Class III
- 2412 Biopsy of alveolus Class III
- 2419 Other diagnostic procedures on teeth, gums, and alveoli Class III
- 2501 Closed (needle) biopsy of tongue Class III
- 2509 Other diagnostic procedures on tongue Class III
- 2619 Other diagnostic procedures on salivary glands and ducts Class III
- 2723 Biopsy of lip Class III
- 2724 Biopsy of mouth, unspecified structure Class III
- 2729 Other diagnostic procedures on oral cavity Class III
- 2912 Pharyngeal biopsy Class III
- 2919 Other diagnostic procedures on pharynx Class III
- 3143 Closed (endoscopic) biopsy of larynx Class III
- 3148 Other diagnostic procedures on larynx Class III
383
U-3-14 PROSEDUR TES FUNGSI

PADA TELINGA, HIDUNG, MULUT
DAN TENGGOROKAN
- 2031 Electrocochleography Class III
- 8912 Nasal function study Class III
- 9541 Audiometry Class III
- 9542 Clinical test of hearing Class III
- 9543 Audiological evaluation Class III
- 9544 Clinical vestibular function tests Class III
- 9545 Rotation tests Class III
- 9546 Other auditory and vestibular function tests Class III
- 9547 Hearing examination, not otherwise specified Class III
384
U-3-15 PROSEDUR LAIN-LAIN PADA

TENGGOROKAN
- 1801 Piercing of ear lobe Class III
- 201 Removal of tympanostomy tube Class III
- 2094 Injection of tympanum Class III
- 9548 Fitting of hearing aid Class III
- 9611 Packing of external auditory canal Class III
- 9621 Dilation of frontonasal duct Class III
- 9652 Irrigation of ear Class III
- 9653 Irrigation of nasal passages Class III
- 9732 Removal of nasal packing Class III
- 9736 Removal of other external mandibular fixation device Class III
- 9738 Removal of sutures from head and neck Class III
- 9739 Removal of other therapeutic device from head and neck Class III
- 9801 Removal of intraluminal foreign body from mouth without incision Class
III
- 9811 Removal of intraluminal foreign body from ear without incision Class III
- 9812 Removal of intraluminal foreign body from nose without incision Class III
- 9813 Removal of intraluminal foreign body from pharynx without incision Class
III
- 9814 Removal of intraluminal foreign body from larynx without incision Class
III
385
U-3-16 PROSEDUR PADA GIGI

- 2301 Extraction of deciduous tooth Class III
- 2309 Extraction of other tooth Class III
- 2311 Removal of residual root Class III
- 2319 Other surgical extraction of tooth Class III
- 232 Restoration of tooth by filling Class III
- 233 Restoration of tooth by inlay Class III
- 2341 Application of crown Class III
- 2342 Insertion of fixed bridge Class III
- 2343 Insertion of removable bridge Class III
- 2349 Other dental restoration Class III
- 235 Implantation of tooth Class III
- 236 Prosthetic dental implant Class III
- 2370 Root canal, not otherwise specified Class III
- 2371 Root canal therapy with irrigation Class III
- 2372 Root canal therapy with apicoectomy Class III
- 2373 Apicoectomy Class III
- 246 Exposure of tooth Class III
- 247 Application of orthodontic appliance Class III
- 248 Other orthodontic operation Class III
- 2499 Other dental operations Class III
- 9355 Dental wiring Class III
- 9654 Dental scaling, polishing, and debridement Class III
- 9722 Replacement of dental packing Class III
- 9733 Removal of dental wiring Class III
- 9734 Removal of dental packing Class III
- 9735 Removal of dental prosthesis Class III
386
- 9997 Fitting of denture Class III
387
V-1-10 PROSEDUR PENGANGKATAN

PROSTAT KOMPLEK
- 603 Suprapubic prostatectomy Class II
- 604 Retropubic prostatectomy Class II
- 605 Radical prostatectomy Class II
- 6062 Perineal prostatectomy Class II
388
V-1-11 PROSEDUR PADA PENIS

- 6411 Biopsy of penis Class II
- 642 Local excision or destruction of lesion of penis Class II
- 643 Amputation of penis Class II
- 6441 Suture of laceration of penis Class II
- 6442 Release of chordee Class II
- 6443 Construction of penis Class II
- 6444 Reconstruction of penis Class II
- 6445 Replantation of penis Class II
- 6449 Other repair of penis Class II
- 645 Operations for sex transformation, not elsewhere classified Class II
- 6492 Incision of penis Class II
- 6493 Division of penile adhesions Class II
- 6495 Insertion or replacement of non-inflatable penile prosthesis Class II
- 6496 Removal of internal prosthesis of penis Class II
- 6497 Insertion or replacement of inflatable penile prosthesis Class II
- 6498 Other operations on penis Class II
- 6499 Other operations on male genital organs Class II
389
V-1-12 PROSEDUR PADA SKROTUM

DAN PROSTAT KOMPLEK-MODERAT
- 6073 Excision of seminal vesicle Class II
- 6082 Excision of periprostatic tissue Class II
- 6094 Control of (postoperative) hemorrhage of prostate Class II
- 612 Excision of hydrocele (of tunica vaginalis) Class II
- 6142 Repair of scrotal fistula Class II
- 6149 Other repair of scrotum and tunica vaginalis Class II
- 6241 Removal of both testes at same operative episode Class II
- 625 Orchiopexy Class II
- 631 Excision of varicocele and hydrocele of spermatic cord Class II
- 634 Epididymectomy Class II
- 6352 Reduction of torsion of testis or spermatic cord Class II
- 6353 Transplantation of spermatic cord Class II
- 6382 Reconstruction of surgically divided vas deferens Class II
- 6383 Epididymovasostomy Class II
390
V-1-13 PROSEDUR PADA SKROTUM

DAN PROSTAT NON KOMPLEK
- 600 Incision of prostate Class II
- 6012 Open biopsy of prostate Class II
- 6014 Open biopsy of seminal vesicles Class II
- 6015 Biopsy of periprostatic tissue Class II
- 6018 Other diagnostic procedures on prostate and periprostatic tissue Class II
- 6019 Other diagnostic procedures on seminal vesicles Class II
- 6061 Local excision of lesion of prostate Class II
- 6069 Other prostatectomy Class II
- 6072 Incision of seminal vesicle Class II
- 6079 Other operations on seminal vesicles Class II
- 6081 Incision of periprostatic tissue Class II
- 6093 Repair of prostate Class II
- 6095 Transurethral balloon dilation of the prostatic urethra Class II
- 6099 Other operations on prostate Class II
- 610 Incision and drainage of scrotum and tunica vaginalis Class II
- 613 Excision or destruction of lesion or tissue of scrotum Class II
- 6141 Suture of laceration of scrotum and tunica vaginalis Class II
- 6192 Excision of lesion of tunica vaginalis other than hydrocele Class II
- 6199 Other operations on scrotum and tunica vaginalis Class II
- 620 Incision of testis Class II
- 6212 Open biopsy of testis Class II
- 6219 Other diagnostic procedures on testes Class II
- 622 Excision or destruction of testicular lesion Class II
- 623 Unilateral orchiectomy Class II
- 6242 Removal of remaining testis Class II
391
- 6261 Suture of laceration of testis Class II

