Juni 2019

JUNI 2019
LAPORAN KEUANGAN PASIEN RAWAT INAP

PERIODE : 28 JUNI 2019
LAM
KELA DIAGNOSA
A TOTAL
NO CM KAMAR TGL MASUK NAMA PASIEN S KODING SELISIH KET DOKTER
RAW TRANSAKSI PRIMER SEKUNDER PROSEDUR
SEP
AT
Exploratory
laparotomy54.11Microscopic
Acute appendicitis with Septicaemia,
1 E202952 212C 6/16/19 13 BAGAS PRATAMA AN 2 20,465,613 18,011,700 -2,453,913 generalized peritonitisK35.2 unspecifiedA41.9
examination of blood, Other NI MADE R
microscopic examination90.59Routine
chest x-ray, so described87.44
Microscopic examination of blood,

Hypoglycaemia,
Other microscopic
Septicaemia, unspecifiedE16.2 Sekund
2 E416097 410Q 6/18/19 11 EMIH NY 3 37,521,273 40,168,300 2,647,027 unspecifiedA41.9 erHypo-osmolality and
examination90.59Continuous invasive 1,000,000 AGUNG BI
mechanical ventilation for 96
hyponatraemiaE87.1
consecutive hours or more96.72
Essential (primary) Computerized axial tomography of
Cerebral infarction, hypertensionI10 Sekunde head87.03Microscopic examination of
3 E416161 318P 6/18/19 11 S MAULANA TN 3 29,414,734 6,909,500 -22,505,234 unspecifiedI63.9 rHemiplegia, blood, Other microscopic
YUDHISMA
unspecifiedG81.9 examination90.59
Exploratory
Anaemia,
4 E416288 363B 6/19/19 10 SYAFIA NUR RAHMANIA AN 3 26,581,705 8,857,200 -17,724,505 Peritonitis, unspecifiedK65.9 unspecifiedD64.9
laparotomy54.11Transfusion of ALEXANDR
packed cells99.04
Septicaemia, Exploratory
Benign neoplasm, unspecifiedA41.9 Sekund laparotomy54.11Microscopic
5 E416367 360F 6/20/19 9 JAWARIAH NY 3 41,961,734 15,009,700 -26,952,034 caecumD12.0 erAbnormality of examination of blood, Other
DION ADE
albuminR77.0 microscopic examination90.59
Other microscopic
Abnormality of
examination90.59Continuous invasive
albuminR77.0 SekunderS
6 E258095 360E 6/20/19 9 MASEAH. NY 3 43,452,535 69,600,200 26,147,665 Congestive heart failureI50.0
epticaemia,
mechanical ventilation for 96 CARMONTH
consecutive hours or
unspecifiedA41.9
more96.72Temporary
tracheostomy31.1
Other microscopic
Septicaemia,
7 E416370 410B 6/21/19 8 ACHMAD ROHENDI TN 3 28,616,833 66,331,600 37,714,767 Pneumonia, unspecifiedJ18.9 unspecifiedA41.9
examination90.59Continuous invasive AGUNG BI
mechanical ventilation for 96
consecutive hours or more96.72
Dengue haemorrhagic Microscopic examination of blood,
8 E416386 281Q 6/21/19 8 SHANDY RAFAEL AN 3 4,655,453 2,090,000 -2,565,453 feverA91 Other microscopic examination90.59
MISKIAH,D

Tuberculosis of lung,
Anaemia, Other microscopic
9 E416540 102C 6/22/19 7 ENDANG WIJAYA TN 3 9,017,021 5,180,900 -3,836,121 confirmed by unspecified unspecifiedD64.9 examination90.59Transfusion of
MARTIN W
meansA15.3
packed cells99.04
Non-insulin-dependent
Other myectomy83.45Microscopic
diabetes mellitus with Hypo-osmolality and
10 E357862 314C 6/22/19 7 NOPITA PAIKAH NY 3 10,822,035 8,847,700 -1,974,335 peripheral circulatory hyponatraemiaE87.1
examination of blood, Other OKY NOVIA
microscopic examination90.59
complicationsE11.5
11 E416467 403B 6/22/19 7 SUPRIADI TN 2 5,560,408 2,507,900 -3,052,508 feverA91 Other microscopic examination90.59
MARTIN W

12 E416591 105E 6/23/19 6 ERNAWATI NN 3 3,888,655 1,452,800 -2,435,855 DyspepsiaK30
Other microscopic examination90.59
DWI BAGA
Pleural effusion, not Microscopic examination of blood,

13 E416566 105D 6/23/19 6 INDAH WULANDARI NN 3 3,724,521 4,640,500 915,979 elsewhere classifiedJ90 Other microscopic examination90.59
SUTAMI.D

14 E416571 314N 6/23/19 6 JAHROH NY 3 3,555,776 1,452,800 -2,102,976 DyspepsiaK30 Other microscopic examination90.59
DWI BAGA
Chronic kidney disease, stage Microscopic examination of blood,

15 E181282 316D 6/23/19 6 NOVIE SUSANTI.NY 2 15,039,513 3,976,600 -11,062,913 5N18.5 Other microscopic examination90.59
DWI BAGA

Other microscopic
Other and unspecified AscitesR18 SekunderAbn examination90.59Percutaneous
16 E416563 310E 6/23/19 6 SUKARDI TN 2 6,100,212 5,877,400 -222,812 cirrhosis of liverK74.6 ormality of albuminR77.0 abdominal drainage54.91Diagnostic
DWI BAGA
ultrasound of abdomen and
retroperitoneum88.76
Bacterial infection, Microscopic examination of blood,
17 E416598 324O 6/23/19 6 TEGUH SAEPUDIN TN 3 2,622,039 2,268,700 -353,339 unspecifiedA49.9 Other microscopic examination90.59
DWI BAGA
Page 1
JUNI 2019
Fetus and newborn affected by
Transient tachypnoea of caesarean
18 E416701 362G 6/24/19 5 BY NY SUPRIYANTI 2 7,781,956 5,066,300 -2,715,656 newbornP22.1 deliveryP03.4 SekunderSingleton, born
ADI KUSUM
in hospitalZ38.0
Hydronephrosis with renal Transurethral removal of obstruction

19 E323780 310B 6/24/19 5 MULYADI TN 2 12,109,104 9,649,200 -2,459,904 and ureteral calculous from ureter and renal TEGUH RIS
obstructionN13.2 pelvis56.0Ureteral catheterization59.8
Pleural effusion, not Microscopic examination of blood,
20 E416605 360G 6/24/19 5 NINA SUSANTI NY 1 15,100,745 6,071,100 -9,029,645 confirmed by unspecified elsewhere classifiedJ90 Other microscopic examination90.59
USYINARA
meansA15.3
Other microscopic
examination90.59Continuous invasive
mechanical ventilation for less than 96
Chronic kidney disease, stage Pneumothorax,
21 E269094 360B 6/24/19 5 SUTRISNO TN 1 30,090,425 12,472,300 -17,618,125 5N18.5 unspecifiedJ93.9
consecutive AGUNG BI
hours96.71Hemodialysis39.95Venous
catheterization for renal
dialysis38.95Thoracoscopic drainage
of pleural cavity34.06
Other transurethral
22 E387748 318B 6/24/19 5 TUMIYO BUDIYONO TN 3 8,024,292 8,837,900 813,608 Hyperplasia of prostateN40 prostatectomy60.29
JEFRI EFF
Chronic kidney disease, stage Arteriovenostomy for renal

23 E261954 436C 6/24/19 5 UMAR SAMIN TN 3 10,888,957 4,340,500 -6,548,457 5N18.5 dialysis39.27Hemodialysis39.95
DWI BAGA
Other transurethral
Urethral stricture,
24 E416809 314D 6/25/19 4 ANADAR TN 3 8,032,163 8,837,900 805,737 Hyperplasia of prostateN40 unspecifiedN35.9
prostatectomy60.29Release of TEGUH RIS
urethral stricture58.5
Other and unspecified Microscopic examination of blood,
25 E416802 314B 6/25/19 4 ASMAN BINTI ABDULROJAK NY 3 6,545,927 4,204,300 -2,341,627 cirrhosis of liverK74.6 Other microscopic examination90.59
RYAN RAC
Stroke, not specified as Microscopic examination of blood,

26 E416774 103D 6/25/19 4 CHATARINA WIDIYATI NY 3 4,426,534 4,096,200 -330,334 haemorrhage or infarctionI64 Other microscopic examination90.59
YUDHISMA
Hyperemesis gravidarum
27 E409393 215B 6/25/19 4 DESMA ROZA NY 3 1,966,482 2,168,300 201,818 with metabolic Other microscopic examination90.59
AGUS SUPR
disturbanceO21.1
Chronic kidney disease, stage Venous catheterization for renal
28 E174983 436L 6/25/19 4 H. MUMIN HB. TN 3 10,801,817 4,340,500 -6,461,317 5N18.5 dialysis38.95
DWI BAGA

