KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)

No. Nama Penyakit Kode dan Nama Diagnosa ICD 10

1 Refluks (K21-Gastro-oesophageal reflux disease); (K21.9-Gastro-oesophageal

gastroesofagus reflux disease without oesophagitis)

2 Tinea fasialis (B35-Dermatophytosis); (B35.8-Other dermatophytoses); (B35.9-

Dermatophytosis, unspecified)

3 Dermatitis atopik (L20-Atopic dermatitis); (L20.0-Besnier prurigo); (L20.8-Other atopic

(kecuali recalcitrant) dermatitis); (L20.9-Atopic dermatitis, unspecified)

4 Napkin eczema (L22-Diaper [napkin] dermatitis)

5 Pertusis (A37-Whooping cough); (A37.0-Whooping cough due to Bordetella

pertussis); (A37.1-Whooping cough due to Bordetella parapertussis);
(A37.8-Whooping cough due to other Bordetella species); (A37.9-
Whooping cough, unspecified)

6 Tinea pedis (B35-Dermatophytosis); (B35.3- Tinea pedis)

7 Blefaritis (H01-Other inflammation of eyelid); (H01.0-Blepharitis)

8 Gastroenteritis (A09-Other gastroenteritis and colitis of infectious and unspecified

(termasuk kolera, origin); (A09.0-Other and unspecified gastroenteritis and colitis of
giardiasis) infectious origin); (A09.9-Gastroenteritis and colitis of unspecified
origin); (A08-Viral and other specified intestinal infections); (A08.0-
Rotaviral enteritis); (A08.1-Acute gastroenteropathy due to Norwalk
agent); (A08.2-Adenoviral enteritis); (A08.3-Other viral enteritis);
(A08.4-Viral intestinal infection, unspecified); (A08.5-Other specified
intestinal infections); (A02-Other salmonella infections); (A02.0-
Salmonella enteritis)

9 Moluskum (B08-Other viral infections characterized by skin and mucous

kontagiosum membrane lesions, not elsewhere classified); (B08.1-Molluscum
contagiosum)

10 Dermatitis seboroik (L21-Seborrhoeic dermatitis); (L21.0-Seborrhoea capitis); (L21.1-

Seborrhoeic infantile dermatitis); (L21.8-Other seborrhoeic dermatitis);
(L21.9-Seborrhoeic dermatitis, unspecified)

10 Tinea manus (B35-Dermatophytosis); (B35.2-Tinea manuum)

 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
No. Nama Penyakit Kode dan Nama Diagnosa ICD 10

11 Pitiriasis versikolor (B36-Other superficial mycoses); (B36.0-Pityriasis versicolor); (B36.1-

Tinea nigra); (B36.2-White piedra); (B36.3-Black piedra); (B36.8-Other
specified superficial mycoses); (B36.9-Superficial mycosis,
unspecified)

12 Buta senja (H53-Visual disturbances); (H53.6-Night blindness)

13 Bronkitis akut (J20-Acute bronchitis); (J20.0-Acute bronchitis due to Mycoplasma

pneumoniae); (J20.1-Acute bronchitis due to Haemophilus influenzae);
(J20.2-Acute bronchitis due to streptococcus); (J20.3-Acute bronchitis
due to coxsackievirus); (J20.4-Acute bronchitis due to parainfluenza
virus); (J20.5-Acute bronchitis due to respiratory syncytial virus);
(J20.6-Acute bronchitis due to rhinovirus); (J20.7-Acute bronchitis due
to echovirus); (J20.8-Acute bronchitis due to other specified
organisms); (J20.9-Acute bronchitis, unspecified); (J40-Bronchitis, not
specified as acute or chronic); (J41-Simple and mucopurulent chronic
bronchitis); (J41.0-Simple chronic bronchitis); (J41.1-Mucopurulent
chronic bronchitis); (J41.8-Mixed simple and mucopurulent chronic
bronchitis); (J42-Unspecified chronic bronchitis)

14 Skistosomiasis (B65-Schistosomiasis [bilharziasis]); (B65.0-Schistosomiasis due to

Schistosoma haematobium [urinary schistosomiasis]); (B65.1-
Schistosomiasis due to Schistosoma mansoni [intestinal
schistosomiasis]); (B65.2-Schistosomiasis due to Schistosoma
japonicum); (B65.3-Cercarial dermatitis); (B65.8-Other
schistosomiases); (B65.9-Schistosomiasis, unspecified)

15 Taeniasis (B68-Taeniasis); (B68.0-Taenia solium taeniasis); (B68.1-Taenia

saginata taeniasis); (B68.9-Taeniasis, unspecified)

16 Pertusis (A37-Whooping cough); (A37.0-Whooping cough due to Bordetella

pertussis); (A37.1-Whooping cough due to Bordetella parapertussis);
(A37.8-Whooping cough due to other Bordetella species); (A37.9-
Whooping cough, unspecified)

17 Tinea pedis (B35-Dermatophytosis); (B35.3- Tinea pedis)

18 Blefaritis (H01-Other inflammation of eyelid); (H01.0-Blepharitis)

19 Gastroenteritis (A09-Other gastroenteritis and colitis of infectious and unspecified

(termasuk kolera, origin); (A09.0-Other and unspecified gastroenteritis and colitis of
giardiasis) infectious origin); (A09.9-Gastroenteritis and colitis of unspecified
origin); (A08-Viral and other specified intestinal infections); (A08.0-
Rotaviral enteritis); (A08.1-Acute gastroenteropathy due to Norwalk
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
No. Nama Penyakit Kode dan Nama Diagnosa ICD 10

agent); (A08.2-Adenoviral enteritis); (A08.3-Other viral enteritis);

(A08.4-Viral intestinal infection, unspecified); (A08.5-Other specified
intestinal infections); (A02-Other salmonella infections); (A02.0-
Salmonella enteritis)

20 Moluskum (B08-Other viral infections characterized by skin and mucous

kontagiosum membrane lesions, not elsewhere classified); (B08.1-Molluscum
contagiosum)

20 Skistosomiasis (B65-Schistosomiasis [bilharziasis]); (B65.0-Schistosomiasis due to

Schistosoma haematobium [urinary schistosomiasis]); (B65.1-
Schistosomiasis due to Schistosoma mansoni [intestinal
schistosomiasis]); (B65.2-Schistosomiasis due to Schistosoma
japonicum); (B65.3-Cercarial dermatitis); (B65.8-Other
schistosomiases); (B65.9-Schistosomiasis, unspecified)

21 Taeniasis (B68-Taeniasis); (B68.0-Taenia solium taeniasis); (B68.1-Taenia

saginata taeniasis); (B68.9-Taeniasis, unspecified)

22 Pielonefritis tanpa (N10-Acute tubulo-interstitial nephritis); (N12-Tubulo-interstitial

komplikasi nephritis, not specified as acute or chronic)