- 6269 Other repair of testis Class II
- 627 Insertion of testicular prosthesis Class II
- 6299 Other operations on testes Class II
- 6309 Other diagnostic procedures on spermatic cord, epididymis, and vas
deferens Class II
- 632 Excision of cyst of epididymis Class II
- 633 Excision of other lesion or tissue of spermatic cord and epididymis Class II
- 6351 Suture of laceration of spermatic cord and epididymis Class II
- 6359 Other repair of spermatic cord and epididymis Class II
- 636 Vasotomy Class II
- 6381 Suture of laceration of vas deferens and epididymis Class II
- 6385 Removal of valve from vas deferens Class II
- 6389 Other repair of vas deferens and epididymis Class II
- 6392 Epididymotomy Class II
- 6393 Incision of spermatic cord Class II
- 6394 Lysis of adhesions of spermatic cord Class II
- 6395 Insertion of valve in vas deferens Class II
- 6399 Other operations on spermatic card, epididymis, and vas deferens Class
II
392
V-1-14 PROSEDUR PENGANGKATAN

PROSTAT MELALUI URETRA
- 6021 Transurethral (ultrasound) guided laser induced prostatectomy (TULIP)
Class II
- 6029 Other transurethral prostatectomy Class II
- 602 Transurethral prostatectomy Class II
- 6096 Transurethral destruction of prostate tissue by microwave thermotherapy
Class II
- 6097 Other transurethral destruction of prostate tissue by other
thermotherapy Class II
393
V-1-15 PROSEDUR SIRKUMSISI

- 640 Circumcision Class II
394
V-2-10 PROSEDUR BESAR PADA

PENGANGKATAN PROSTAT
- 603 Suprapubic prostatectomy Class II
- 604 Retropubic prostatectomy Class II
- 605 Radical prostatectomy Class II
- 6062 Perineal prostatectomy Class II
395
V-2-11 PROSEDUR PADA PENIS

- 6411 Biopsy of penis Class II
- 642 Local excision or destruction of lesion of penis Class II
- 643 Amputation of penis Class II
- 6441 Suture of laceration of penis Class II
- 6442 Release of chordee Class II
- 6443 Construction of penis Class II
- 6444 Reconstruction of penis Class II
- 6445 Replantation of penis Class II
- 6449 Other repair of penis Class II
- 6492 Incision of penis Class II
- 6493 Division of penile adhesions Class II
- 6495 Insertion or replacement of non-inflatable penile prosthesis Class II
- 6496 Removal of internal prosthesis of penis Class II
- 6497 Insertion or replacement of inflatable penile prosthesis Class II
- 6498 Other operations on penis Class II
- 6499 Other operations on male genital organs Class II
396
V-2-12 PROSEDUR SEDANG PADA

PROSTAT DAN SKROTUM
- 6073 Excision of seminal vesicle Class II
- 6082 Excision of periprostatic tissue Class II
- 6094 Control of (postoperative) hemorrhage of prostate Class II
- 612 Excision of hydrocele (of tunica vaginalis) Class II
- 6142 Repair of scrotal fistula Class II
- 6149 Other repair of scrotum and tunica vaginalis Class II
- 6241 Removal of both testes at same operative episode Class II
- 625 Orchiopexy Class II
- 631 Excision of varicocele and hydrocele of spermatic cord Class II
- 634 Epididymectomy Class II
- 6352 Reduction of torsion of testis or spermatic cord Class II
- 6353 Transplantation of spermatic cord Class II
- 6382 Reconstruction of surgically divided vas deferens Class II
- 6383 Epididymovasostomy Class II
397
V-2-13 PROSEDUR KECIL PADA

PROSTAT DAN SKROTUM
- 600 Incision of prostate Class II
- 6012 Open biopsy of prostate Class II
- 6014 Open biopsy of seminal vesicles Class II
- 6015 Biopsy of periprostatic tissue Class II
- 6018 Other diagnostic procedures on prostate and periprostatic tissue Class II
- 6019 Other diagnostic procedures on seminal vesicles Class II
- 6061 Local excision of lesion of prostate Class II
- 6069 Other prostatectomy Class II
- 6072 Incision of seminal vesicle Class II
- 6079 Other operations on seminal vesicles Class II
- 6081 Incision of periprostatic tissue Class II
- 6093 Repair of prostate Class II
- 6095 Transurethral balloon dilation of the prostatic urethra Class II
- 6099 Other operations on prostate Class II
- 610 Incision and drainage of scrotum and tunica vaginalis Class II
- 613 Excision or destruction of lesion or tissue of scrotum Class II
- 6141 Suture of laceration of scrotum and tunica vaginalis Class II
- 6192 Excision of lesion of tunica vaginalis other than hydrocele Class II
- 6199 Other operations on scrotum and tunica vaginalis Class II
- 620 Incision of testis Class II
- 6212 Open biopsy of testis Class II
- 6219 Other diagnostic procedures on testes Class II
- 622 Excision or destruction of testicular lesion Class II
- 623 Unilateral orchiectomy Class II
- 6242 Removal of remaining testis Class II
398
- 6261 Suture of laceration of testis Class II

- 6269 Other repair of testis Class II
- 627 Insertion of testicular prosthesis Class II
- 6299 Other operations on testes Class II
- 6309 Other diagnostic procedures on spermatic cord, epididymis, and vas
deferens Class II
- 632 Excision of cyst of epididymis Class II
- 633 Excision of other lesion or tissue of spermatic cord and epididymis Class II
- 6351 Suture of laceration of spermatic cord and epididymis Class II
- 6359 Other repair of spermatic cord and epididymis Class II
- 636 Vasotomy Class II
- 6381 Suture of laceration of vas deferens and epididymis Class II
- 6385 Removal of valve from vas deferens Class II
- 6389 Other repair of vas deferens and epididymis Class II
- 6392 Epididymotomy Class II
- 6393 Incision of spermatic cord Class II
- 6394 Lysis of adhesions of spermatic cord Class II
- 6395 Insertion of valve in vas deferens Class II
- 6399 Other operations on spermatic card, epididymis, and vas deferens Class
II
399
V-2-14 PENGANGKATAN PROSTAT