29 E382806 404B 6/25/19 4 HARIS TN 1 5,732,455 5,022,200 -710,255 Tremor, unspecifiedR25.1 Other microscopic examination90.59
YUDHISMA
Gastroenteritis and colitis of Microscopic examination of blood,

30 E188888 421K 6/25/19 4 KHALIILA FIZGYNIA RAUDHAH. 1 4,569,364 2,405,100 -2,164,264 unspecified originA09.9 Other microscopic examination90.59
NIA NIASA
Respiratory medication administered

Other specified chronic
by nebulizer93.94Microscopic
31 E350505 318E 6/25/19 4 MARDI KARSIMAN TN 3 3,058,569 3,688,800 630,231 obstructive pulmonary examination of blood, Other
USYINARA
diseaseJ44.8
microscopic examination90.59
Bacterial infection,
32 E416798 318C 6/25/19 4 MISNAWATI NN 3 2,334,327 2,268,700 -65,627 unspecifiedA49.9 RYAN RAC
Dengue haemorrhagic
33 E048435 403C 6/25/19 4 MUHAMMAD ALVITO AN 2 3,293,859 2,507,900 -785,959 feverA91 TAUFAN IS
Septicaemia, Microscopic examination of blood,

34 E416201 323C 6/25/19 4 NADIA UTAMI NY 3 9,256,571 2,534,700 -6,721,871 unspecifiedA41.9 Other microscopic examination90.59
RYAN RAC
Other peripheral Microscopic examination of blood,

35 E416817 436B 6/25/19 4 NASAR SAINAN TN 3 4,134,840 1,517,500 -2,617,340 vertigoH81.3 Other microscopic examination90.59
YUDHISMA
Septicaemia, Abnormality of Microscopic examination of blood,

36 E416742 360H 6/25/19 4 RACHMAT ANDI MULYA TN 1 22,200,598 3,548,600 -18,651,998 unspecifiedA41.9 albuminR77.0 Other microscopic examination90.59
AGUNG BI
Benign neoplasm of
37 E414526 410L 6/25/19 4 RODIAH MARYANI NY 3 9,821,608 6,535,800 -3,285,808 breastD24
Unilateral radical mastectomy85.45 LUKAS ANT

38 E416608 313B 6/25/19 4 TUTIK LESTARI NY 1 4,632,816 2,925,900 -1,706,916 feverA91 Other microscopic examination90.59
RYAN RAC
Other specified congenitalo

Resection of vessel with anastomosis,
39 E374338 281D 6/26/19 3 AFIKA RINJANI KHANZABILA AN 3 7,675,562 15,363,900 7,688,338 malformations of peripheral
unspecified site38.30
OKY NOVIA
vascular systemQ27.8
Spontaneous vertex
40 E399729 212Q 6/26/19 3 AJENG SRI WENNY NY 2 5,377,161 2,009,900 -3,367,261 deliveryO80.0 Single live birthZ37.0 Other manually assisted delivery73.59 KATRINA

41 E416828 410P 6/26/19 3 ALIKA KHANSA SALVINA AN 3 1,820,404 2,090,000 269,596 feverA91 Other microscopic examination90.59
NATHANNE

42 E329183 323A 6/26/19 3 ATJENG RUDJAJA TN 3 6,294,841 3,575,600 -2,719,241 Congestive heart failureI50.0 Other microscopic examination90.59
CARMONTH

43 E208544 281A 6/26/19 3 AURELL FELICIA SITUMORANG 3 1,318,437 2,090,000 771,563 feverA91 Other microscopic examination90.59
NATHANNE
Page 2
JUNI 2019
44 E347967 323G 6/26/19 3 BARBARENS TAMBUNAN TN 2 7,313,056 5,043,100 -2,269,956 Unstable anginaI20.0 Other microscopic examination90.59
CARMONTH
Prophylactic administration of vaccine

against other
Fetus and newborn affected Singleton, born in
45 E416915 252L 6/26/19 3 BY NY NOVI SHANTY 1 1,306,043 5,118,000 3,811,957 by caesarean deliveryP03.4 hospitalZ38.0
diseases99.55Microscopic examination ADI KUSUM
of blood, Other microscopic
examination90.59
Spontaneous vertex
46 E406919 212L 6/26/19 3 CICIH NURHAYATI NY 2 4,716,632 2,009,900 -2,706,732 deliveryO80.0 Single live birthZ37.0 Other manually assisted delivery73.59 DASEP SU

47 E413444 212R 6/26/19 3 DELI NY 2 2,417,546 1,994,600 -422,946 Threatened abortionO20.0 Other microscopic examination90.59
SYARIFAH

48 E340116 318G 6/26/19 3 DIAN KRISNAYATI NY 3 3,530,934 3,417,600 -113,334 Unspecified renal colicN23 Other microscopic examination90.59
AMIR LUTH
Delivery by elective
Maternal care due to uterine
caesarean Other cesarean section of unspecified
49 E416910 215E 6/26/19 3 DINNIE ARIESTA ROHIDIN NY 3 5,704,045 4,986,800 -717,245 scar from previous
sectionO82.0 SekunderSi type74.99
KATRINA
surgeryO34.2
ngle live birthZ37.0
50 E294659 277B 6/26/19 3 FADHIL HADI H.AN 1 3,018,521 2,925,900 -92,621 feverA91 Other microscopic examination90.59
NATHANNE
Viral infection, Microscopic examination of blood,

51 E416880 410O 6/26/19 3 FAJRINA BIS SALWA AN 3 1,582,847 2,090,000 507,153 unspecifiedB34.9 Other microscopic examination90.59
NATHANNE

52 E346742 281Z 6/26/19 3 FERRO ARUM WIJAYA AN 3 1,317,727 1,718,000 400,273 Nausea and vomitingR11 Other microscopic examination90.59
NATHANNE

53 E416911 280A 6/26/19 3 FFAHREZI PUTRA AN 2 1,801,651 2,507,900 706,249 unspecifiedB34.9 Other microscopic examination90.59
NATHANNE

54 E416907 314K 6/26/19 3 FITRI SULASTRI NY 3 1,351,106 1,718,000 366,894 unspecified originA09.9 Other microscopic examination90.59
JASIRWAN,

55 E416835 318F 6/26/19 3 HEKKY HIDAYAT TN 3 1,653,426 3,575,600 1,922,174 Congestive heart failureI50.0 Other microscopic examination90.59
CARMONTH
Chronic kidney disease, stage Atherosclerosis of other Arteriovenostomy for renal

56 E309340 305A 6/26/19 3 HENDRA SASMITRA TN 1 6,770,704 6,076,700 -694,004 5N18.5 arteriesI70.8 dialysis39.27
OKY NOVIA

57 E416830 277C 6/26/19 3 HIPZA KHUMAIRA PUTRI AN 3 4,936,470 1,718,000 -3,218,470 unspecified originA09.9 Other microscopic examination90.59
3,000,000 NATHANNE
Other transurethral
58 E416209 436A 6/26/19 3 KASMARI TN 3 6,954,453 8,837,900 1,883,447 Hyperplasia of prostateN40 prostatectomy60.29
TEGUH RIS

59 E397385 101A 6/26/19 3 LASIMIN TN 2 6,545,988 1,743,400 -4,802,588 DyspepsiaK30 Other microscopic examination90.59
RYAN RAC
Gastroenteritis and colitis of

60 E416913 281B 6/26/19 3 M FAZA FAUZIL AN 3 1,307,964 1,718,000 410,036 unspecified originA09.9
NATHANNE
Septicaemia, Microscopic examination of blood,

61 E337467 410E 6/26/19 3 MARHASAN TN 3 3,139,364 2,534,700 -604,664 unspecifiedA41.9 Other microscopic examination90.59
SAYID DR
False labour before 37

62 E389252 215C 6/26/19 3 MIRANTI NY 3 1,374,200 1,580,800 206,600 completed weeks of
BOY RIVA
gestationO47.0
Unspecified acute lower Microscopic examination of blood,
63 E416879 363A 6/26/19 3 MUHAMMAD RAFIF AN 3 3,955,692 2,798,500 -1,157,192 respiratory infectionJ22 Other microscopic examination90.59
NATHANNE
Pre-eclampsia, caesarean Other cesarean section of unspecified
64 E413768 214A 6/26/19 3 NOVI SHANTY NY 1 9,547,757 6,981,500 -2,566,257 unspecifiedO14.9 sectionO82.0 SekunderSi type74.99
KATRINA