23 Gonore (A54-Gonococcal infection); (A54.0-Gonococcal infection of lower

genitourinary tract without periurethral or accessory gland abscess);
(A54.3-Gonococcal infection of eye); (A54.5-Gonococcal pharyngitis);
(A54.6-Gonococcal infection of anus and rectum); (A54.8-Other
gonococcal infections); (A54.9-Gonococcal infection, unspecified);
(A64-Unspecified sexually transmitted disease)

24 Tinea barbe (B35-Dermatophytosis); (B35.0- Tinea barbae and tinea capitis)

25 Benda asing di (T15-Foreign body on external eye); (T15.1-Foreign body in

konjungtiva conjunctival sac); (T15.8- Foreign body in other and multiple parts of
external eye); (T15.9-Foreign body on external eye, part unspecified)

26 Abses folikel rambut (L02-Cutaneous abscess, furuncle, and carbuncle); (L02.0-Cutaneous

atau kelenjar abscess, furuncle and carbuncle of face); (L02.1-Cutaneous abscess,
sebasea furuncle and carbuncle of neck); (L02.2-Cutaneous abscess, furuncle
and carbuncle of trunk); (L02.3-Cutaneous abscess, furuncle and
carbuncle of buttock); (L02.4-Cutaneous abscess, furuncle and
carbuncle of limb); (L02.8-Cutaneous abscess, furuncle and carbuncle
of other sites); (L02.9-Cutaneous abscess, furuncle and carbuncle,
unspecified)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
No. Nama Penyakit Kode dan Nama Diagnosa ICD 10

27 Keracunan makanan (T62-Toxic effect of other noxious substances eaten as food); (T62.0-
Ingested mushrooms); (T62.1-Ingested berries); (T62.2-Other ingested
(parts of) plant(s)); (T62.8-Other specified noxious substances eaten
as food); (T62.9-Noxious substance eaten as food, unspecified); (T61-
Toxic effect of noxious substances eaten as seafood); (T61.0-
Ciguatera fish poisoning); (T61.1-Scombroid fish poisoning); (T61.2-
Other fish and shellfish poisoning); (T61.8-Toxic effect of other
seafoods); (T61.9-Toxic effect of unspecified seafood); (K52-Other
noninfective gastroenteritis and colitis); (K52.1-Toxic gastroenteritis
and colitis); (K52.8-Other specified noninfective gastroenteritis and
colitis); (K52.9-Noninfective gastroenteritis and colitis, unspecified)

28 Pneumonia, (J12-Viral pneumonia, not elsewhere classified); (J12.0-Adenoviral

bronkopneumonia pneumonia); (J12.1-Respiratory syncytial virus pneumonia); (J12.2-
Parainfluenza virus pneumonia); (J12.3-Human metapneumovirus
pneumonia); (J12.8-Other viral pneumonia); (J12.9-Viral pneumonia,
unspecified); (J13-Pneumonia due to Streptococcus pneumoniae);
(J14-Pneumonia due to Haemophilus influenzae); (J15-Bacterial
pneumonia, not elsewhere classified); (J15.0-Pneumonia due to
Klebsiella pneumoniae); (J15.1-Pneumonia due to Pseudomonas);
(J15.2-Pneumonia due to staphylococcus); (J15.3-Pneumonia due to
streptococcus, group B); (J15.4-Pneumonia due to other streptococci);
(J15.5-Pneumonia due to Escherichia coli); (J15.6-Pneumonia due to
other aerobic Gram-negative bacteria); (J15.7-Pneumonia due to
Mycoplasma pneumoniae); (J15.8-Other bacterial pneumonia); (J15.9-
Bacterial pneumonia, unspecified); (J16-Pneumonia due to other
infectious organisms, not elsewhere classified); (J16.0-Chlamydial
pneumonia); (J16.8-Pneumonia due to other specified infectious
organisms); (J17-Pneumonia in diseases classified elsewhere); (J17.0-
Pneumonia in bacterial diseases classified elsewhere); (J17.1-
Pneumonia in viral diseases classified elsewhere); (J17.2-Pneumonia
in mycoses); (J17.3-Pneumonia in parasitic diseases); (J17.8-
Pneumonia in other diseases classified elsewhere); (J18-Pneumonia,
organism unspecified); (J18.0-Bronchopneumonia, unspecified);
(J18.1-Lobar pneumonia, unspecified); (J18.2-Hypostatic pneumonia,
unspecified); (J18.8-Other pneumonia, organism unspecified); (J18.9-
Pneumonia, unspecified)

29 Otitis eksterna (H60-Otitis externa); (H60.0-Abscess of external ear); (H60.3-Other

infective otitis externa); (H60.5-Acute otitis externa, noninfective);
(H60.8-Other otitis externa); (H60.9-Otitis externa, unspecified); (H62-
Disorders of external ear in diseases classified elsewhere); (H62.0-
Otitis externa in bacterial diseases classified elsewhere); (H62.1-Otitis
externa in viral diseases classified elsewhere); (H62.2-Otitis externa in
mycoses); (H62.3-Otitis externa in other infectious and parasitic
diseases classified elsewhere); (H62.4-Otitis externa in other diseases
classified elsewhere); (H62.8-Other disorders of external ear in
diseases classified elsewhere)

30 Asma bronkial (J45-Asthma); (J45.0-Predominantly allergic asthma); (J45.1-

Nonallergic asthma); (J45.8-Mixed asthma); (J45.9-Asthma,
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
No. Nama Penyakit Kode dan Nama Diagnosa ICD 10

unspecified)

30 Vaginosis bakterialis (N76-Other inflammation of vagina and vulva); (N76.0-Acute vaginitis);

(N76.1-Subacute and chronic vaginitis); (N76.6-Ulceration of vagina);
(N76.8-Other specified inflammation of vagina and vulva); (N77-
Vulvovaginal ulceration and inflammation in diseases classified
elsewhere); (N77.1-Vaginitis, vulvitis and vulvovaginitis in infectious
and parasitic diseases classified elsewhere); (N77.8-Vulvovaginal
ulceration and inflammation in other diseases classified elsewhere)

31 Hemoroid grade 1-2 (I84-Haemorrhoids); (I84.2-Internal haemorrhoids without

complication); (I84.5-External haemorrhoids without complication);
(I84.9-Unspecified haemorrhoids without complication)

32 Dermatitis kontak (L24-Irritant contact dermatitis); (L24.0-Irritant contact dermatitis due

iritan to detergents); (L24.1-Irritant contact dermatitis due to oils and
greases); (L24.2-Irritant contact dermatitis due to solvents); (L24.3-
Irritant contact dermatitis due to cosmetics); (L24.4-Irritant contact
dermatitis due to drugs in contact with skin); (L24.5-Irritant contact
dermatitis due to other chemical products); (L24.6-Irritant contact
dermatitis due to food in contact with skin); (L24.7-Irritant contact
dermatitis due to plants, except food); (L24.8-Irritant contact dermatitis
due to other agents); (L24.9-Irritant contact dermatitis, unspecified
cause); (L25-Unspecified contact dermatitis); (L25.0-Unspecified
contact dermatitis due to cosmetics); (L25.1-Unspecified contact
dermatitis due to drugs in contact with skin); (L25.2-Unspecified
contact dermatitis due to dyes); (L25.3-Unspecified contact dermatitis
due to other chemical products); (L25.4-Unspecified contact dermatitis
due to food in contact with skin); (L25.5-Unspecified contact dermatitis
due to plants, except food); (L25.8-Unspecified contact dermatitis due
to other agents); (L25.9-Unspecified contact dermatitis, unspecified
cause)