MELALUI TRANSURETHRAL
- 6021 Transurethral (ultrasound) guided laser induced prostatectomy (TULIP)
Class II
- 6029 Other transurethral prostatectomy Class II
- 602 Transurethral prostatectomy Class II
- 6096 Transurethral destruction of prostate tissue by microwave thermotherapy
Class II
- 6097 Other transurethral destruction of prostate tissue by other
thermotherapy Class II
400
V-2-15 SIRKUMSISI/SUNAT
- 640 Circumcision Class II
401
V-3-10 PROSEDUR STERILISASI

PADA LAKI-LAKI
- 6370 Male sterilization procedure, not otherwise specified Class III
- 6371 Ligation of vas deferens Class III
- 6372 Ligation of spermatic cord Class III
- 6373 Vasectomy Class III
402
V-3-11 PROSEDUR DIAGNOSTIK

DAN TERAPEUTIK PADA ALAT
GENITAL LAKI-LAKI
- 6011 Closed [percutaneous] [needle] biopsy of prostate Class III
- 6013 Closed [percutaneous] biopsy of seminal vesicles Class III
- 6071 Percutaneous aspiration of seminal vesicle Class III
- 6092 Injection into prostate test link Class III
- 6111 Biopsy of scrotum or tunica vaginalis Class III
- 6119 Other diagnostic procedures on scrotum and tunica vaginalis Class III
- 6191 Percutaneous aspiration of tunica vaginalis Class III
- 6211 Closed (percutaneous) (needle) biopsy of testis Class III
- 6291 Aspiration of testis Class III
- 6292 Injection of therapeutic substance into testis Class III
- 6301 Biopsy of spermatic cord, epididymis, or vas deferens Class III
- 6384 Removal of ligature from vas deferens Class III
- 6391 Aspiration of spermatocele Class III
- 6419 Other diagnostic procedures on penis Class III
- 6491 Dorsal or lateral slit of prepuce Class III
403
V-3-12 PROSEDUR LAIN PADA ALAT

GENITAL LAKI-LAKI
- 6494 Fitting of external prosthesis of penis Class III
- 9824 Removal of foreign body from scrotum or penis without incision Class III
- 9994 Prostatic massage Class III
- 9995 Stretching of foreskin Class III
- 9996 Collection of sperm for artificial insemination Class III
404
W-1-01 PROSEDUR OPERASI

PENGANGKATAN RAHIM DAN VULVA
RADIKAL & EVISCERASI
- 686 Radical abdominal hysterectomy Class I
- 687 Radical vaginal hysterectomy Class I
- 688 Pelvic evisceration Class I
- 715 Radical vulvectomy Class I
405
W-1-10 PROSEDUR ABORSI

- 6901 Dilation and curettage for termination of pregnancy Class II
- 6951 Aspiration curettage of uterus for termination of pregnancy Class II
- 7491 Hysterotomy to terminate pregnancy Class II
406
W-1-11 PROSEDUR DILATASI,

KURET, INTRAUTERIN & SERVIK
- 6695 Insufflation of therapeutic agent into fallopian tubes Class II
- 6821 Division of endometrial synechiae Class II
- 6822 Incision or excision of congenital septum of uterus Class II
- 6999 Other operations on cervix and uterus Class II
- 719 Other operations on female genital organs Class II
407
W-1-12 PROSEDUR OPERASI

MEMBUKA TUBA YANG
TERHALANG/TERGANGGU
408
W-1-13 PROSEDUR INTERUPSI

TUBA DENGAN ENDOSKOP
Class II
409
W-1-20 PROSEDUR PADA RAHIM &

ADNEKSA
- 6501 Laparoscopic oophorotomy Class II
- 6509 Other oophorotomy Class II
- 650 Oophorotomy Class II
- 6511 Aspiration biopsy of ovary Class II
- 6512 Other biopsy of ovary Class II
- 6513 Laparoscopic biopsy of ovary Class II
- 6514 Other laparoscopic diagnostic procedures on ovaries Class II
- 6519 Other diagnostic procedures on ovaries Class II
- 6521 Marsupialization of ovarian cyst Class II
- 6522 Wedge resection of ovary Class II
- 6523 Laparoscopic marsupialization of ovarian cyst Class II
- 6524 Laparoscopic wedge resection of ovary Class II
- 6525 Other laparoscopic local excision or destruction of ovary Class II
- 6529 Other local excision or destruction of ovary Class II
- 6531 Laparoscopic unilateral oophorectomy Class II
- 6539 Other unilateral oophorectomy Class II
- 653 Unilateral oophorectomy Class II
- 6541 Laparoscopic unilateral salpingo-oophorectomy Class II
- 6549 Other unilateral salpingo-oophorectomy Class II
- 654 Unilateral salpingo-oophorectomy Class II
- 6551 Other removal of both ovaries at same operative episode Class II
- 6552 Other removal of remaining ovary Class II
- 6553 Laparoscopic removal of both ovaries at same operative episode Class II
- 6554 Laparoscopic removal of remaining ovary Class II
410
- 6561 Other removal of both ovaries and tubes at same operative episode
Class II
- 6562 Other removal of remaining ovary and tube Class II
- 6563 Laparoscopic removal of both ovaries and tubes at the same operative
episode Class II
- 6564 Laparoscopic removal of remaining ovary and tube Class II
- 6571 Other simple suture of ovary Class II
- 6572 Other reimplantation of ovary Class II
- 6573 Other salpingo-oophoroplasty Class II
- 6574 Laparoscopic simple suture of ovary Class II
- 6575 Laparoscopic reimplantation of ovary Class II
- 6576 Laparoscopic salpingo-oophoroplasty Class II
- 6579 Other repair of ovary Class II
- 6581 Laparoscopic lysis of adhesions of ovary and fallopian tube Class II
- 6589 Other lysis of adhesions of ovary and fallopian tube Class II
- 658 Lysis of adhesions of ovary and fallopian tube Class II
- 6591 Aspiration of ovary Class II
- 6592 Transplantation of ovary Class II
- 6593 Manual rupture of ovarian cyst Class II
- 6594 Ovarian denervation Class II
- 6595 Release of torsion of ovary Class II
- 6599 Other operations on ovary Class II
- 6601 Salpingotomy Class II
- 6602 Salpingostomy Class II
- 660 Salpingotomy and salpingostomy Class II
- 6611 Biopsy of fallopian tube Class II
411
- 6661 Excision or destruction of lesion of fallopian tube Class II