65 E416822 314Q 6/26/19 3 NURIMI NY 3 5,190,235 4,096,200 -1,094,035 haemorrhage or infarctionI64 Other microscopic examination90.59
ULY INDRA

66 E416833 410I 6/26/19 3 PANI NY 3 2,273,701 3,687,800 1,414,099 Low back painM54.5 Other microscopic examination90.59
ULY INDRA

67 E149081 324Z 6/26/19 3 PILIYANTI.NY 3 2,950,852 1,452,800 -1,498,052 DyspepsiaK30 Other microscopic examination90.59
JASIRWAN,
68 E416902 111A 6/26/19 3 RIDHO PUTRI ANGGRAINI NN 3 1,361,657 4,336,500 2,974,843 confirmed by unspecified
USYINARA
meansA15.3
69 E378740 318L 6/26/19 3 RUSMINI NY 3 5,269,167 3,313,800 -1,955,367 5N18.5 Other microscopic examination90.59
DWI BAGA

70 E173657 403A 6/26/19 3 SAMALI. TN 1 6,093,906 5,734,600 -359,306 haemorrhage or infarctionI64 Other microscopic examination90.59
ULY INDRA
Other transurethral
71 E399968 314E 6/26/19 3 SANUSI TN 3 6,686,091 8,837,900 2,151,809 Hyperplasia of prostateN40 prostatectomy60.29
TEGUH RIS

72 E416839 324R 6/26/19 3 SELFINA BILHA TANGPADA NY 3 2,946,501 1,452,800 -1,493,701 DyspepsiaK30 Other microscopic examination90.59
JASIRWAN,
Page 3
JUNI 2019
Other transurethral
73 E415704 314P 6/26/19 3 SUGITO TN 3 6,759,719 12,841,200 6,081,481 Hyperplasia of prostateN40 Calculus in bladderN21.0 prostatectomy60.29Transurethral TEGUH RIS
clearance of bladder57.0
74 E416865 311A 6/26/19 3 TUGINEM NY 1 4,158,222 3,917,900 -240,322 respiratory infectionJ22 Other microscopic examination90.59
USYINARA

75 E091601 409A 6/26/19 3 VINA ANANDA WITJAKSONO NN 1 2,950,874 2,925,900 -24,974 unspecifiedB34.9 Other microscopic examination90.59
JASIRWAN,

76 E350605 410H 6/26/19 3 WIJI WIYATNO TN 3 2,795,890 1,452,800 -1,343,090 DyspepsiaK30 Other microscopic examination90.59
DWI BAGA
77 E416716 214B 6/26/19 3 YULINAR SYAFITRI NY 1 9,145,140 11,569,900 2,424,760 Tubal pregnancyO00.1 Total unilateral salpingectomy66.4 KATRINA
Dengue fever [classical Microscopic examination of blood,
78 E416983 281F 6/27/19 2 AHMAD ALDY FAUZY AN 3 316,557 2,090,000 1,773,443 dengue]A90 Other microscopic examination90.59
NATHANNE

79 E409037 281K 6/27/19 2 ALISHA CAMILA ISHANA AN 3 219,552 1,718,000 1,498,448 unspecified originA09.9 Other microscopic examination90.59
NATHANNE
Hydronephrosis with renal Other cystoscopy57.32Transurethral

80 E409301 310A 6/27/19 2 ANWAR ARAHMAN TN 2 9,358,509 9,649,200 290,691 and ureteral calculous removal of obstruction from ureter JEFRI EFF
obstructionN13.2 and renal pelvis56.0
Internal haemorrhoids
81 E411018 304A 6/27/19 2 AZHAR TN 1 6,832,359 8,335,900 1,503,541 without complicationI84.2 Excision of hemorrhoids49.46 ERWIN SU
Fracture of shaft of
82 E416797 281O 6/27/19 2 BAYU NURWAHID AN 3 7,448,248 2,947,400 -4,500,848 radiusS52.3
FEBI ANDR

83 E416920 365A 6/27/19 2 BY NY AJENG SRI WENNY 2 7,219,923 4,386,800 -2,833,123 Other preterm infantsP07.3
NATHANNE
Fetus and newborn affected Singleton, born in

84 E416917 252X 6/27/19 2 BY NY DINNE ARIESTA ROHIDI 3 389,053 3,655,700 3,266,647 by caesarean deliveryP03.4 hospitalZ38.0
NATHANNE
85 E416963 252W 6/27/19 2 BY NY MARLINA LAOLI 384,452 -384,452 BELUM ADA BERKAS NATHANNE
86 E416966 252J 6/27/19 2 BY NY NOVIATI 1,144,152 -1,144,152 BELUM ADA BERKAS NATHANNE
87 E416965 252Q 6/27/19 2 BY NY NURHAMIDAH 726,852 -726,852 BELUM ADA BERKAS NATHANNE
88 E416999 252S 6/27/19 2 BY NY ROSITI 475,616 -475,616 BELUM ADA BERKAS NATHANNE
89 E416977 252P 6/27/19 2 BY NY SENNI 726,852 -726,852 BELUM ADA BERKAS NATHANNE
90 E375879 279A 6/27/19 2 CYRUS SALEH ABADI AN 1 307,114 2,405,100 2,097,986 unspecified originA09.9 Other microscopic examination90.59
NATHANNE
91 E405883 323B 6/27/19 2 GUNAWAN TN 3,753,721 -3,753,721 BELUM ADA BERKAS SAYID DR
Other specified headache Microscopic examination of blood,
92 E294787 314F 6/27/19 2 H. M JABIR TN 3 274,410 2,650,100 2,375,690 syndromesG44.8 Other microscopic examination90.59
ULY INDRA

93 E300368 281C 6/27/19 2 HANA AISH SALMA. AN 3 1,236,476 2,655,900 1,419,424 convulsionsR56.8 Other microscopic examination90.59
NATHANNE

94 E417005 318H 6/27/19 2 HARTOYO TN 3 1,120,001 3,417,600 2,297,599 Unspecified renal colicN23 Other microscopic examination90.59
TEGUH RIS
diabetes mellitus with Microscopic examination of blood,
95 E319998 315L 6/27/19 2 HENDRIK LIOE TN 1 1,387,946 6,275,300 4,887,354 peripheral circulatory Other microscopic examination90.59
SAYID DR
complicationsE11.5
96 E239666 324L 6/27/19 2 HJ. HAMLIYAH NY 3 1,011,594 4,204,300 3,192,706 AscitesR18 DWI BAGA
97 E416986 279B 6/27/19 2 INARA IZZATUNNISA AN 1 405,103 2,405,100 1,999,997 unspecified originA09.9 Other microscopic examination90.59
NATHANNE

98 E416967 318D 6/27/19 2 ITEM NY 3 849,288 2,798,500 1,949,212 respiratory infectionJ22 Other microscopic examination90.59
AMIR LUTH
Bacterial infection, Microscopic examination of blood,

99 E348165 281G 6/27/19 2 KHANZA SHALUM OKTAVIANI A 3 828,201 2,268,700 1,440,499 unspecifiedA49.9 Other microscopic examination90.59
NATHANNE

100 E417004 280B 6/27/19 2 M FIER ABILFAQH AN 2 327,547 2,507,900 2,180,353 unspecifiedB34.9 Other microscopic examination90.59
NATHANNE
101 E416862 215F 6/27/19 2 MARLINA LAOLI NY 3 5,180,694 4,986,800 -193,894 scar from previous
sectionO82.0 SekunderSi type74.99
EVY ASALI
surgeryO34.2
102 E397670 303K 6/27/19 2 MASUDI MUKTAR TN 1 667,686 3,917,900 3,250,214 respiratory infectionJ22 Other microscopic examination90.59
SAYID DR
103 E416988 430A 6/27/19 2 MOH MUMIN TN 3 2,527,060 4,336,500 1,809,440 confirmed by unspecified
AMIR LUTH
meansA15.3
Fracture of upper end of Microscopic examination of blood,
104 E328513 303A 6/27/19 2 NG GIOK KHENG NY 1 9,824,317 4,126,300 -5,698,017 ulna, closedS52.00 Other microscopic examination90.59
HAMDAN,
Chronic kidney disease, stage