33 Disentri basiler, (A06-Amoebiasis); (A06.0-Acute amoebic dysentery); (A06.1-Chronic

disentri amuba intestinal amoebiasis); (A06.2-Amoebic nondysenteric colitis); (A06.3-
Amoeboma of intestine); (A06.7-Cutaneous amoebiasis); (A06.8-
Amoebic infection of other sites); (A06.9-Amoebiasis, unspecified);
(A03-Shigellosis); (A03.0-Shigellosis due to Shigella dysenteriae);
(A03.1-Shigellosis due to Shigella flexneri); (A03.2-Shigellosis due to
Shigella boydii); (A03.3-Shigellosis due to Shigella sonnei); (A03.8-
Other shigellosis); (A03.9-Shigellosis, unspecified)

34 Reaksi gigitan (T63-Toxic effect of contact with venomous animals); (T63.4- Venom
serangga of other arthropods)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
35 Filariasis (B74-Filariasis); (B74.0-Filariasis due to Wuchereria bancrofti);
(B74.1-Filariasis due to Brugia malayi); (B74.2-Filariasis due to Brugia
timori); (B74.3-Loiasis); (B74.4-Mansonelliasis); (B74.8-Other
filariases); (B74.9-Filariasis, unspecified); (Z11.6-Special screening
examination for other protozoal diseases and helminthiases)

36 Epistaksis (R04-Haemorrhage from respiratory passages); (R04.0-Epistaxis)

37 Veruka vulgaris (B07-Viral warts)

38 Herpes zoster tanpa (B02-Zoster [herpes zoster]); (B02.9-Zoster without complication)

komplikasi

39 Demam tifoid (A01-Typhoid and paratyphoid fevers); (A01.0-Typhoid fever); (A01.1-

Paratyphoid fever A); (A01.2-Paratyphoid fever B); (A01.3-
Paratyphoid fever C); (A01.4-Paratyphoid fever, unspecified)

40 Inverted nipple (O92-Other disorders of breast and lactation associated with

childbirth); (O92.0-Retracted nipple associated with childbirth)

40 Konjungtivitis (H10-Conjunctivitis); (H10.0-Mucopurulent conjunctivitis); (H10.1-

Acute atopic conjunctivitis); (H10.2-Other acute conjunctivitis); (H10.3-
Acute conjunctivitis, unspecified); (H10.4-Chronic conjunctivitis);
(H10.5-Blepharoconjunctivitis); (H10.8-Other conjunctivitis); (H10.9-
Conjunctivitis, unspecified); (B30-Viral conjunctivitis); (B30.1-
Conjunctivitis due to adenovirus ); (B30.2-Viral
pharyngoconjunctivitis); (B30.8-Other viral conjunctivitis ); (B30.9-Viral
conjunctivitis, unspecified); (H13.1-Conjunctivitis in infectious and
parasitic diseases classified elsewhere)

41 Impetigo (L01-Impetigo); (L01.0-Impetigo [any organism] [any site]); (L01.1-

Impetiginization of other dermatoses)

42 Dislipidemia (E78-Disorders of lipoprotein metabolism and other lipidaemias);

(E78.0-Pure hypercholesterolaemia); (E78.1-Pure
hyperglyceridaemia); (E78.2-Mixed hyperlipidaemia); (E78.3-
Hyperchylomicronaemia); (E78.4-Other hyperlipidaemia); (E78.5-
Hyperlipidaemia, unspecified); (E78.6-Lipoprotein deficiency); (E78.8-
Other disorders of lipoprotein metabolism); (E78.9-Disorder of
lipoprotein metabolism, unspecified)

43 Demam dengue, DHF (A90-Dengue fever [classical dengue]); (A91-Dengue haemorrhagic

fever)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
44 Serumen prop (H61-Other disorders of external ear); (H61.2-Impacted cerumen)

45 Obesitas (E66-Obesity); (E66.0-Obesity due to excess calories); (E66.1-Drug-

induced obesity); (E66.8-Other obesity); (E66.9-Obesity, unspecified)

46 Furunkel, karbunkel (L02-cutaneous abscess, furuncle and carbuncle); (L02.0-Cutaneous

abscess, furuncle and carbuncle of face); (L02.1-Cutaneous abscess,
furuncle and carbuncle of neck); (L02.2-Cutaneous abscess, furuncle
and carbuncle of trunk); (L02.3-Cutaneous abscess, furuncle and
carbuncle of buttock); (L02.4-Cutaneous abscess, furuncle and
carbuncle of limb); (L02.8-Cutaneous abscess, furuncle and carbuncle
of other sites); (L02.9-Cutaneous abscess, furuncle and carbuncle,
unspecified); (H04.0-Dacryoadenitis ); (H60.0-Abscess of external
ear ); (H04.3-Acute and unspecified inflammation of lacrimal
passages ); (N76.4-Abscess of vulva); (N48.2- Other inflammatory
disorders of penis); (N49.2-Inflammatory disorders of scrotum);
(N49.8-Inflammatory disorders of other specified male genital
organs ); (N49.9-Inflammatory disorder of unspecified male genital
organ); (N61-Inflammatory disorders of breast)

47 Pedikulosis kapitis (B85-Pediculosis and phthiriasis); (B85.0- Pediculosis due to

Pediculus humanus capitis); (B85.1- Pediculosis due to Pediculus
humanus corporis); (B85.4- Mixed pediculosis and phthiriasis)

48 Limfadenitis (I88-Nonspecific lymphadenitis); (I88.0-Nonspecific mesenteric

lymphadenitis); (I88.1-Chronic lymphadenitis, except mesenteric);
(I88.8-Other nonspecific lymphadenitis); (I88.9-Nonspecific
lymphadenitis, unspecified); (L04-Acute lymphadenitis); (L04.0-Acute
lymphadenitis of face, head and neck); (L04.1-Acute lymphadenitis of
trunk); (L04.2-Acute lymphadenitis of upper limb); (L04.3-Acute
lymphadenitis of lower limb); (L04.8-Acute lymphadenitis of other
sites); (L04.9-Acute lymphadenitis, unspecified)

49 Epistaksis (R04-Haemorrhage from respiratory passages); (R04.0-Epistaxis)

50 Veruka vulgaris (B07-Viral warts)

50 Taeniasis (B68-Taeniasis); (B68.0-Taenia solium taeniasis); (B68.1-Taenia

saginata taeniasis); (B68.9-Taeniasis, unspecified)