- 6662 Salpingectomy with removal of tubal pregnancy Class II
- 6671 Simple suture of fallopian tube Class II
- 6672 Salpingo-oophorostomy Class II
- 6673 Salpingo-salpingostomy Class II
- 6674 Salpingo-uterostomy Class II
- 6679 Other repair of fallopian tube Class II
- 6693 Implantation or replacement of prosthesis of fallopian tube Class II
- 6694 Removal of prosthesis of fallopian tube Class II
- 6696 Dilation of fallopian tube Class II
- 6699 Other operations on fallopian tubes Class II
- 680 Hysterotomy Class II
- 6813 Open biopsy of uterus Class II
- 6814 Open biopsy of uterine ligaments Class II
- 6815 Closed biopsy of uterine ligaments Class II
- 6816 Closed biopsy of uterus Class II
- 6819 Other diagnostic procedures on uterus and supporting structures Class II
- 6823 Endometrial ablation Class II
- 6829 Other excision or destruction of lesion of uterus Class II
- 6831 Laparoscopic supracervical hysterectomy LSH Class II
- 6839 Other and unspecified subtotal abdominal hysterectomy Class II
- 683 Subtotal abdominal hysterectomy Class II
- 684 Total abdominal hysterectomy Class II
- 689 Other and unspecified hysterectomy Class II
- 6919 Other excision or destruction of uterus and supporting structures Class II
412
- 6921 Interposition operation Class II

- 6922 Other uterine suspension Class II
- 6923 Vaginal repair of chronic inversion of uterus Class II
- 6929 Other repair of uterus and supporting structures Class II
- 693 Paracervical uterine denervation Class II
- 6941 Suture of laceration of uterus Class II
- 6942 Closure of fistula of uterus Class II
- 6949 Other repair of uterus Class II
- 6998 Other operations on supporting structures of uterus Class II
- 743 Removal of extratubal ectopic pregnancy Class I
- 7536 Correction of fetal defect Class II
- 7550 Repair of current obstetric laceration of uterus, not otherwise specified
Class II
- 7552 Repair of current obstetric laceration of corpus uteri Class II
- 7593 Surgical correction of inverted uterus Class II
- 7599 Other obstetric operations Class II
413
W-1-30 PROSEDUR PADA VAGINA,

SERVIK & VULVA
- 594 Suprapubic sling operation Class II
- 595 Retropubic urethral suspension Class II
- 596 Paraurethral suspension Class II
- 5971 Levator muscle operation for urethrovesical suspension Class II
- 5979 Other repair of urinary stress incontinence Class II
- 6619 Other diagnostic procedures on fallopian tubes Class II
- 6711 Endocervical biopsy Class II
- 6712 Other cervical biopsy Class II
- 6719 Other diagnostic procedures on cervix Class II
- 672 Conization of cervix Class II
- 6731 Marsupialization of cervical cyst Class II
- 6732 Destruction of lesion of cervix by cauterization Class II
- 6733 Destruction of lesion of cervix by cryosurgery Class II
- 6739 Other excision or destruction of lesion or tissue of cervix Class II
- 674 Amputation of cervix Class II
- 6751 Transabdominal cerclage of cervix Class II
- 6759 Other repair of internal cervical os Class II
- 675 Repair of internal cervical os Class II
- 6761 Suture of laceration of cervix Class II
- 6762 Repair of fistula of cervix Class II
- 6769 Other repair of cervix Class II
- 6851 Laparoscopically assisted vaginal hysterectomy LAVH Class II
- 6859 Other and unspecified vaginal hysterectomy Class II
- 685 Vaginal hysterectomy Class II
414
- 6995 Incision of cervix Class II

- 6997 Removal of other penetrating foreign body from cervix Class II
- 7012 Culdotomy Class II
- 7013 Lysis of intraluminal adhesions of vagina Class II
- 7014 Other vaginotomy Class II
- 7023 Biopsy of cul-de-sac Class II
- 7024 Vaginal biopsy Class II
- 7029 Other diagnostic procedures on vagina and cul-de-sac Class II
- 7031 Hymenectomy Class II
- 7032 Excision or destruction of lesion of cul-de-sac Class II
- 7033 Excision or destruction of lesion of vagina Class II
- 704 Obliteration and total excision of vagina Class II
- 7050 Repair of cystocele and rectocele Class II
- 7051 Repair of cystocele Class II
- 7052 Repair of rectocele Class II
- 7061 Vaginal construction Class II
- 7062 Vaginal reconstruction Class II
- 7071 Suture of laceration of vagina Class II
- 7075 Repair of other fistula of vagina Class II
- 7076 Hymenorrhaphy Class II
- 7077 Vaginal suspension and fixation Class II
- 7079 Other repair of vagina Class II
- 708 Obliteration of vaginal vault Class II
- 7091 Other operations on vagina Class II
- 7092 Other operations on cul-de-sac Class II
- 7101 Lysis of vulvar adhesions Class II
- 7109 Other incision of vulva and perineum Class II
- 7111 Biopsy of vulva Class II
415
- 7119 Other diagnostic procedures on vulva Class II

- 7122 Incision of Bartholin\s gland (cyst) Class II
- 7123 Marsupialization of Bartholin\s gland (cyst) Class II
- 7124 Excision or other destruction of Bartholin\s gland (cyst) Class II
- 7129 Other operations on Bartholin\s gland Class II
- 713 Other local excision or destruction of vulva and perineum Class II
- 714 Operations on clitoris Class II
- 7161 Unilateral vulvectomy Class II
- 7162 Bilateral vulvectomy Class II
- 7171 Suture of laceration of vulva or perineum Class II
- 7172 Repair of fistula of vulva or perineum Class II
- 7179 Other repair of vulva and perineum Class II
- 718 Other operations on vulva Class II
- 751 Diagnostic amniocentesis Class II
- 7531 Amnioscopy Class II
- 7533 Fetal blood sampling and biopsy Class II
- 7535 Other diagnostic procedures on fetus and amnion Class II
- 7551 Repair of current obstetric laceration of cervix Class II
- 7562 Repair of current obstetric laceration of rectum and sphincter ani Class II
- 7569 Repair of other current obstetric laceration Class II
- 7591 Evacuation of obstetrical incisional hematoma of perineum Class II
- 7592 Evacuation of other hematoma of vulva or vagina Class II
416
W-2-10 PROSEDUR ABORSI

- 6901 Dilation and curettage for termination of pregnancy Class II
- 6951 Aspiration curettage of uterus for termination of pregnancy Class II
- 7491 Hysterotomy to terminate pregnancy Class II
417
W-2-11 PROSEDUR PELEBARAN,