105 E322616 360L 6/27/19 2 NIUN TN 3 12,538,592 3,313,800 -9,224,792 5N18.5
AGUNG BI
Page 4
JUNI 2019
False labour before 37
106 E416936 215G 6/27/19 2 NORITA ZHONARTI NY 3 1,553,792 1,580,800 27,008 completed weeks of Other microscopic examination90.59
SYARIFAH
gestationO47.0
107 E210119 215A 6/27/19 2 NOVIATI. NY 3 5,416,727 4,986,800 -429,927 scar from previous sectionO82.0 SekunderSi type74.99
KURNIATI,
surgeryO34.2
108 E412862 212T 6/27/19 2 NURHAMIDAH NY 2 6,796,951 5,984,100 -812,851 scar from previous sectionO82.0 SekunderSi type74.99
KATRINA
surgeryO34.2
Tonsillectomy without
109 E092497 281E 6/27/19 2 RIANDY JULIAN PUTRA AN 3 5,211,066 3,900,700 -1,310,366 Chronic tonsillitisJ35.0 adenoidectomy28.2
NANCY DA

110 E233481 281S 6/27/19 2 RISMA AULIA AN 3 941,808 2,090,000 1,148,192 feverA91 Other microscopic examination90.59
NATHANNE
Delivery by elective Other cesarean section of unspecified

caesarean type74.99Microscopic examination of
111 E415709 215K 6/27/19 2 ROSITI NY 3 5,073,693 4,986,800 -86,893 scar from previous
sectionO82.0 SekunderSi blood, Other microscopic
EVY ASALI
surgeryO34.2
ngle live birthZ37.0 examination90.59
112 E219390 212P 6/27/19 2 SENNI. NY 2 6,626,864 5,984,100 -642,764 scar from previous sectionO82.0 SekunderSi type74.99
DASEP SU
surgeryO34.2
Essential (primary)
113 E362583 323F 6/27/19 2 SITI MURYANI NY 3 2,166,945 1,906,700 -260,245 hypertensionI10 Electrocardiogram89.52 CARMONTH
Fracture of shaft of Open reduction of fracture with

114 E388573 314M 6/27/19 2 SRI DEWI NN 3 2,247,638 8,672,000 6,424,362 radiusS52.3 internal fixation, radius and ulna79.32
HAMDAN,

115 E397628 314L 6/27/19 2 SUPANI NY 3 1,599,484 1,452,800 -146,684 DyspepsiaK30 Other microscopic examination90.59
SAYID DR

116 E367425 436D 6/27/19 2 SUTIYAKNO TN 3 998,602 2,090,000 1,091,398 unspecifiedB34.9 Other microscopic examination90.59
SAYID DR

117 E235493 318O 6/27/19 2 TITIS APRILIA SUSANTI . NN 3 1,190,250 2,090,000 899,750 feverA91 Other microscopic examination90.59
SAYID DR
118 E216058 318K 6/27/19 2 TJIOE KIM GIOK. NY 416,949 -416,949 2000000/BLM ADA BERKAS SAYID DR
119 E416244 410C 6/27/19 2 WIWIN KUSWINTARI NY 3 4,529,878 3,313,800 -1,216,078 5N18.5 Other microscopic examination90.59
DWI BAGA

120 E417014 281L 6/28/19 1 FIRA YULIYANTI AN 3 205,222 1,718,000 1,512,778 abdominal painR10.4 Other microscopic examination90.59
BARRY AR

121 E215192 408C 6/28/19 1 LIONG KIM NI NY 2 1,688,333 3,976,600 2,288,267 5N18.5 Other microscopic examination90.59
0 DWI BAGA

122 E383050 407C 6/28/19 1 MUHAMMAD TAQI MALIK AN 2 411,676 2,061,500 1,649,824 unspecified originA09.9 Other microscopic examination90.59
BARRY AR

123 E399806 360C 6/28/19 1 NASAH NY 3 2,515,608 4,202,600 1,686,992 Unstable anginaI20.0 Other microscopic examination90.59
AGUNG BI

124 E022412 410N 6/28/19 1 PIPIN NY 3 411,678 1,718,000 1,306,322 unspecified originA09.9 Other microscopic examination90.59
JASIRWAN,

125 E417017 307A 6/28/19 1 PURWANTO TN 1 2,159,130 4,181,800 2,022,670 Anaemia, unspecifiedD64.9 Other microscopic examination90.59
JASIRWAN,
Leiomyoma of uterus, Microscopic examination of blood,

126 E399415 314A 6/28/19 1 SULASTRI NY 3 578,473 2,809,400 2,230,927 unspecifiedD25.9 Other microscopic examination90.59
KURNIATI,
Maternal care for transverse caesarean Other cesarean section of unspecified
127 E365217 214C 6/28/19 1 WINDARI HANDAYANI NY 1 940,717 6,981,500 6,040,783 and oblique lieO32.2 sectionO82.0 SekunderSi type74.99
KATRINA
128 E397230 318A 6/28/19 1 YUYUN NY 465,320 -465,320 BELUM ADA BERKAS JASIRWAN,
TOTAL 770,746,636 689,808,400 -80,938,236

PERSENTASE SELISIH DARI TRANKSAKSI -10.50%
Page 5
26
LAPORAN KEUANGAN PASIEN RAWAT INAP
PERIODE : 26 JUNI 2019
MA KEL DIAGNOSA
TGL TOTAL
NO CM KAMAR RA NAMA PASIEN AS KODING SELISIH KET DOKTER
MASUK TRANSAKSI PRIMER SEKUNDER PROSEDUR
WA SEP
Microscopic examination of
Essential (primary)
1 E383730 318A 6/25/19 2 ABDUL MANAN TN 3 494,191 1,906,700 1,412,509 hypertensionI10 blood, Other microscopic KURNIA ME
examination90.59
blood, Other microscopic
examination90.59Continuou
Pneumonia, Septicaemia,
2 E416370 360M 6/21/19 6 ACHMAD ROHENDI TN 3 26,063,952 66,331,300 40,267,348 unspecifiedJ18.9 unspecifiedA41.9
s invasive mechanical AGUNG BI
ventilation for 96
more96.72
Nausea and
3 E325124 281L 6/26/19 1 ADHYASTHA ATHALLA ABQARI AN 3 233,538 171,800 -61,738 vomitingR11 blood, Other microscopic TAUFAN I
examination90.59
Septicaemia,
4 E416569 314O 6/23/19 4 AGUS IRFAN MUSTOOFA TN 3 3,717,211 2,534,700 -1,182,511 unspecifiedA41.9 examination90.59Diagnostic DWI BAGA
ultrasound of abdomen and
HIV disease resulting in Microscopic examination of

5 E415703 360A 6/13/19 14 AHMAD KURNIAWAN TN 3 23,517,191 14,467,700 -9,049,491 mycobacterial blood, Other microscopic SUTAMI.D
infectionB20.0 examination90.59
Dengue haemorrhagic
6 E416828 281O 6/26/19 1 ALIKA KHANSA SALVINA AN 3 193,842 2,090,000 1,896,158 feverA91 blood, Other microscopic NATHANNE
examination90.59
Urethral stricture, Release of urethral

7 E416809 314D 6/25/19 2 ANADAR TN 3 517,079 8,041,000 7,523,921 unspecifiedN35.9 stricture58.5
TEGUH RIS
Localized enlarged Excision of deep cervical

8 E416654 324L 6/25/19 2 ANGGI DAMAYANTI NN 3 1,683,966 5,164,200 3,480,234 lymph nodesR59.0 lymph node40.21
SOPIAN,D
Leiomyoma of uterus,
9 E416622 215D 6/24/19 3 ANNEKE MUTIARA TANUJAYA NY 3 6,586,008 2,809,400 -3,776,608 unspecifiedD25.9 blood, Other microscopic KATRINA
examination90.59
Follow-up care involving