51 Rhinitis akut (J00-Acute nasopharyngitis [common cold])

52 Intoleransi makanan (K90-Intestinal malabsorption); (K90.4-Malabsorption due to

intolerance, not elsewhere classified)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
53 Tinea manus (B35-Dermatophytosis); (B35.2-Tinea manuum)

54 Pitiriasis versikolor (B36-Other superficial mycoses); (B36.0-Pityriasis versicolor); (B36.1-

Tinea nigra); (B36.2-White piedra); (B36.3-Black piedra); (B36.8-Other
specified superficial mycoses); (B36.9-Superficial mycosis,
unspecified)

55 Epistaksis (R04-Haemorrhage from respiratory passages); (R04.0-Epistaxis)

56 Veruka vulgaris (B07-Viral warts)

57 Herpes zoster tanpa (B02-Zoster [herpes zoster]); (B02.9-Zoster without complication)

komplikasi

58 Malnutrisi energi- (E40-Kwashiorkor); (E41-Nutritional marasmus); (E42-Marasmic

protein kwashiorkor); (E44-Protein-energy malnutrition of moderate and mild
degree); (E44.0-Moderate protein-energy malnutrition); (E44.1-Mild
protein-energy malnutrition); (E46-Unspecified protein-energy
malnutrition); (E64.0-Sequelae of protein-energy malnutrition)

59 Erisipelas (A46-Erysipelas); (O86.8-Other specified puerperal infections )

60 Skabies (B86-Scabies)

60 Vertigo (Benign (R42-Dizziness and giddiness); (H81-Disorders of vestibular function);

paroxysmal positional (H81.1-Benign paroxysmal vertigo); (H81.3-Other peripheral vertigo);
vertigo) (H81.4-Vertigo of central origin); (H82-Vertiginous syndromes in
diseases classified elsewhere); (T75.2-Effects of vibration)

61 Gangguan (F45-Somatoform disorders); (F45.0-Somatization disorder); (F45.1-

somatoform Undifferentiated somatoform disorder); (F45.2-Hypochondriacal
disorder); (F45.3-Somatoform autonomic dysfunction); (F45.4-
Persistent somatoform pain disorder); (F45.8-Other somatoform
disorders); (F45.9-Somatoform disorder, unspecified)

62 Exanthematous drug (L27-Dermatitis due to substances taken internally); (L27.0-

eruption, fixed drug Generalized skin eruption due to drugs and medicaments); (L27.1-
eruption Localized skin eruption due to drugs and medicaments); (R21-Rash
and other nonspecific skin eruption)

63 Kandidiasis mulut (B37-Candidiasis); (B37.0-Candidal stomatitis); (B37.9-Candidiasis,

unspecified)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
64 Infeksi saluran kemih (N39-Other disorders of urinary system); (N39.0-Urinary tract
bagian bawah infection, site not specified); (N39.8-Other specified disorders of
urinary system); (N39.9-Disorder of urinary system, unspecified);
(O08.8-Other complications following abortion and ectopic and molar
pregnancy); (N37.8-Other urethral disorders in diseases classified
elsewhere)

65 Cracked nipple (O92-Other disorders of breast and lactation associated with

childbirth); (O92.1-Cracked nipple associated with childbirth); (N64-
Other disorders of breast); (N64.0-Fissure and fistula of nipple)

66 Strongiloidiasis (B78-Strongyloidiasis); (B78.0-Intestinal strongyloidiasis); (B78.1-

Cutaneous strongyloidiasis); (B78.7-Disseminated strongyloidiasis);
(B78.9-Strongyloidiasis, unspecified)

67 Kehamilan normal (O80-Single spontaneous delivery); (O80.0-Spontaneous vertex

delivery); (O80.1-Spontaneous breech delivery); (O80.8-Other single
spontaneous delivery); (O80.9-Single spontaneous delivery,
unspecified); (O26.8-Other specified pregnancy-related conditions);
(O26.9-Pregnancy-related condition, unspecified)

68 Epistaksis (R04-Haemorrhage from respiratory passages); (R04.0-Epistaxis)

69 Veruka vulgaris (B07-Viral warts)

70 Herpes zoster tanpa (B02-Zoster [herpes zoster]); (B02.9-Zoster without complication)

komplikasi

70 Herpes zoster tanpa (B02-Zoster [herpes zoster]); (B02.9-Zoster without complication)

komplikasi

71 Demam tifoid (A01-Typhoid and paratyphoid fevers); (A01.0-Typhoid fever); (A01.1-

Paratyphoid fever A); (A01.2-Paratyphoid fever B); (A01.3-
Paratyphoid fever C); (A01.4-Paratyphoid fever, unspecified)

72 Inverted nipple (O92-Other disorders of breast and lactation associated with

childbirth); (O92.0-Retracted nipple associated with childbirth)

73 Malnutrisi energi- (E40-Kwashiorkor); (E41-Nutritional marasmus); (E42-Marasmic

protein kwashiorkor); (E44-Protein-energy malnutrition of moderate and mild
degree); (E44.0-Moderate protein-energy malnutrition); (E44.1-Mild
protein-energy malnutrition); (E46-Unspecified protein-energy
malnutrition); (E64.0-Sequelae of protein-energy malnutrition)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
74 Erisipelas (A46-Erysipelas); (O86.8-Other specified puerperal infections )

75 Skabies (B86-Scabies)

76 HIV AIDS tanpa (Z21-Asymptomatic human immunodeficiency virus [HIV] infection

komplikasi status); (R75-Laboratory evidence of human immunodeficiency virus
[HIV]); (Z11.4-Special screening examination for human
immunodeficiency virus [HIV]); (Z20.6-Contact with and exposure to
human immunodeficiency virus [HIV]); (Z71.7-Human
immunodeficiency virus [HIV] counselling)

77 Perdarahan (H11-Other disorders of conjunctiva); (H11.3-Conjunctival

subkonjungtiva haemorrhage); (H57-Other disorders of eye and adnexa); (H57.8-
Other specified disorders of eye and adnexa); (H57.9-Disorder of eye
and adnexa, unspecified)

78 Ruptur perineum (O70-Perineal laceration during delivery); (O70.0-First degree perineal

tingkat 1-2 laceration during delivery); (O70.1-Second degree perineal laceration
during delivery)

79 Morbili tanpa (B05-Measles); (B05.9-Measles without complication)

komplikasi

80 Skrofuloderma (A18-Tuberculosis of other organs); (A18.4-Tuberculosis of skin and

subcutaneous tissue)

80 Skrofuloderma (A18-Tuberculosis of other organs); (A18.4-Tuberculosis of skin and

subcutaneous tissue)

81 Dislipidemia (E78-Disorders of lipoprotein metabolism and other lipidaemias);

(E78.0-Pure hypercholesterolaemia); (E78.1-Pure
hyperglyceridaemia); (E78.2-Mixed hyperlipidaemia); (E78.3-
Hyperchylomicronaemia); (E78.4-Other hyperlipidaemia); (E78.5-
Hyperlipidaemia, unspecified); (E78.6-Lipoprotein deficiency); (E78.8-
Other disorders of lipoprotein metabolism); (E78.9-Disorder of
lipoprotein metabolism, unspecified)