KURETASE DALAM RAHIM & LEHER
RAHIM
- 6695 Insufflation of therapeutic agent into fallopian tubes Class II
- 6821 Division of endometrial synechiae Class II
- 6822 Incision or excision of congenital septum of uterus Class II
- 6999 Other operations on cervix and uterus Class II
- 719 Other operations on female genital organs Class II
418
W-2-12 PROSEDUR MEMBUKA TUBA

YANG TERHALANG/TERGANGGU
419
W-2-13 PROSEDUR ENDOSKOPI

TUBA YANG
TERHALANG/TERGANGGU
Class II
420
W-2-21 PROSEDUR BESAR PADA

FRAKTUR RONGGA PANGGUL
TERBUKA
- 6549 Other unilateral salpingo-oophorectomy Class II
- 6551 Other removal of both ovaries at same operative episode Class II
- 6561 Other removal of both ovaries and tubes at same operative episode
Class II
- 6673 Salpingo-salpingostomy Class II
- 6674 Salpingo-uterostomy Class II
- 6679 Other repair of fallopian tube Class II
- 680 Hysterotomy Class II
- 6831 Laparoscopic supracervical hysterectomy LSH Class II
- 6839 Other and unspecified subtotal abdominal hysterectomy Class II
- 683 Subtotal abdominal hysterectomy Class II
- 684 Total abdominal hysterectomy Class II
- 689 Other and unspecified hysterectomy Class II
- 6919 Other excision or destruction of uterus and supporting structures Class II
- 6921 Interposition operation Class II
- 6922 Other uterine suspension Class II
- 6929 Other repair of uterus and supporting structures Class II
- 6941 Suture of laceration of uterus Class II
- 6942 Closure of fistula of uterus Class II
- 6949 Other repair of uterus Class II
- 6998 Other operations on supporting structures of uterus Class II
421
W-2-22 PROSEDUR KECIL PADA

FRAKTUR RONGGA PANGGUL
TERBUKA
- 6509 Other oophorotomy Class II
- 650 Oophorotomy Class II
- 6511 Aspiration biopsy of ovary Class II
- 6512 Other biopsy of ovary Class II
- 6519 Other diagnostic procedures on ovaries Class II
- 6521 Marsupialization of ovarian cyst Class II
- 6522 Wedge resection of ovary Class II
- 6529 Other local excision or destruction of ovary Class II
- 6539 Other unilateral oophorectomy Class II
- 653 Unilateral oophorectomy Class II
- 654 Unilateral salpingo-oophorectomy Class II
- 6552 Other removal of remaining ovary Class II
- 6562 Other removal of remaining ovary and tube Class II
- 6571 Other simple suture of ovary Class II
- 6572 Other reimplantation of ovary Class II
- 6573 Other salpingo-oophoroplasty Class II
- 6579 Other repair of ovary Class II
- 6589 Other lysis of adhesions of ovary and fallopian tube Class II
- 658 Lysis of adhesions of ovary and fallopian tube Class II
- 6591 Aspiration of ovary Class II
- 6592 Transplantation of ovary Class II
- 6593 Manual rupture of ovarian cyst Class II
- 6594 Ovarian denervation Class II
- 6595 Release of torsion of ovary Class II
422
- 6599 Other operations on ovary Class II

- 6601 Salpingotomy Class II
- 6602 Salpingostomy Class II
- 660 Salpingotomy and salpingostomy Class II
- 6611 Biopsy of fallopian tube Class II
- 6661 Excision or destruction of lesion of fallopian tube Class II
- 6662 Salpingectomy with removal of tubal pregnancy Class II
- 6671 Simple suture of fallopian tube Class II
- 6672 Salpingo-oophorostomy Class II
- 6693 Implantation or replacement of prosthesis of fallopian tube Class II
- 6694 Removal of prosthesis of fallopian tube Class II
- 6696 Dilation of fallopian tube Class II
- 6699 Other operations on fallopian tubes Class II
- 6813 Open biopsy of uterus Class II
- 6814 Open biopsy of uterine ligaments Class II
- 6819 Other diagnostic procedures on uterus and supporting structures Class II
- 6829 Other excision or destruction of lesion of uterus Class II
- 6923 Vaginal repair of chronic inversion of uterus Class II
- 693 Paracervical uterine denervation Class II
- 7536 Correction of fetal defect Class II
- 7550 Repair of current obstetric laceration of uterus, not otherwise specified
Class II
- 7552 Repair of current obstetric laceration of corpus uteri Class II
- 7593 Surgical correction of inverted uterus Class II
423
- 7599 Other obstetric operations Class II
424
W-2-23 PROSEDUR LAPAROSKOPI

GINEKOLOGI
- 6501 Laparoscopic oophorotomy Class II
- 6513 Laparoscopic biopsy of ovary Class II
- 6514 Other laparoscopic diagnostic procedures on ovaries Class II
- 6523 Laparoscopic marsupialization of ovarian cyst Class II
- 6524 Laparoscopic wedge resection of ovary Class II
- 6525 Other laparoscopic local excision or destruction of ovary Class II
- 6531 Laparoscopic unilateral oophorectomy Class II
- 6541 Laparoscopic unilateral salpingo-oophorectomy Class II
- 6553 Laparoscopic removal of both ovaries at same operative episode Class II
- 6554 Laparoscopic removal of remaining ovary Class II
- 6563 Laparoscopic removal of both ovaries and tubes at the same operative
episode Class II
- 6564 Laparoscopic removal of remaining ovary and tube Class II
- 6574 Laparoscopic simple suture of ovary Class II
- 6575 Laparoscopic reimplantation of ovary Class II
- 6576 Laparoscopic salpingo-oophoroplasty Class II
- 6581 Laparoscopic lysis of adhesions of ovary and fallopian tube Class II
- 6815 Closed biopsy of uterine ligaments Class II
- 6816 Closed biopsy of uterus Class II
- 6823 Endometrial ablation Class II
425
W-2-31 PROSEDUR PEMBUANGAN

RAHIM MELALUI JALAN LAHIR
- 6851 Laparoscopically assisted vaginal hysterectomy LAVH Class II
- 6859 Other and unspecified vaginal hysterectomy Class II
- 685 Vaginal hysterectomy Class II
- 7062 Vaginal reconstruction Class II
- 708 Obliteration of vaginal vault Class II
426
W-2-32 PROSEDUR PERBAIKAN