removal of fracture Removal of implanted
10 E334920 281M 6/25/19 2 ANNISA AINUL AZIZAH AN 3 3,928,226 4,315,600 387,374 plate and other internal device, unspecified site78.60
HAMDAN,
fixation deviceZ47.0
Computerized axial
tomography of
head87.03Routine chest x-
ray, so
Cerebral infarction, Hemiplegia, described87.44Microscopic
11 E416579 307A 6/23/19 4 ANTON CHRISBIANTORO TN 1 8,147,009 9,673,300 1,526,291 unspecifiedI63.9 unspecifiedG81.9 examination of blood, Other
ULY INDRA
microscopic
examination90.59Exercise,
not elsewhere
classified93.19
Amputation above
Ischaemic infarction knee84.17Transfusion of
of muscle, lower platelets99.05Microscopic
legM62.26 Sekunder examination of blood, Other
diabetes mellitus with
12 E416038 360D 6/17/19 10 ARDI TN 3 54,211,041 25,707,400 -28,503,641 peripheral circulatory Septicaemia, microscopic AGUNG BI
unspecifiedA41.9 Se examination90.59Endarterec
complicationsE11.5
kunderAnaemia, tomy of lower limb
unspecifiedD64.9 arteries38.18Transfusion of
packed cells99.04
Page 6
26
Other and unspecified
13 E416802 314B 6/25/19 2 ASMAN BINTI ABDULROJAK NY 3 2,210,406 4,204,300 1,993,894 cirrhosis of liverK74.6 blood, Other microscopic RYAN RAC
examination90.59
Exploratory
laparotomy54.11Microscopic
Acute appendicitis with examination of blood, Other
Septicaemia,
14 E202952 212C 6/16/19 11 BAGAS PRATAMA AN 2 18,568,117 18,011,700 -556,417 generalized
unspecifiedA41.9
microscopic NI MADE R
peritonitisK35.2 examination90.59Routine
chest x-ray, so
described87.44
15 E347967 323G 6/26/19 1 BARBARENS TAMBUNAN TN 297,460 -297,460 BELUM ADA BERKAS CARMONTH
16 E416650 314M 6/24/19 3 BELLA CHYTNTIA NY 3 2,144,179 2,268,700 124,521 unspecifiedA49.9 blood, Other microscopic JASIRWAN,
examination90.59
Hemiplegia,
unspecifiedG81.9 Se
Stroke, not specified as kunderHeart failure, Microscopic examination of
17 E186704 422K 6/19/19 8 BERLIAN WIDJAJA. TN 1 16,766,039 6,844,000 -9,922,039 haemorrhage or unspecifiedI50.9 Se blood, Other microscopic 5,000,000 ULY INDRA
infarctionI64 kunderBacterial examination90.59
infection,
unspecifiedA49.9
Dengue haemorrhagic
18 E106454 306A 6/23/19 4 BIMO PRAWIRADIJAYA. AN 1 4,774,208 2,925,900 -1,848,308 feverA91 blood, Other microscopic DWI BAGA
examination90.59
Fetus and newborn Microscopic examination of

Singleton, born in
19 E416644 252C 6/24/19 3 BY NY EMELIA SITUMORANG 1 2,227,165 5,118,000 2,890,835 affected by caesarean hospitalZ38.0
blood, Other microscopic TAUFAN I
deliveryP03.4 examination90.59
Fetus and newborn

Singleton, born in
20 E416751 252K 6/25/19 2 BY NY LASMIATI 1 1,144,152 5,118,000 3,973,848 affected by caesarean hospitalZ38.0
TAUFAN I
deliveryP03.4

Singleton, born in
21 E416606 252G 6/24/19 3 BY NY ORA SAM LAULI 1 1,615,380 5,118,000 3,502,620 affected by caesarean hospitalZ38.0
blood, Other microscopic TAUFAN I
Fetus and newborn

Singleton, born in
22 E416661 252M 6/24/19 3 BY NY SARTIKA PUTRI PERTIWI 1 1,665,415 5,118,000 3,452,585 affected by caesarean hospitalZ38.0
TAUFAN I
deliveryP03.4

Singleton, born in
23 E416611 252H 6/24/19 3 BY NY SISKA DESRI 1 1,665,415 5,118,000 3,452,585 affected by caesarean hospitalZ38.0
blood, Other microscopic ADI KUSUM
Fetus and newborn

Singleton, born in
24 E416722 252X 6/24/19 3 BY NY SITI DIANAH 3 378,205 3,655,700 3,277,495 affected by caesarean hospitalZ38.0
BUDI PUR
deliveryP03.4
Fetus and newborn
affected by
Transient tachypnoea of caesarean
25 E416701 362G 6/24/19 3 BY NY SUPRIYANTI 2 3,961,304 5,066,300 1,104,996 newbornP22.1 deliveryP03.4 Sekun
ADI KUSUM
derSingleton, born
in hospitalZ38.0
Fetus and newborn
Singleton, born in
26 E416647 252V 6/24/19 3 BY NY SURYANTI 3 525,865 3,655,700 3,129,835 affected by caesarean hospitalZ38.0
TAUFAN I
deliveryP03.4
Fetus and newborn
Singleton, born in
27 E416784 252O 6/25/19 2 BY NY YENI ANGGAINI 2 726,852 4,386,800 3,659,948 affected by caesarean hospitalZ38.0
TAUFAN I
deliveryP03.4
28 E416774 103D 6/25/19 2 CHATARINA WIDIYATI NY 2,362,916 -2,362,916 BELUM ADA BERKAS YUDHISMA
Venous catheterization for

renal
Chronic kidney disease, dialysis38.95Hemodialysis39
29 E416609 310F 6/24/19 3 DARYONNO BBIN SURIF TN 2 6,891,965 5,208,600 -1,683,365 stage 5N18.5 .95Microscopic examination
DWI BAGA
of blood, Other microscopic
examination90.59
Page 7
26
Hyperemesis
gravidarum with
30 E409393 215B 6/25/19 2 DESMA ROZA NY 3 1,116,068 2,168,300 1,052,232 metabolic blood, Other microscopic AGUS SUPR
examination90.59
disturbanceO21.1
diabetes mellitus
31 E307293 315A 6/21/19 6 DESMANITA . NY 3 11,824,541 4,894,400 -6,930,141 without HypokalaemiaE87.6 blood, Other microscopic JASIRWAN,
examination90.59
complicationsE11.9
Unspecified renal
32 E340116 318G 6/26/19 1 DIAN KRISNAYATI NY 3 182,188 3,417,600 3,235,412 colicN23 blood, Other microscopic TEGUH RIS
examination90.59
Other
Calculus in
33 E375169 409M 6/24/19 3 DJONG TJUN NEN TN 1 10,059,968 11,257,400 1,197,432 bladderN21.0 cystoscopy57.32Transurethr JEFRI EFF
al clearance of bladder57.0
Tuberculosis of
Viral infection, lung, confirmed by
34 E225416 317B 6/24/19 3 DWIYAN SULAKSONO TN 2 2,720,554 3,200,900 480,346 unspecifiedB34.9 unspecified
blood, Other microscopic JASIRWAN,
examination90.59
meansA15.3
Gastroenteritis and Microscopic examination of

35 E393214 280C 6/24/19 3 ELANG IHSAN SAGARMATHMA AN 2 2,529,207 2,061,500 -467,707 colitis of unspecified blood, Other microscopic ISKANDAR,
originA09.9 examination90.59
Hypoglycaemia,
unspecifiedE16.2 Se
examination90.59Continuou
Septicaemia, kunderHypo-
36 E416097 325 6/18/19 9 EMIH NY 3 32,008,899 40,168,300 8,159,401 unspecifiedA41.9 osmolality and
s invasive mechanical 1,000,000 AGUNG BI
ventilation for 96
hyponatraemiaE87.
1
more96.72
Maternal care due to caesarean
Other cesarean section of
37 E081058 423 6/23/19 4 EMILIA. NY 1 11,221,444 7,567,300 -3,654,144 uterine scar from sectionO82.0 Sekun
unspecified type74.99
5,000,000 KATRINA
previous surgeryO34.2 derTwins, both
livebornZ37.2
38 E396421 214C 6/24/19 3 ENDAH AGUS TRIYANI NY 1 15,024,056 7,567,300 -7,456,756 uterine scar from sectionO82.0 Sekun
5,000,000 KATRINA
previous surgeryO34.2 derTwins, both
livebornZ37.2
Anaemia, blood, Other microscopic
39 E416540 411B 6/22/19 5 ENDANG WIJAYA TN 3 6,804,055 5,180,900 -1,623,155 confirmed by unspecifiedD64.9 examination90.59Transfusio
MARTIN W
unspecified meansA15.3
n of packed cells99.04
Chronic kidney disease,
40 E345779 309B 6/25/19 2 ENGKUS KUSNADI TN 1 3,889,261 4,639,400 750,139 stage 5N18.5 blood, Other microscopic DWI BAGA
examination90.59
41 E416591 105E 6/23/19 4 ERNAWATI NN 3 2,055,984 1,452,800 -603,184 DyspepsiaK30 blood, Other microscopic DWI BAGA
examination90.59

42 E415485 280D 6/24/19 3 FANYA FARRENZA ARIYONO AN 2 1,773,776 2,061,500 287,724 colitis of unspecified blood, Other microscopic TAUFAN I
Dengue haemorrhagic
43 E416820 317C 6/26/19 1 FEBRI SUPRIYADI TN 2 150,980 2,507,900 2,356,920 feverA91 blood, Other microscopic RYAN RAC
examination90.59