82 Demam dengue, DHF (A90-Dengue fever [classical dengue]); (A91-Dengue haemorrhagic

fever)

83 Serumen prop (H61-Other disorders of external ear); (H61.2-Impacted cerumen)

 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
84 Obesitas (E66-Obesity); (E66.0-Obesity due to excess calories); (E66.1-Drug-
induced obesity); (E66.8-Other obesity); (E66.9-Obesity, unspecified)

85 Furunkel, karbunkel (L02-cutaneous abscess, furuncle and carbuncle); (L02.0-Cutaneous

abscess, furuncle and carbuncle of face); (L02.1-Cutaneous abscess,
furuncle and carbuncle of neck); (L02.2-Cutaneous abscess, furuncle
and carbuncle of trunk); (L02.3-Cutaneous abscess, furuncle and
carbuncle of buttock); (L02.4-Cutaneous abscess, furuncle and
carbuncle of limb); (L02.8-Cutaneous abscess, furuncle and carbuncle
of other sites); (L02.9-Cutaneous abscess, furuncle and carbuncle,
unspecified); (H04.0-Dacryoadenitis ); (H60.0-Abscess of external
ear ); (H04.3-Acute and unspecified inflammation of lacrimal
passages ); (N76.4-Abscess of vulva); (N48.2- Other inflammatory
disorders of penis); (N49.2-Inflammatory disorders of scrotum);
(N49.8-Inflammatory disorders of other specified male genital
organs ); (N49.9-Inflammatory disorder of unspecified male genital
organ); (N61-Inflammatory disorders of breast)

86 Pedikulosis kapitis (B85-Pediculosis and phthiriasis); (B85.0- Pediculosis due to

Pediculus humanus capitis); (B85.1- Pediculosis due to Pediculus
humanus corporis); (B85.4- Mixed pediculosis and phthiriasis)

87 Konjungtivitis (H10-Conjunctivitis); (H10.0-Mucopurulent conjunctivitis); (H10.1-

Acute atopic conjunctivitis); (H10.2-Other acute conjunctivitis); (H10.3-
Acute conjunctivitis, unspecified); (H10.4-Chronic conjunctivitis);
(H10.5-Blepharoconjunctivitis); (H10.8-Other conjunctivitis); (H10.9-
Conjunctivitis, unspecified); (B30-Viral conjunctivitis); (B30.1-
Conjunctivitis due to adenovirus ); (B30.2-Viral
pharyngoconjunctivitis); (B30.8-Other viral conjunctivitis ); (B30.9-Viral
conjunctivitis, unspecified); (H13.1-Conjunctivitis in infectious and
parasitic diseases classified elsewhere)

88 Impetigo (L01-Impetigo); (L01.0-Impetigo [any organism] [any site]); (L01.1-

Impetiginization of other dermatoses)

89 Limfadenitis (I88-Nonspecific lymphadenitis); (I88.0-Nonspecific mesenteric

lymphadenitis); (I88.1-Chronic lymphadenitis, except mesenteric);
(I88.8-Other nonspecific lymphadenitis); (I88.9-Nonspecific
lymphadenitis, unspecified); (L04-Acute lymphadenitis); (L04.0-Acute
lymphadenitis of face, head and neck); (L04.1-Acute lymphadenitis of
trunk); (L04.2-Acute lymphadenitis of upper limb); (L04.3-Acute
lymphadenitis of lower limb); (L04.8-Acute lymphadenitis of other
sites); (L04.9-Acute lymphadenitis, unspecified)

90 Pielonefritis tanpa (N10-Acute tubulo-interstitial nephritis); (N12-Tubulo-interstitial

komplikasi nephritis, not specified as acute or chronic)

90 Pielonefritis tanpa (N10-Acute tubulo-interstitial nephritis); (N12-Tubulo-interstitial

 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
komplikasi nephritis, not specified as acute or chronic)

91 Abses folikel rambut (L02-Cutaneous abscess, furuncle, and carbuncle); (L02.0-Cutaneous

atau kelenjar sebasea abscess, furuncle and carbuncle of face); (L02.1-Cutaneous abscess,
furuncle and carbuncle of neck); (L02.2-Cutaneous abscess, furuncle
and carbuncle of trunk); (L02.3-Cutaneous abscess, furuncle and
carbuncle of buttock); (L02.4-Cutaneous abscess, furuncle and
carbuncle of limb); (L02.8-Cutaneous abscess, furuncle and carbuncle
of other sites); (L02.9-Cutaneous abscess, furuncle and carbuncle,
unspecified)

92 Gonore (A54-Gonococcal infection); (A54.0-Gonococcal infection of lower

genitourinary tract without periurethral or accessory gland abscess);
(A54.3-Gonococcal infection of eye); (A54.5-Gonococcal pharyngitis);
(A54.6-Gonococcal infection of anus and rectum); (A54.8-Other
gonococcal infections); (A54.9-Gonococcal infection, unspecified);
(A64-Unspecified sexually transmitted disease)

93 Tinea barbe (B35-Dermatophytosis); (B35.0- Tinea barbae and tinea capitis)

94 Benda asing di (T15-Foreign body on external eye); (T15.1-Foreign body in

konjungtiva conjunctival sac); (T15.8- Foreign body in other and multiple parts of
external eye); (T15.9-Foreign body on external eye, part unspecified)

95 Penyakit cacing (B76-Hookworm diseases); (B76.0-Ancylostomiasis); (B76.1-

tambang Necatoriasis); (B76.8-Other hookworm diseases); (B76.9-Hookworm
disease, unspecified)

96 Keracunan makanan (T62-Toxic effect of other noxious substances eaten as food); (T62.0-
Ingested mushrooms); (T62.1-Ingested berries); (T62.2-Other
ingested (parts of) plant(s)); (T62.8-Other specified noxious
substances eaten as food); (T62.9-Noxious substance eaten as food,
unspecified); (T61-Toxic effect of noxious substances eaten as
seafood); (T61.0-Ciguatera fish poisoning); (T61.1-Scombroid fish
poisoning); (T61.2-Other fish and shellfish poisoning); (T61.8-Toxic
effect of other seafoods); (T61.9-Toxic effect of unspecified seafood);
(K52-Other noninfective gastroenteritis and colitis); (K52.1-Toxic
gastroenteritis and colitis); (K52.8-Other specified noninfective
gastroenteritis and colitis); (K52.9-Noninfective gastroenteritis and
colitis, unspecified)