CYSTOCELE DAN VULVOVAGINAL
INTERMEDIATE
- 594 Suprapubic sling operation Class II
- 595 Retropubic urethral suspension Class II
- 596 Paraurethral suspension Class II
- 5971 Levator muscle operation for urethrovesical suspension Class II
- 5979 Other repair of urinary stress incontinence Class II
- 704 Obliteration and total excision of vagina Class II
- 7050 Repair of cystocele and rectocele Class II
- 7051 Repair of cystocele Class II
- 7052 Repair of rectocele Class II
- 7061 Vaginal construction Class II
- 7075 Repair of other fistula of vagina Class II
- 7077 Vaginal suspension and fixation Class II
- 7161 Unilateral vulvectomy Class II
- 7162 Bilateral vulvectomy Class II
427
W-2-33 PROSEDUR KECIL

VULVOVAGINAL
- 672 Conization of cervix Class II
- 6731 Marsupialization of cervical cyst Class II
- 674 Amputation of cervix Class II
- 6751 Transabdominal cerclage of cervix Class II
- 6759 Other repair of internal cervical os Class II
- 675 Repair of internal cervical os Class II
- 6761 Suture of laceration of cervix Class II
- 6762 Repair of fistula of cervix Class II
- 6769 Other repair of cervix Class II
- 6995 Incision of cervix Class II
- 6997 Removal of other penetrating foreign body from cervix Class II
- 7012 Culdotomy Class II
- 7013 Lysis of intraluminal adhesions of vagina Class II
- 7014 Other vaginotomy Class II
- 7031 Hymenectomy Class II
- 7032 Excision or destruction of lesion of cul-de-sac Class II
- 7071 Suture of laceration of vagina Class II
- 7076 Hymenorrhaphy Class II
- 7079 Other repair of vagina Class II
- 7091 Other operations on vagina Class II
- 7092 Other operations on cul-de-sac Class II
- 7123 Marsupialization of Bartholin\s gland (cyst) Class II
- 7124 Excision or other destruction of Bartholin\s gland (cyst) Class II
- 7129 Other operations on Bartholin\s gland Class II
- 714 Operations on clitoris Class II
428
- 7171 Suture of laceration of vulva or perineum Class II

- 7172 Repair of fistula of vulva or perineum Class II
- 7179 Other repair of vulva and perineum Class II
- 718 Other operations on vulva Class II
- 7562 Repair of current obstetric laceration of rectum and sphincter ani Class II
- 7569 Repair of other current obstetric laceration Class II
- 7591 Evacuation of obstetrical incisional hematoma of perineum Class II
- 7592 Evacuation of other hematoma of vulva or vagina Class II
429
W-2-34 PROSEDUR GINEKOLOGI

LAIN-LAIN
- 6619 Other diagnostic procedures on fallopian tubes Class II
- 6711 Endocervical biopsy Class II
- 6712 Other cervical biopsy Class II
- 6719 Other diagnostic procedures on cervix Class II
- 6732 Destruction of lesion of cervix by cauterization Class II
- 6733 Destruction of lesion of cervix by cryosurgery Class II
- 6739 Other excision or destruction of lesion or tissue of cervix Class II
- 7023 Biopsy of cul-de-sac Class II
- 7024 Vaginal biopsy Class II
- 7029 Other diagnostic procedures on vagina and cul-de-sac Class II
- 7033 Excision or destruction of lesion of vagina Class II
- 7101 Lysis of vulvar adhesions Class II
- 7109 Other incision of vulva and perineum Class II
- 7111 Biopsy of vulva Class II
- 7119 Other diagnostic procedures on vulva Class II
- 7122 Incision of Bartholin\s gland (cyst) Class II
- 713 Other local excision or destruction of vulva and perineum Class II
- 751 Diagnostic amniocentesis Class II
- 7531 Amnioscopy Class II
- 7533 Fetal blood sampling and biopsy Class II
- 7535 Other diagnostic procedures on fetus and amnion Class II
- 7551 Repair of current obstetric laceration of cervix Class II
430

GINEKOLOGI & ENDOSKOPI
- 6812 Hysteroscopy Class III
- 6959 Other aspiration curettage of uterus Class III
- 7021 Vaginoscopy Class III
- 7022 Culdoscopy Class III
431
W-3-11 PROSEDUR SEDANG

GINEKOLOGI
- 668 Insufflation of fallopian tube Class III
- 6691 Aspiration of fallopian tube Class III
- 670 Dilation of cervical canal Class III
- 696 Menstrual extraction or regulation Class III
- 697 Insertion of intrauterine contraceptive device Class III
- 6991 Insertion of therapeutic device into uterus Class III
- 6992 Artificial insemination Class III
- 6993 Insertion of laminaria Class III
- 6994 Manual replacement of inverted uterus Class III
- 6996 Removal of cerclage material from cervix Class III
- 700 Culdocentesis Class III
- 7011 Hymenotomy Class III
- 750 Intra-amniotic injection for abortion Class III
- 9649 Other genitourinary instillation Class III
432

GINEKOLOGI
- 7121 Percutaneous aspiration of Bartholin\s gland (cyst) Class III
- 9614 Vaginal packing Class III
- 9615 Insertion of vaginal mold Class III
- 9616 Other vaginal dilation Class III
- 9617 Insertion of vaginal diaphragm Class III
- 9618 Insertion of other vaginal pessary Class III
- 9724 Replacement and refitting of vaginal diaphragm Class III
- 9725 Replacement of other vaginal pessary Class III
- 9726 Replacement of vaginal or vulvar packing or drain Class III
- 9771 Removal of intrauterine contraceptive device Class III
- 9772 Removal of intrauterine pack Class III
- 9773 Removal of vaginal diaphragm Class III
- 9774 Removal of other vaginal pessary Class III
- 9775 Removal of vaginal or vulvar packing Class III
- 9779 Removal of other device from genital tract Class III
- 9816 Removal of intraluminal foreign body from uterus without incision Class
III
- 9817 Removal of intraluminal foreign body from vagina without incision Class
III
- 9823 Removal of foreign body from vulva without incision Class III
433
Z-3-10 PROSEDUR RADIOSURGICAL

- 9230 Stereotactic radiosurgery, not otherwise specified Class III
- 9231 Single source photon radiosurgery Class III
- 9232 Multi-source photon radiosurgery Class III
- 9233 Particulate radiosurgery Class III
- 9239 Stereotactic radiosugery, not elsewhere classified Class III
- 923 Stereotactic radiosurgery Class III
434
Z-3-11 EXTRACORPOREAL
SHOCKWAVE LITHOTRIPSY ESWL
SELAIN URINARI DAN SALURAN
EMPEDU
- 9859 Extracorporeal shockwave lithotripsy (ESWL) of other sites Class III
435
Z-3-12 PROSEDUR REHABILITASI