44 E371677 281A 6/23/19 4 FEYZA ATALLAH KURNIA AN 3 2,425,657 1,718,000 -707,657 colitis of unspecified blood, Other microscopic NIA NIASA
Febrile
45 E378951 212K 6/25/19 2 GAMALIEL TANTOWI JAYA AN 2 493,414 3,187,000 2,693,586 convulsionsR56.0 blood, Other microscopic TAUFAN I
examination90.59
Page 8
26
46 E174983 436L 6/25/19 2 H. MUMIN HB. TN 3 3,882,541 1,452,800 -2,429,741 MelaenaK92.1 blood, Other microscopic DWI BAGA
examination90.59
Tremor,
47 E382806 463L 6/25/19 2 HARIS TN 1 4,066,635 5,022,200 955,565 unspecifiedR25.1 blood, Other microscopic YUDHISMA
examination90.59
Gastroenteritis and
48 E212105 281E 6/25/19 2 HILMAN NURHAFIZD. AN 3 1,210,230 1,718,000 507,770 colitis of unspecified TAUFAN I
originA09.9
49 E416830 363B 6/26/19 1 HIPZA KHUMAIRA PUTRI AN 656,338 -656,338 3000000/BLM ADA BERKAS NATHANNE
50 E416576 318F 6/23/19 4 HJ MASENAH NY 3 2,445,232 2,268,700 -176,532 unspecifiedA49.9 ConstipationK59.0 blood, Other microscopic DWI BAGA
examination90.59
Pleural effusion, not
51 E416566 105D 6/23/19 4 INDAH WULANDARI NN 3 2,674,334 4,640,500 1,966,166 elsewhere classifiedJ90 blood, Other microscopic SUTAMI.D
examination90.59
52 E416571 314N 6/23/19 4 JAHROH NY 3 1,890,443 1,452,800 -437,643 DyspepsiaK30 blood, Other microscopic DWI BAGA
examination90.59
Septicaemia, Microscopic examination of

Benign neoplasm, unspecifiedA41.9 Se blood, Other microscopic
53 E416367 360F 6/20/19 7 JAWARIAH NY 3 34,075,372 15,009,700 -19,065,672 caecumD12.0 kunderAbnormality examination90.59Explorator
DION ADE
of albuminR77.0 y laparotomy54.11
54 E390177 310K 6/24/19 3 KASIYAH NY 2 4,199,426 4,203,300 3,874 unspecified blood, Other microscopic JASIRWAN,
examination90.59
complicationsE11.8
Transurethral removal of
obstruction from ureter and
Hydronephrosis with
renal pelvis56.0Ureteral
renal and ureteral
55 E414331 310A 6/22/19 5 KASIYO TN 2 11,679,066 9,649,200 -2,029,866 calculous
catheterization59.8Microsco INDRA CAH
pic examination of blood,
obstructionN13.2
Other microscopic
examination90.59

56 E188888 421K 6/25/19 2 KHALIILA FIZGYNIA RAUDHAH. A 1 307,077 2,405,100 2,098,023 colitis of unspecified blood, Other microscopic TAUFAN I

colitis of unspecified blood, Other microscopic
Febrile
57 E416706 363A 6/24/19 3 KHAYIRA YUNA ALMAHYRA AN 1 6,376,053 5,551,000 -825,053 convulsionsR56.0
originA09.9 Sekund examination90.59Cardiopul HENNY ROS
erCardiac arrest, monary resuscitation, not
unspecifiedI46.9 otherwise specified99.60
Hyperplasia of Other transurethral

58 E415875 318H 6/24/19 3 KUSWANTO TN 3 8,613,470 8,837,900 224,430 prostateN40 prostatectomy60.29
TEGUH RIS
59 E397385 406A 6/26/19 1 LASIMIN TN 2 1,899,406 1,743,400 -156,006 DyspepsiaK30 blood, Other microscopic RYAN RAC
examination90.59
Stroke, not specified as Microscopic examination of

60 E416562 323A 6/23/19 4 LASIYAH NY 3 12,326,143 4,096,200 -8,229,943 haemorrhage or blood, Other microscopic ULY INDRA
infarctionI64 examination90.59
Delivery by elective Single live Other cesarean section of

61 E410675 214K 6/25/19 2 LASMIATI NY 1 8,742,572 6,981,500 -1,761,072 caesarean sectionO82.0 birthZ37.0 unspecified type74.99
KATRINA
Anaemia in other
Chronic kidney disease, chronic diseases
62 E346129 305C 6/21/19 6 LIM LIAN NIO NY 1 14,383,820 5,784,900 -8,598,920 stage 5N18.5 classified
examination90.59Transfusio DWI BAGA
n of packed
elsewhereD63.8
cells99.04Hemodialysis39.95
Page 9
26
Follow-up care involving

Removal of implanted
removal of fracture
63 E413708 318L 6/24/19 3 LINDA SILABAN NY 3 5,372,678 4,315,600 -1,057,078 plate and other internal device from other bone, HAMDAN,
except facial bone78.69
fixation deviceZ47.0
Septicaemia, Microscopic examination of

unspecifiedA41.9 Se blood, Other microscopic
Pneumonia, kunderHypo- examination90.59Continuou
64 E227867 360J 6/20/19 7 LIU NJIT HIOENG TN 2 18,300,260 34,963,000 16,662,740 unspecifiedJ18.9 osmolality and s invasive mechanical
AGUNG BI
hyponatraemiaE87. ventilation for less than 96
1 consecutive hours96.71
Other
myectomy83.45Microscopic
65 E341749 318M 6/21/19 6 MAMUL TN 3 9,770,825 5,331,600 -4,439,225 peripheral circulatory
examination of blood, Other OKY NOVIA
microscopic
complicationsE11.5
examination90.59
Respiratory medication
administered by
Other specified chronic
nebulizer93.94Microscopic
66 E350505 318E 6/25/19 2 MARDI KARSIMAN TN 3 755,529 3,688,800 2,933,271 obstructive pulmonary
examination of blood, Other
USYINARA
diseaseJ44.8
microscopic
examination90.59
Septicaemia,
67 E337467 410E 6/26/19 1 MARHASAN TN 3 785,766 2,534,700 1,748,934 unspecifiedA41.9 blood, Other microscopic JASIRWAN,
examination90.59
68 E328344 360C 6/21/19 6 MARIAM NY 3 26,131,829 3,313,800 -22,818,029 stage 5N18.5 blood, Other microscopic AGUNG BI
examination90.59
Congestive heart Abnormality of examination90.59Continuou
69 E258095 360E 6/20/19 7 MASEAH. NY 3 35,080,432 14,980,500 -20,099,932 failureI50.0 albuminR77.0 s invasive mechanical
CARMONTH
ventilation for less than 96
consecutive hours96.71
HypokalaemiaE87.6
SekunderHypo- Microscopic examination of
70 E320235 318N 6/24/19 3 MEIYANI NY. 3 1,714,833 2,451,500 736,667 DyspepsiaK30 osmolality and blood, Other microscopic JASIRWAN,
hyponatraemiaE87. examination90.59
1
71 E416798 318C 6/25/19 2 MISNAWATI NN 3 484,346 2,268,700 1,784,354 unspecifiedA49.9 RYAN RAC
Excisional debridement of
72 E416660 281G 6/25/19 2 MUHAMMAD AIDDIL JALLAL AN 3 3,752,502 3,688,200 -64,302 GlossitisK14.0 wound, infection, or ERWIN SU
burn86.22
Gastroenteritis and
73 E277863 280K 6/25/19 2 MUHAMMAD ALDIANSYAH AN 2 1,939,330 2,061,500 122,170 colitis of unspecified TAUFAN I
originA09.9
Dengue haemorrhagic
74 E048435 280L 6/25/19 2 MUHAMMAD ALVITO AN 2 1,170,866 2,507,900 1,337,034 feverA91 TAUFAN I

75 E416584 279A 6/23/19 4 MUHAMMAD BAIHAQI FAUZAN AN 1 4,642,988 2,405,100 -2,237,888 colitis of unspecified blood, Other microscopic NIA NIASA
Acute appendicitis with

Septicaemia, Exploratory
76 E352628 281N 6/20/19 7 MUHAMMAD IBNU RAZAB AN 3 11,539,379 15,009,700 3,470,321 generalized unspecifiedA41.9 laparotomy54.11
NI MADE R
peritonitisK35.2
77 E416805 281K 6/25/19 2 MUHAMMAD VICKY RAMADHAN AN 425,280 -425,280 2000000/BLM ADA BERKAS TAUFAN I
Hydronephrosis with Transurethral removal of

renal and ureteral obstruction from ureter and
78 E323780 310B 6/24/19 3 MULYADI TN 2 9,240,107 9,649,200 409,093 calculous renal pelvis56.0Ureteral
TEGUH RIS
obstructionN13.2 catheterization59.8
Dengue haemorrhagic
79 E416572 410P 6/23/19 4 MUNALIS NY 3 1,804,083 2,090,000 285,917 feverA91 blood, Other microscopic DWI BAGA
examination90.59
Page 10
26
Unspecified acute lower
80 E416707 281C 6/24/19 3 MUTIARA BALQIS AN 3 2,759,518 2,798,500 38,982 respiratory infectionJ22 blood, Other microscopic TAUFAN I
examination90.59
Unspecified acute lower
81 E416201 323C 6/25/19 2 NADIA UTAMI NY 3 3,710,377 2,798,500 -911,877 respiratory infectionJ22 blood, Other microscopic MARTIN W
examination90.59