97 Pneumonia, (J12-Viral pneumonia, not elsewhere classified); (J12.0-Adenoviral

bronkopneumonia pneumonia); (J12.1-Respiratory syncytial virus pneumonia); (J12.2-
Parainfluenza virus pneumonia); (J12.3-Human metapneumovirus
pneumonia); (J12.8-Other viral pneumonia); (J12.9-Viral pneumonia,
unspecified); (J13-Pneumonia due to Streptococcus pneumoniae);
(J14-Pneumonia due to Haemophilus influenzae); (J15-Bacterial
pneumonia, not elsewhere classified); (J15.0-Pneumonia due to
Klebsiella pneumoniae); (J15.1-Pneumonia due to Pseudomonas);
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
(J15.2-Pneumonia due to staphylococcus); (J15.3-Pneumonia due to
streptococcus, group B); (J15.4-Pneumonia due to other streptococci);
(J15.5-Pneumonia due to Escherichia coli); (J15.6-Pneumonia due to
other aerobic Gram-negative bacteria); (J15.7-Pneumonia due to
Mycoplasma pneumoniae); (J15.8-Other bacterial pneumonia);
(J15.9-Bacterial pneumonia, unspecified); (J16-Pneumonia due to
other infectious organisms, not elsewhere classified); (J16.0-
Chlamydial pneumonia); (J16.8-Pneumonia due to other specified
infectious organisms); (J17-Pneumonia in diseases classified
elsewhere); (J17.0-Pneumonia in bacterial diseases classified
elsewhere); (J17.1-Pneumonia in viral diseases classified elsewhere);
(J17.2-Pneumonia in mycoses); (J17.3-Pneumonia in parasitic
diseases); (J17.8-Pneumonia in other diseases classified elsewhere);
(J18-Pneumonia, organism unspecified); (J18.0-Bronchopneumonia,
unspecified); (J18.1-Lobar pneumonia, unspecified); (J18.2-Hypostatic
pneumonia, unspecified); (J18.8-Other pneumonia, organism
unspecified); (J18.9-Pneumonia, unspecified)

98 Otitis eksterna (H60-Otitis externa); (H60.0-Abscess of external ear); (H60.3-Other

infective otitis externa); (H60.5-Acute otitis externa, noninfective);
(H60.8-Other otitis externa); (H60.9-Otitis externa, unspecified); (H62-
Disorders of external ear in diseases classified elsewhere); (H62.0-
Otitis externa in bacterial diseases classified elsewhere); (H62.1-Otitis
externa in viral diseases classified elsewhere); (H62.2-Otitis externa in
mycoses); (H62.3-Otitis externa in other infectious and parasitic
diseases classified elsewhere); (H62.4-Otitis externa in other diseases
classified elsewhere); (H62.8-Other disorders of external ear in
diseases classified elsewhere)

99 Asma bronkial (J45-Asthma); (J45.0-Predominantly allergic asthma); (J45.1-

Nonallergic asthma); (J45.8-Mixed asthma); (J45.9-Asthma,
unspecified)

100 Aborsi spontan (O03-Spontaneous abortion); (O03.9-Complete or unspecified, without

komplit complication); (O04-Medical Abortion); (O04.9-Complete or
unspecified, without complication); (O05-Other Abortion); (O05.9-
Complete or unspecified, without complication); (O06-Unspecified
abortion); (O06.9-Complete or unspecified, without complication)

100 Aborsi spontan (O03-Spontaneous abortion); (O03.9-Complete or unspecified, without

komplit complication); (O04-Medical Abortion); (O04.9-Complete or
unspecified, without complication); (O05-Other Abortion); (O05.9-
Complete or unspecified, without complication); (O06-Unspecified
abortion); (O06.9-Complete or unspecified, without complication)

101 Impetigo ulseratif (L08-Other local infections of skin and subcutaneous tissue); (L08.0-
(ektima) Pyoderma); (L08.8-Other specified local infections of skin and
subcutaneous tissue); (L08.9-Local infection of skin and
subcutaneous tissue, unspecified)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
102 Cutaneus larva (B76-Hookworm diseases); (B76.0-Ancylostomiasis); (B76.1-
migran Necatoriasis); (B76.8-Other hookworm diseases); (B76.9-Hookworm
disease, unspecified); (B87.0-Cutaneous myiasis); (B87.9-Myiasis,
unspecified)

103 Miliaria (L74-Eccrine sweat disorders); (L74.0-Miliaria rubra); (L74.1-Miliaria

crystallina); (L74.2-Miliaria profunda); (L74.3-Miliaria, unspecified);
(L74.8-Other eccrine sweat disorders); (L74.9-Eccrine sweat disorder,
unspecified)

104 Rhinitis alergika (J30-Vasomotor and allergic rhinitis); (J30.2-Allergic rhinitis due to
pollen); (J30.3-Other seasonal allergic rhinitis); (J30.4- Other allergic
rhinitis); (J30.5-Allergic rhinitis, unspecified); (J45.0-Predominantly
allergic asthma)

105 Furunkel pada hidung (J34-Other disorders of nose and nasal sinuses); (J34.0-Abscess,
furuncle and carbuncle of nose)

106 Diabetes melitus tipe (E11-Non-insulin-dependent diabetes mellitus); (E11.9-Non-insulin-

2 dependent diabetes mellitus without complications)

107 Tension headache (G44-Other Headache Syndromes); (G44.1-Vascular headache, not

elsewhere classified); (G44.2-Tension-type headache); (G44.3-
Chronic post-traumatic headache); (G44.4-Drug-induced headache,
not elsewhere classified); (G44.8-Other specified headache
syndromes); (R51-Headache)

108 Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis); (J30.1-Vasomotor rhinitis)

109 Defisiensi mineral (E58-Dietary calcium deficiency); (E59-Dietary selenium deficiency);

(E60-Dietary zinc deficiency); (E61-Deficiency of other nutrient
elements); (E61.0-Copper deficiency); (E61.1-Iron deficiency); (E61.2-
Magnesium deficiency); (E61.3-Manganese deficiency); (E61.4-
Chromium deficiency); (E61.5-Molybdenum deficiency); (E61.6-
Vanadium deficiency); (E61.7-Deficiency of multiple nutrient
elements); (E61.8-Deficiency of other specified nutrient elements);
(E61.9-Deficiency of nutrient element, unspecified); (E63-Other
nutritional deficiencies); (E63.0-Essential fatty acid [EFA] deficiency);
(E63.1-Imbalance of constituents of food intake); (E63.8-Other
specified nutritional deficiencies); (E63.9-Nutritional deficiency,
unspecified)

110 Infeksi saluran kemih (N39-Other disorders of urinary system); (N39.0-Urinary tract
infection, site not specified); (N39.8-Other specified disorders of
urinary system); (N39.9-Disorder of urinary system, unspecified);
(O08.8-Other complications following abortion and ectopic and molar
pregnancy); (N37.8-Other urethral disorders in diseases classified
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
elsewhere)

110 Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis); (J30.1-Vasomotor rhinitis)