- 9318 Breathing exercise Class III
- 9319 Exercise, not elsewhere classified Class III
- 9336 Cardiac retraining Class III
- 9371 Dyslexia training Class III
- 9372 Dysphasia training Class III
- 9373 Esophageal speech training Class III
- 9374 Speech defect training Class III
- 9375 Other speech training and therapy Class III
- 9376 Training in use of lead dog for the blind Class III
- 9377 Training in braille or moon Class III
- 9378 Other rehabilitation for the blind Class III
- 9381 Recreational therapy Class III
- 9382 Educational therapy Class III
- 9383 Occupational therapy Class III
- 9384 Music therapy Class III
- 9385 Vocational rehabilitation Class III
- 9389 Rehabilitation, not elsewhere classified Class III
436
Z-3-13 PROSEDUR KECIL

PELAYANAN PENUNJANG LAIN-LAIN
- 8960 Continuous intra-arterial blood gas monitoring Class III
- 9927 Iontophoresis Class III
- 9976 Extracorporeal immunoadsorption Class III
- 9979 Other Class III
- 9981 Hypothermia (central) (local) Class V
- 9985 Hyperthermia for treatment of cancer Class V
- 9988 Therapeutic photopheresis Class V
- 9992 Other acupuncture Class III
437
Z-3-14 DIAGNOSTIK TIDUR

- 8917 Polysomnogram Class III
- 8918 Other sleep disorder function tests Class III
438
Z-3-15 IMAGING NUKLIR JANTUNG

- 8944 Other cardiovascular stress test Class III
439
Z-3-16 PROSEDUR MAGNETIC

RESONANCE IMAGING MRI
- 8891 Magnetic resonance imaging of brain and brain stem Class III
- 8892 Magnetic resonance imaging of chest and myocardium for evaluation of
Class III
- 8893 Magnetic resonance imaging of spinal canal Class III
- 8894 Magnetic resonance imaging of musculoskeletal Class III
- 8895 Magnetic resonance imaging of pelvis, prostate, and bladder Class III
- 8896 Other intraoperative magnetic resonance imaging Class III
- 8897 Magnetic resonance imaging of other and unspecified sites Class III
440
Z-3-17 PENGOBATAN NUKLIR

- 9201 Thyroid scan and radioisotope function studies Class III
- 9202 Liver scan and radioisotope function study Class III
- 9203 Renal scan and radioisotope function study Class III
- 9204 Gastrointestinal scan and radioisotope function study Class III
- 9205 Cardiovascular and hematopoietic scan and radioisotope function study
Class III
- 9209 Other radioisotope function studies Class III
- 9211 Cerebral scan Class III
- 9212 Scan of other sites of head Class III
- 9213 Parathyroid scan Class III
- 9214 Bone scan Class III
- 9215 Pulmonary scan Class III
- 9216 Scan of lymphatic system Class III
- 9218 Total body scan Class III
- 9219 Scan of other site Class III
441
Z-3-18 CT-SCAN KEPALA

- 8703 Computerized axial tomography of head Class III
442
Z-3-19 CT SCAN LAIN-LAIN

- 8741 Computerized axial tomography of thorax Class III
- 8771 Computerized axial tomography of kidney Class III
- 8801 Computerized axial tomography of abdomen Class III
- 8838 Other computerized axial tomography Class III
- 8898 Bone mineral density studies Class III
443
Z-3-20 IMAGING KONTRAS

SALURAN URINARI
- 8774 Retrograde pyelogram Class III
- 8775 Percutaneous pyelogram Class III
- 8776 Retrograde cystourethrogram Class III
- 8777 Other cystogram Class III
- 8778 Ileal conduitogram Class III
444
Z-3-21 IMAGING KONTRAS

PEMBULUH DARAH
- 4695 Local perfusion of small intestine Class III
- 4696 Local perfusion of large intestine Class III
- 8840 Arteriography using contrast material, unspecified site Class III
- 8841 Arteriography of cerebral arteries Class III
- 8842 Aortography Class III
- 8843 Arteriography of pulmonary arteries Class III
- 8844 Arteriography of other intrathoracic vessels Class III
- 8845 Arteriography of renal arteries Class III
- 8846 Arteriography of placenta Class III
- 8847 Arteriography of other intra-abdominal arteries Class III
- 8848 Arteriography of femoral and other lower extremity arteries Class III
- 8849 Arteriography of other specified sites Class V
- 8850 Angiocardiography, not otherwise specified Class III
- 8851 Angiocardiography of venae cavae Class III
- 8860 Phlebography using contrast material, unspecified site Class III
- 8861 Phlebography of veins of head and neck using contrast material Class III
- 8862 Phlebography of pulmonary veins using contrast material Class III
- 8863 Phlebography of other intrathoracic veins using contrast material Class
III
- 8864 Phlebography of the portal venous system using contrast material Class
III
- 8865 Phlebography of other intra-abdominal veins using contrast material
Class III
- 8866 Phlebography of femoral and other lower extremity veins using contra
Class III
- 8867 Phlebography of other specified sites using contrast material Class III
- 8868 Impedance phlebography Class III
445
446
Z-3-22 IMAGING KONTRAS LAINLAIN

- 8702 Other contrast radiogram of brain and skull Class III
- 8706 Contrast radiogram of nasopharynx Class III
- 8707 Contrast laryngogram Class III
- 8708 Cervical lymphangiogram Class III
- 8713 Temporomandibular contrast arthrogram Class III
- 8715 Contrast radiogram of sinus Class III
- 8721 Contrast myelogram Class III
- 8731 Endotracheal bronchogram Class III
- 8732 Other contrast bronchogram Class III
- 8734 Intrathoracic lymphangiogram Class III
- 8738 Sinogram of chest wall Class III
- 8751 Percutaneous hepatic cholangiogram Class III
- 8752 Intravenous cholangiogram Class III
- 8754 Other cholangiogram Class III
- 8759 Other biliary tract x-ray Class III
- 8766 Contrast pancreatogram Class III
- 8782 Gas contrast hysterosalpingogram Class III
- 8783 Opaque dye contrast hysterosalpingogram Class III
- 8784 Percutaneous hysterogram Class III
- 8791 Contrast seminal vesiculogram Class III
- 8793 Contrast epididymogram Class III
- 8794 Contrast vasogram Class III
- 8803 Sinogram of abdominal wall Class III
- 8804 Abdominal lymphangiogram Class V
- 8811 Pelvic opaque dye contrast radiography Class III
447
- 8812 Pelvic gas contrast radiography Class III

- 8814 Retroperitoneal fistulogram Class III
- 8832 Contrast arthrogram Class III
- 8834 Lymphangiogram of upper limb Class III
- 8836 Lymphangiogram of lower limb Class III
448
Z-3-23 PROSEDUR ULTRASOUND