82 E368865 281V 6/24/19 3 NAFEEZA AURELIA ZAFANANI AN 3 1,854,471 1,718,000 -136,471 colitis of unspecified blood, Other microscopic TAUFAN I
Viral infection,
83 E416600 279B 6/23/19 4 NAIMA MAALIHA FUADY AN 1 3,584,945 2,925,900 -659,045 unspecifiedB34.9 blood, Other microscopic TAUFAN I
examination90.59
Other peripheral
84 E416817 436B 6/25/19 2 NASAR SAINAN TN 3 2,418,160 1,517,500 -900,660 vertigoH81.3 blood, Other microscopic YUDHISMA
examination90.59
Internal haemorrhoids
Excision of
85 E416413 410D 6/25/19 2 NASRUL HIDAYATULLAH TN 3 4,571,250 5,954,200 1,382,950 without hemorrhoids49.46
SOPIAN,D
complicationI84.2
86 E416724 281B 6/25/19 2 NIDA SARAH FADHILAH AN 3 2,243,115 1,718,000 -525,115 abdominal painR10.4 blood, Other microscopic TAUFAN I
examination90.59
Tuberculosis of lung, Microscopic examination of

87 E416605 360G 6/24/19 3 NINA SUSANTI NY 1 8,636,530 6,071,100 -2,565,430 confirmed by blood, Other microscopic USYINARA
unspecified meansA15.3 examination90.59
Other
Hypo-osmolality and myectomy83.45Microscopic
88 E357862 314C 6/22/19 5 NOPITA PAIKAH NY 3 8,801,617 8,847,700 46,083 peripheral circulatory hyponatraemiaE87. examination of blood, Other OKY NOVIA
1 microscopic
complicationsE11.5
examination90.59

89 E364601 408A 6/24/19 3 NOVI DWI ARDIANI NN 2 1,812,082 2,061,500 249,418 colitis of unspecified blood, Other microscopic JASIRWAN,
90 E181282 316D 6/23/19 4 NOVIE SUSANTI.NY 2 9,723,013 3,976,600 -5,746,413 stage 5N18.5 blood, Other microscopic DWI BAGA
examination90.59
Unilateral or unspecified
Repair of inguinal hernia
inguinal hernia, without
91 E334739 314A 6/25/19 2 NURHANIF TN 3 4,464,102 5,489,000 1,024,898 obstruction or with graft or prosthesis, not ERWIN SU
otherwise specified53.05
gangreneK40.9
Stroke, not specified as Microscopic examination of

92 E416822 314Q 6/26/19 1 NURIMI NY 3 2,895,743 4,096,200 1,200,457 haemorrhage or blood, Other microscopic ULY INDRA
infarctionI64 examination90.59

93 E383740 304A 6/25/19 2 NURSAIDA PAKPAHAN NY 1 438,180 2,405,100 1,966,920 colitis of unspecified blood, Other microscopic RYAN RAC
Essential (primary)
94 E344131 323B 6/24/19 3 ONG HIAN NIO NY (LISNAWATI) 3 7,191,665 1,906,700 -5,284,965 hypertensionI10 blood, Other microscopic ULY INDRA
examination90.59
Embolism and
Arteriovenostomy for renal
95 E191914 311A 6/25/19 2 ONG LIANG BIE TN 1 143,401 6,076,700 5,933,299 thrombosis of dialysis39.27
OKY NOVIA
unspecified veinI82.9
96 E413978 214A 6/23/19 4 ORA SAM LAULI PINEM NY 1 9,506,182 6,981,500 -2,524,682 uterine scar from sectionO82.0 Sekun
IRSAN HAN
previous surgeryO34.2 derSingleton, born
in hospitalZ38.0
97 E411356 324M 6/22/19 5 PENDI TN 1 2,980,155 2,646,600 -333,555 Ileus, unspecifiedK56.7 blood, Other microscopic ERWIN SU
examination90.59
Page 11
26
Septicaemia,
98 E416742 360H 6/25/19 2 RACHMAT ANDI MULYA TN 1 4,903,963 3,548,600 -1,355,363 unspecifiedA41.9 blood, Other microscopic AGUNG BI
examination90.59
Acute appendicitis with

Exploratory
99 E218183 280A 6/20/19 7 RAHMADANI DWI AGUSTINE AN 2 13,415,439 9,351,000 -4,064,439 localized laparotomy54.11
ALEXANDR
peritonitisK35.3
Gastroenteritis and
Continuous invasive
colitis of unspecified
Pneumonia, mechanical ventilation for
100 E415854 363E 6/15/19 12 RAIHAN ADHHI PRATAMA AN 3 35,792,132 40,168,300 4,376,168 unspecifiedJ18.9
originA09.9 Sekund
96 consecutive hours or
BARRY AR
erVentricular septal
more96.72
defectQ21.0
Benign neoplasm of Unilateral radical

101 E414526 436K 6/25/19 2 RODIAH MARYANI NY 3 7,535,351 6,535,800 -999,551 breastD24 mastectomy85.45
LUKAS ANT
102 E416457 436Q 6/22/19 5 ROMLI TN 3 4,981,000 3,313,800 -1,667,200 stage 5N18.5 blood, Other microscopic DWI BAGA
examination90.59
Computerized axial
Essential (primary) tomography of
Cerebral infarction, hypertensionI10 Se head87.03Microscopic
103 E416161 318P 6/18/19 9 S MAULANA TN 3 27,918,574 6,909,500 -21,009,074 unspecifiedI63.9 kunderHemiplegia, examination of blood, Other
YUDHISMA
unspecifiedG81.9 microscopic
examination90.59
Hydronephrosis with Transurethral removal of

renal and ureteral obstruction from ureter and
104 E414507 410B 6/24/19 3 SAMSURI TN 3 7,604,313 8,041,000 436,687 calculous renal pelvis56.0Ureteral
TEGUH RIS
obstructionN13.2 catheterization59.8
Maternal care for caesarean
105 E294581 214L 6/24/19 3 SARTIKA PUTRI PERTIWI NY 1 9,888,707 6,981,000 -2,907,707 transverse and oblique sectionO82.0 Sekun
KURNIATI,
lieO32.2 derSingle live
birthZ37.0
Dengue haemorrhagic
106 E416386 281Q 6/21/19 6 SHANDY RAFAEL AN 3 3,502,736 2,090,000 -1,412,736 feverA91 blood, Other microscopic MISKIAH,D
examination90.59

107 E027801 311B 6/24/19 3 SHEM TJIN KHOEN TN 1 13,126,081 12,373,100 -752,981 prostateN40 prostatectomy60.29
TEGUH RIS
Calculus of gallbladder blood, Other microscopic
108 E327276 410C 6/24/19 3 SIM KOK JEN TN 3 1,924,713 4,199,800 2,275,087 with other examination90.59Diagnostic JASIRWAN,
cholecystitisK80.1 ultrasound of abdomen and
Spontaneous vertex Single live Other manually assisted

109 E226773 214B 6/22/19 5 SISKA DESRI F .NY 1 11,935,294 2,344,900 -9,590,394 deliveryO80.0 birthZ37.0 delivery73.59
ADY SUTJ
110 E409899 215A 6/24/19 3 SITI DIANAH NY 3 5,639,658 4,986,800 -652,858 uterine scar from sectionO82.0 Sekun
I.B.P.WID
previous surgeryO34.2 derSingle live
birthZ37.0

111 E399287 313A 6/25/19 2 SITI MASITOH NY 1 2,196,692 2,405,100 208,408 colitis of unspecified blood, Other microscopic RYAN RAC
Hydronephrosis with
renal and ureteral Nephrotomy55.01Ureteroto
112 E409966 103E 6/21/19 6 SONNY ALEXANDER TN 3 9,506,689 9,783,500 276,811 calculous my56.2
JEFRI EFF
obstructionN13.2
113 E056324 314G 6/24/19 3 SOPIAH NY 3 848,392 1,452,800 604,408 DyspepsiaK30 blood, Other microscopic JASIRWAN,
examination90.59
114 E318613 413B 6/24/19 3 SRI HANDAYANI LAGAI. NN 1 3,424,597 3,176,200 -248,397 unspecifiedA49.9 blood, Other microscopic JASIRWAN,
examination90.59
Cyst of kidney, Marsupialization of kidney