111 Defisiensi mineral (E58-Dietary calcium deficiency); (E59-Dietary selenium deficiency);

(E60-Dietary zinc deficiency); (E61-Deficiency of other nutrient
elements); (E61.0-Copper deficiency); (E61.1-Iron deficiency); (E61.2-
Magnesium deficiency); (E61.3-Manganese deficiency); (E61.4-
Chromium deficiency); (E61.5-Molybdenum deficiency); (E61.6-
Vanadium deficiency); (E61.7-Deficiency of multiple nutrient
elements); (E61.8-Deficiency of other specified nutrient elements);
(E61.9-Deficiency of nutrient element, unspecified); (E63-Other
nutritional deficiencies); (E63.0-Essential fatty acid [EFA] deficiency);
(E63.1-Imbalance of constituents of food intake); (E63.8-Other
specified nutritional deficiencies); (E63.9-Nutritional deficiency,
unspecified)

112 Infeksi saluran kemih (N39-Other disorders of urinary system); (N39.0-Urinary tract
infection, site not specified); (N39.8-Other specified disorders of
urinary system); (N39.9-Disorder of urinary system, unspecified);
(O08.8-Other complications following abortion and ectopic and molar
pregnancy); (N37.8-Other urethral disorders in diseases classified
elsewhere)

113 Anemia defisiensi (D50-Iron deficiency anaemia); (D50.8-Other iron deficiency

besi anaemias); (D50.9-Iron deficiency anaemia, unspecified); (D64-Other
anaemias); (D64.8-Other specified anaemias); (D64.9-Anaemia,
unspecified)

114 Urtikaria akut (L50-Urticaria); (L50.0-Allergic urticaria); (L50.2-Urticaria due to cold

and heat); (L50.3-Dermatographic urticaria); (L50.4-Vibratory
urticaria); (L50.6-Contact urticaria); (L50.9-Urticaria, unspecified);
(L56.3-Solar urticaria); (L29-Pruritus); (L29.0-Pruritus ani); (L29.1-
Pruritus scroti); (L29.2-Pruritus vulvae); (L29.3-Anogenital pruritus,
unspecified); (L29.8-Other pruritus); (L29.9-Pruritus, unspecified);
(T80.6-Other serum reactions)

115 Migren (G43-Migraine); (G43.0-Migraine without aura [common migraine]);

(G43.1-Migraine with aura [classical migraine]); (G43.2-Status
migrainosus); (G43.8-Other migraine); (G43.9-Migraine, unspecified);
(N94.3-Premenstrual tension syndrome)

116 Bells' palsy (G51-Facial nerve disorders); (G51.0-Bell's palsy)

117 Askariasis (B77-Ascariasis); (B77.9-Ascariasis, unspecified); (K93.8-Disorders of

other specified digestive organs in diseases classified elsewhere)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
118 Folikulitis superfisialis (L72-Follicular cysts of skin and subcutaneous tissue); (L72.0-
Epidermal cyst); (L72.1-Trichilemmal cyst); (L72.2-Steatocystoma
multiplex); (L72.8-Other follicular cysts of skin and subcutaneous
tissue); (L72.9-Follicular cyst of skin and subcutaneous tissue,
unspecified); (L08-Other local infections of skin and subcutaneous
tissue); (L08.0-Pyoderma); (L08.8-Other specified local infections of
skin and subcutaneous tissue); (L08.9-Local infection of skin and
subcutaneous tissue, unspecified); (L66.2-Folliculitis decalvans );
(L66.3-Perifolliculitis capitis abscedens ); (L66.4-Folliculitis
ulerythematosa reticulata)

119 Vulnus laseratum, (T00-Superficial injuries involving multiple body regions); (T00.0-
vulnus punctum Superficial injuries involving head with neck); (T00.1-Superficial
injuries involving thorax with abdomen, lower back and pelvis); (T00.2-
Superficial injuries involving multiple regions of upper limb(s)); (T00.3-
Superficial injuries involving multiple regions of lower limb(s)); (T00.6-
Superficial injuries involving multiple regions of upper limb(s) with
lower limb(s)); (T00.8-Superficial injuries involving other combinations
of body regions); (T00.9-Multiple superficial injuries, unspecified);
(T14-Injury of unspecified body region); (T14.0-Superficial injury of
unspecified body region); (T14.1-Open wound of unspecified body
region); (T14.8-Other injuries of unspecified body region); (T14.9-
Injury, unspecified)

120 Gastritis (K29-Gastritis and duodenitis); (K29.1-Other acute gastritis); (K29.2-

Alcoholic gastritis); (K29.5-Chronic gastritis, unspecified); (K29.6-
Other gastritis); (K29.7-Gastritis, unspecified); (K30-Functional
dyspepsia); (R10.1-Pain localized to upper abdomen)

120 Gastritis (K29-Gastritis and duodenitis); (K29.1-Other acute gastritis); (K29.2-

Alcoholic gastritis); (K29.5-Chronic gastritis, unspecified); (K29.6-
Other gastritis); (K29.7-Gastritis, unspecified); (K30-Functional
dyspepsia); (R10.1-Pain localized to upper abdomen)

121 Parafismosis (N47-Redundant prepuce, phimosis and paraphimosis)

122 Hipoglikemia ringan (E16-Other disorders of pancreatic internal secretion); (E16.1-Other

hypoglycaemia); (E16.2-Hypoglycaemia, unspecified)

123 Vaginitis (N76-Other inflammation of vagina and vulva); (N76.0-Acute vaginitis);

(N76.1-Subacute and chronic vaginitis); (N76.6-Ulceration of vagina);
(N76.8-Other specified inflammation of vagina and vulva)

124 Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified); (T78.2-Anaphylactic

shock, unspecified); (T80.5-Anaphylactic shock due to serum); (T78.0-
Anaphylactic shock due to adverse food reaction); (T88.6-
Anaphylactic shock due to adverse effect of correct drug or
medicament properly administered)
 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
125 Pitiriasis rosea (L42-Pityriasis rosea); (L30.5-Pityriasis alba)

126 Trikiasis (H02-Other disorders of eyelid); (H02.0-Entropion and trichiasis of

eyelid)

127 Faringitis (J02-Acute pharyngitis); (J02.0-Streptococcal pharyngitis); (J02.8-

Acute pharyngitis due to other specified organisms); (J02.9-Acute
pharyngitis, unspecified); (J31-Chronic rhinitis, nasopharyngitis and
pharyngitis); (J31.1-Chronic nasopharyngitis); (J31.2-Chronic
pharyngitis)

128 Mastitis (N61-Inflammatory disorders of breast); (O91-Infections of breast

associated with childbirth); (O91.0-Infection of nipple associated with
childbirth); (O91.1-Abscess of breast associated with childbirth);
(O91.2-Nonpurulent mastitis associated with childbirth)

129 Tonsilitis (J03-Acute tonsillitis); (J03.0-Streptococcal tonsillitis); (J03.8-Acute

tonsillitis due to other specified organisms); (J03.9-Acute tonsillitis,
unspecified); (J35-Chronic diseases of tonsils and adenoids); (J35.0-
Chronic tonsillitis); (J35.1-Hypertrophy of tonsils); (J35.8-Other
chronic diseases of tonsils and adenoids); (J35.9-Chronic disease of
tonsils and adenoids, unspecified)