LAIN-LAIN
- 0009 Other therapeutic ultrasound Class III
- 8871 Diagnostic ultrasound of head and neck Class III
- 8873 Diagnostic ultrasound of other sites of thorax Class III
- 8874 Diagnostic ultrasound of digestive system Class III
- 8875 Diagnostic ultrasound of urinary system Class III
- 8876 Diagnostic ultrasound of abdomen and retroperitoneum Class III
- 8879 Other diagnostic ultrasound Class III
449

PEMBULUH DARAH
- 8877 Diagnostic ultrasound of peripheral vascular system Class III
450

GINEKOLOGIK
- 8878 Diagnostic ultrasound of gravid uterus Class III
- 9217 Placental scan Class III
451
Z-3-26 PROSEDUR BESAR

RADIOGRAFI
- 8704 Other tomography of head Class III
- 8722 Other x-ray of cervical spine Class III
- 8742 Other tomography of thorax Class III
- 8761 Barium swallow Class V
- 8762 Upper gi series Class V
- 8763 Small bowel series Class V
- 8764 Lower gi series Class III
- 8772 Other nephrotomogram Class III
- 8773 Intravenous pyelogram Class III
- 8789 Other x-ray of female genital organs Class III
- 8792 Other x-ray of prostate and seminal vesicles Class III
- 8802 Other abdomen tomography Class III
- 8831 Skeletal series Class III
452
Z-3-27 PERAWATAN LUKA

- 9356 Application of pressure dressing Class III
- 9357 Application of other wound dressing Class III
- 9358 Application of pressure trousers Class III
- 9359 Other immobilization, pressure, and attention to wound Class III
- 9658 Irrigation of wound catheter Class III
- 9659 Other irrigation of wound Class III
- 9715 Replacement of wound catheter Class III
- 9716 Replacement of wound packing or drain Class III
453
Z-3-28 IMAGING PAYUDARA

- 8735 Contrast radiogram of mammary ducts Class III
- 8736 Xerography of breast Class III
- 8737 Other mammography Class III
- 8885 Breast thermography Class III
- 8889 Thermography of other sites Class III
454
Z-3-29 IMAGING LAIN-LAIN

- 8701 Pneumoencephalogram Class III
- 8733 Mediastinal pneumogram Class III
- 8813 Other peritoneal pneumogram Class III
- 8815 Retroperitoneal pneumogram Class III
- 8881 Cerebral thermography Class III
- 8883 Bone thermography Class III
- 8884 Muscle thermography Class III
- 8886 Blood vessel thermography Class III
- 8890 Diagnostic imaging, not elsewhere classified Class III
455
Z-3-30 FOTOTERAPI
- 9982 Ultraviolet light therapy Class III
- 9983 Other phototherapy Class III
456

PANDUAN KOMPREHENSIF UNTUK JOMBLO BELAJAR KODING

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PANDUAN

TIM JOMBLO WANT-TO-MIX CENTRE

The Passionate Shepherd to His Love

D-2-11 PROSEDUR LIMPA.................................................................................... 49

H-1-20 PROSEDUR EKTRAOKULER DAN MATA.....................................................88

I-1-30 PROSEDUR PENGGANTIAN ALAT DEFIBRILATOR DAN PACEMAKER JANTUNG

J-3-10 PROSEDUR PADA DINDING DADA............................................................175

K-3-14 PROSEDUR ENDOSKOPI BESAR PADA GASTROINTESTINAL ATAS...........219

M-1-70 PROSEDUR LUTUT DAN TUNGKAI BAWAH SELAIN KAKI.........................258

N-1-40 PROSEDUR PADA URETRA DAN TRANSURETRA.....................................315

T-2-10 PEMULIHAN ALKOHOL, OBAT DAN ATAU TERAPI DETOKSIKASI..............349

V-1-10 PROSEDUR PENGANGKATAN PROSTAT KOMPLEK..................................386

W-3-10 PROSEDUR KECIL GINEKOLOGI & ENDOSKOPI......................................429

B-1-01 PROSEDUR PENCANGKOKAN

B-1-10 PROSEDUR HATI DAN

- 5282 Homotransplant of pancreas Class I

B-1-11 PROSEDUR SALURAN

- 5192 Closure of cholecystostomy Class II

B-1-13 PROSEDUR PANKREAS DAN

B-2-10 PROSEDUR PADA HATI DAN

B-2-11 PROSEDUR BESAR PADA

B-2-13 PROSEDUR LAIN-LAIN PADA

B-3-10 PROSEDUR PADA PERKUTAN

B-3-11 PROSEDUR ENDOSKOPI

B-3-12 PROSEDUR LAIN-LAIN PADA

C-3-10 PROSEDUR RADIOTERAPI

C-3-11 KEMOTERAPI PADA TUMOR

C-3-12 KEMOTERAPI PADA TUMOR

C-3-13 KEMOTERAPI PADA TUMOR

C-3-14 KEMOTERAPI PADA TUMOR

C-3-15 KEMOTERAPI PADA TUMOR

C-3-16 KEMOTERAPI PADA TUMOR

C-3-17 KEMOTERAPI PADA TUMOR

C-3-18 KEMOTERAPI PADA

C-3-19 KEMOTERAPI PADA TUMOR

C-3-20 KEMOTERAPI PADA TUMOR

C-3-21 KEMOTERAPI PADA TUMOR

C-3-22 KEMOTERAPI PADA TUMOR

C-3-23 KEMOTERAPI PADA TUMOR

D-1-10 PROSEDUR PENCANGKOKAN

D-1-11 PROSEDUR LIMPA

D-1-20 PROSEDUR PADA DARAH

- 409 Other operations on lymphatic structures Class II

D-2-10 PROSEDUR PENCANGKOKAN

D-2-11 PROSEDUR LIMPA

D-2-21 PROSEDUR BESAR PADA

D-2-22 PROSEDUR KECIL PADA

D-3-10 PROSEDUR TRANSFUSI &

D-3-11 PROSEDUR DIAGNOSTIK

E-1-01 PROSEDUR KELENJAR

E-1-10 PROSEDUR KELENJAR

E-1-20 PROSEDUR PADA TIROID,

E-2-10 PROSEDUR PADA KELENJAR

E-2-21 PROSEDUR BESAR PADA

E-2-22 PROSEDUR KECIL PADA

E-3-10 PROSEDUR DIAGNOSTIK

F-3-10 TERAPI SHOCK

F-5-10 PELAYANAN KESEHATAN

- 9442 Family therapy Class IV

F-5-11 TERAPI KELOMPOK

F-5-12 PROSEDUR TES DIAGNOSTIK

G-1-01 PROSEDUR PADA