115 E303207 310L 6/24/19 3 SRI RATNANINGSIH NY 2 8,630,860 11,740,200 3,109,340 acquiredN28.1 lesion55.31
JEFRI EFF
Page 12
26
116 E416674 410Q 6/24/19 3 SRI SYAMSINI HJ NY 3 1,502,688 1,452,800 -49,888 DyspepsiaK30 blood, Other microscopic JASIRWAN,
examination90.59
117 E416642 413A 6/24/19 3 SUGIARTI KESUMA ASTUTI NN 1 3,880,956 2,033,900 -1,847,056 DyspepsiaK30 blood, Other microscopic JASIRWAN,
examination90.59
118 E416563 310E 6/23/19 4 SUKARDI TN 2 4,111,931 5,045,200 933,269 cirrhosis of liverK74.6 blood, Other microscopic DWI BAGA
examination90.59
Benign neoplasm,
119 E392857 314F 6/20/19 7 SUKMA TN 3 6,579,519 2,961,500 -3,618,019 nasopharynxD10.6 Pharyngeal biopsy29.12 LINA MARL
Dengue haemorrhagic
120 E416467 403B 6/22/19 5 SUPRIADI TN 2 3,969,680 2,507,900 -1,461,780 feverA91 blood, Other microscopic MARTIN W
examination90.59
121 E188144 212T 6/24/19 3 SUPRIYANTI. NY 2 7,399,567 5,984,100 -1,415,467 uterine scar from sectionO82.0 Sekun
EVY ASALI
birthZ37.0
Dengue haemorrhagic
122 E367369 404A 6/23/19 4 SURYA KOTO TN 2 3,648,854 2,507,900 -1,140,954 feverA91 blood, Other microscopic DWI BAGA
examination90.59
Maternal care for caesarean
123 E414697 215C 6/24/19 3 SURYANTI NY 3 6,730,372 4,986,800 -1,743,572 transverse and oblique sectionO82.0 Sekun
KATRINA
lieO32.2 derSingle live
birthZ37.0
124 E269094 360B 6/24/19 3 SUTRISNO TN 1 17,699,069 4,639,400 -13,059,669 stage 5N18.5 blood, Other microscopic AGUNG BI
examination90.59
Anaemia,
unspecifiedD64.9 Se
kunderHypo-
Exploratory
Peritonitis, osmolality and
125 E416288 281F 6/19/19 8 SYAFIA NUR RAHMANIA AN 3 17,971,565 15,009,700 -2,961,865 unspecifiedK65.9 hyponatraemiaE87.
laparotomy54.11Transfusion ALEXANDR
of packed cells99.04
1 SekunderSepticae
mia,
unspecifiedA41.9
Embolism and
Venous catheterization for
126 E393077 314L 6/25/19 2 SYAIPUL TN 3 6,291,750 4,340,500 -1,951,250 thrombosis of renal dialysis38.95
OKY NOVIA
unspecified veinI82.9
127 E416598 324O 6/23/19 4 TEGUH SAEPUDIN TN 3 1,547,519 2,268,700 721,181 unspecifiedA49.9 blood, Other microscopic DWI BAGA
examination90.59
128 E150608 310C 6/22/19 5 TJIOE SEK NIO. NY 2 4,220,123 1,743,400 -2,476,723 DyspepsiaK30 ConstipationK59.0 blood, Other microscopic MARTIN W
examination90.59

129 E391217 281S 6/23/19 4 TRI AFSHIN PUTRI AN 3 1,617,448 1,718,000 100,552 colitis of unspecified blood, Other microscopic NIA NIASA

130 E387748 318B 6/24/19 3 TUMIYO BUDIYONO TN 3 7,242,175 8,837,900 1,595,725 prostateN40 prostatectomy60.29
JEFRI EFF
Dengue haemorrhagic
131 E416608 313B 6/25/19 2 TUTIK LESTARI NY 1 2,246,789 2,925,900 679,111 feverA91 blood, Other microscopic RYAN RAC
examination90.59
Chronic kidney disease, Arteriovenostomy for renal

132 E261954 360I 6/24/19 3 UMAR SAMIN TN 3 7,018,605 4,340,500 -2,678,105 stage 5N18.5 dialysis39.27
AGUNG BI
133 E416614 318O 6/24/19 3 UNAH NY 3 1,717,492 2,268,700 551,208 unspecifiedA49.9 blood, Other microscopic JASIRWAN,
examination90.59
Page 13
26

134 E270713 309A 6/24/19 3 YEKTI SAWIJI NY 1 3,506,397 2,405,100 -1,101,297 colitis of unspecified blood, Other microscopic JASIRWAN,

unspecified
type74.99Microscopic
135 E183631 212S 6/25/19 2 YENI ANGGRAINI NY 2 7,317,769 5,984,100 -1,333,669 uterine scar from sectionO82.0 Sekun
examination of blood, Other
DYAH IRA
microscopic
birthZ37.0
examination90.59
136 E416801 318D 6/25/19 2 YENTI LUTFIAH NY 3 98,437 2,268,700 2,170,263 unspecifiedA49.9 blood, Other microscopic RYAN RAC
examination90.59

137 E412443 314K 6/26/19 1 YUHELMITA ENDY TN 3 1,189,238 1,718,000 528,762 colitis of unspecified blood, Other microscopic AGUNG BI
138 E282717 409L 6/24/19 3 YUSSI ANDRIANY NY 1 5,733,087 4,639,400 -1,093,687 stage 5N18.5 blood, Other microscopic DWI BAGA
examination90.59
Dengue haemorrhagic unspecifiedA49.9 Se
139 E357055 307C 6/15/19 12 ZAMHERILENDRA TN 1 17,821,842 3,734,400 -14,087,442 feverA91 kunderHeart failure,
blood, Other microscopic MARTIN W
examination90.59
unspecifiedI50.9
140 E416603 101B 6/23/19 4 ZIANDRA RAID AS SYATIR AN 3,933,667 -3,933,667 BELUM ADA BERKAS TAUFAN I
TOTAL 949,343,775 825,871,500 -123,472,275

PERSENTASE SELISIH DARI TRANKSAKSI -13.01%
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JUNI 2019

LAPORAN KEUANGAN PASIEN RAWAT INAP

Microscopic examination of blood,

Microscopic examination of blood,

Microscopic examination of blood,

Pleural effusion, not Microscopic examination of blood,

Microscopic examination of blood,

Chronic kidney disease, stage Microscopic examination of blood,

Microscopic examination of blood,

Hydronephrosis with renal Transurethral removal of obstruction

Chronic kidney disease, stage Arteriovenostomy for renal

Stroke, not specified as Microscopic examination of blood,

Microscopic examination of blood,

Gastroenteritis and colitis of Microscopic examination of blood,

Respiratory medication administered

Septicaemia, Microscopic examination of blood,

Other peripheral Microscopic examination of blood,

Septicaemia, Abnormality of Microscopic examination of blood,

Dengue haemorrhagic Microscopic examination of blood,

Other specified congenitalo

Dengue haemorrhagic Microscopic examination of blood,

Microscopic examination of blood,

Dengue haemorrhagic Microscopic examination of blood,

Prophylactic administration of vaccine

Microscopic examination of blood,

Microscopic examination of blood,

Viral infection, Microscopic examination of blood,

Microscopic examination of blood,

Viral infection, Microscopic examination of blood,

Gastroenteritis and colitis of Microscopic examination of blood,

Microscopic examination of blood,

Chronic kidney disease, stage Atherosclerosis of other Arteriovenostomy for renal

Gastroenteritis and colitis of Microscopic examination of blood,

Microscopic examination of blood,

Gastroenteritis and colitis of

Septicaemia, Microscopic examination of blood,

False labour before 37

Stroke, not specified as Microscopic examination of blood,

Microscopic examination of blood,

Microscopic examination of blood,

Stroke, not specified as Microscopic examination of blood,

Microscopic examination of blood,

Viral infection, Microscopic examination of blood,

Microscopic examination of blood,

Gastroenteritis and colitis of Microscopic examination of blood,

Hydronephrosis with renal Other cystoscopy57.32Transurethral

Microscopic examination of blood,

Fetus and newborn affected Singleton, born in

Other and unspecified Microscopic examination of blood,

Microscopic examination of blood,

Unspecified acute lower Microscopic examination of blood,

Bacterial infection, Microscopic examination of blood,

Viral infection, Microscopic examination of blood,

Chronic kidney disease, stage

Dengue haemorrhagic Microscopic examination of blood,

Delivery by elective Other cesarean section of unspecified

Fracture of shaft of Open reduction of fracture with

Microscopic examination of blood,

Viral infection, Microscopic examination of blood,

Dengue haemorrhagic Microscopic examination of blood,

Other and unspecified Microscopic examination of blood,

Chronic kidney disease, stage Microscopic examination of blood,