130 Lepra (A30-Leprosy [Hansen disease]); (A30.0-Indeterminate leprosy);

(A30.1-Tuberculoid leprosy); (A30.2-Borderline tuberculoid leprosy);
(A30.3-Borderline leprosy); (A30.4-Borderline lepromatous leprosy);
(A30.5-Lepromatous leprosy); (A30.8-Other forms of leprosy); (A30.9-
Leprosy, unspecified); (B92-Sequelae of leprosy)

130 Vaginitis (N76-Other inflammation of vagina and vulva); (N76.0-Acute vaginitis);

(N76.1-Subacute and chronic vaginitis); (N76.6-Ulceration of vagina);
(N76.8-Other specified inflammation of vagina and vulva)

131 Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified); (T78.2-Anaphylactic

shock, unspecified); (T80.5-Anaphylactic shock due to serum); (T78.0-
Anaphylactic shock due to adverse food reaction); (T88.6-
Anaphylactic shock due to adverse effect of correct drug or
medicament properly administered)

132 Pitiriasis rosea (L42-Pityriasis rosea); (L30.5-Pityriasis alba)

133 Episkleritis (H15-Disorders of sclera); (H15.1-Episcleritis)

134 Tinea kruris (B35-Dermatophytosis); (B35.6-Tinea cruris)

 KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
135 Pedikulosis pubis (B85-Pediculosis and phthiriasis); (B85.0- Pediculosis due to
Pediculus humanus capitis)

136 Otitis media akut (H65-Nonsuppurative otitis media); (H65.1-Other acute

nonsuppurative otitis media); (H65.9-Nonsuppurative otitis media,
unspecified); (H66-Suppurative and unspecified otitis media); (H66.0-
Acute suppurative otitis media); (H66.4-Suppurative otitis media,
unspecified); (H66.9-Otitis media, unspecified); (H67-Otitis media in
diseases classified elsewhere); (H67.0-Otitis media in bacterial
diseases classified elsewhere); (H67.1-Otitis media in viral diseases
classified elsewhere); (H67.8-Otitis media in other diseases classified
elsewhere)

137 Tuberkulosis paru (A15-Respiratory tuberculosis, bacteriologically and histologically

tanpa komplikasi confirmed); (A15.0-Tuberculosis of lung, confirmed by sputum
microscopy with or without culture); (A15.1-Tuberculosis of lung,
confirmed by culture only); (A15.2-Tuberculosis of lung, confirmed
histologically); (A15.3-Tuberculosis of lung, confirmed by unspecified
means); (A15.4-Tuberculosis of intrathoracic lymph nodes, confirmed
bacteriologically and histologically); (A15.5-Tuberculosis of larynx,
trachea and bronchus, confirmed bacteriologically and histologically);
(A15.6-Tuberculous pleurisy, confirmed bacteriologically and
histologically); (A15.7-Primary respiratory tuberculosis, confirmed
bacteriologically and histologically); (A15.8-Other respiratory
tuberculosis, confirmed bacteriologically and histologically); (A15.9-
Respiratory tuberculosis unspecified, confirmed bacteriologically and
histologically); (A16.1-Tuberculosis of lung, bacteriological and
histological examination not done); (A16.2-Tuberculosis of lung,
without mention of bacteriological or histological confirmation); (A16.7-
Primary respiratory tuberculosis without mention of bacteriological or
histological confirmation); (A16.8-Other respiratory tuberculosis,
without mention of bacteriological or histological confirmation); (A16.9-
Respiratory tuberculosis unspecified, without mention of
bacteriological or histological confirmation)

138 Luka bakar derajat 1 (T30.0-Burn of unspecified body region, unspecified degree); (T30.1-
dan 2 Burn of first degree, body region unspecified); (T30.2-Burn of second
degree, body region unspecified); (T30.4-Corrosion of unspecified
body region, unspecified degree); (T30.5-Corrosion of first degree,
body region unspecified); (T30.6-Corrosion of second degree, body
region unspecified); (T21-Burn and corrosion of trunk); (T21.0-Burn of
unspecified degree of trunk); (T21.1-Burn of first degree of trunk);
(T21.2-Burn of second degree of trunk); (T21.4-Corrosion of
unspecified degree of trunk); (T21.5-Corrosion of first degree of trunk);
(T21.6-Corrosion of second degree of trunk); (T22-Burn and corrosion
of shoulder and upper limb, except wrist and hand); (T22.0-Burn of
unspecified degree of shoulder and upper limb, except wrist and
hand); (T22.1-Burn of first degree of shoulder and upper limb, except
wrist and hand); (T22.2-Burn of second degree of shoulder and upper
limb, except wrist and hand); (T22.4-Corrosion of unspecified degree
of shoulder and upper limb, except wrist and hand); (T22.5-Corrosion
of first degree of shoulder and upper limb, except wrist and hand);
(T22.6-Corrosion of second degree of shoulder and upper limb,
except wrist and hand); (T23-Burn and corrosion of wrist and hand);
(T23.0-Burn of unspecified degree of wrist and hand); (T23.1-Burn of
KODE DIAGNOSA NON SPESIALISTIK (BPJS KESEHATAN)
first degree of wrist and hand); (T23.2-Burn of second degree of wrist
and hand); (T23.4-Corrosion of unspecified degree of wrist and hand);
(T23.5-Corrosion of first degree of wrist and hand); (T23.6-Corrosion
of second degree of wrist and hand); (T24-Burn and corrosion of hip
and lower limb, except ankle and foot); (T24.0-Burn of unspecified
degree of hip and lower limb, except ankle and foot); (T24.1-Burn of
first degree of hip and lower limb, except ankle and foot); (T30-Burn
and corrosion, body region unspecified); (T24.2-Burn of second
degree of hip and lower limb, except ankle and foot); (T24.4-Corrosion
of unspecified degree of hip and lower limb, except ankle and foot);
(T24.5-Corrosion of first degree of hip and lower limb, except ankle
and foot); (T24.6-Corrosion of second degree of hip and lower limb,
except ankle and foot); (T25-Burn and corrosion of ankle and foot);
(T25.0-Burn of unspecified degree of ankle and foot); (T25.1-Burn of
first degree of ankle and foot); (T25.2-Burn of second degree of ankle
and foot); (T25.4-Corrosion of unspecified degree of ankle and foot);
(T25.5-Corrosion of first degree of ankle and foot); (T25.6-Corrosion
of second degree of ankle and foot); (T29-Burns and corrosions of
multiple body regions); (T29.0-Burns of multiple regions, unspecified
degree); (T29.1-Burns of multiple regions, no more than first-degree
burns mentioned); (T29.2-Burns of multiple regions, no more than
second-degree burns mentioned); (T29.4-Corrosions of multiple
regions, unspecified degree); (T29.5-Corrosions of multiple regions,
no more than first-degree corrosions mentioned); (T29.6-Corrosions of
multiple regions, no more than second-degree corrosions mentioned)