No Kode INA-CBG DESKRIPSI KODE INA-CBG

1. H-1-20-II PROSEDUR EKSTRAOKULER DAN ORBITA

1601 : Orbitotomy with bone flap
1602 : Orbitotomy with insertion of orbital implant
1609 : Other orbitotomy
1641 : Enuclation of eyeball with synchronous
implant into Tenon’s capsule with attachment of
muscles
1642 : Enucleation of eyeball with other
synchronous implant
1649 : Other enucleation of eyeball
1651 : Exentration of orbit with removal of adjacent
structures
1652 : Exentration of orbit with therapeutic removal
of orbital bone
1659 : Other exentration of orbit
1663 : Revision of eucleation socket with graft
1664 : Other revision of enucleation socket
1665 : Secondary graft to exentration cavity
1666 : Other revision of exentration cavity
1669 : Other secondary procedures after removal of
eyeball
1672 : Removal of orbital implant
1681 : Repair of wound of orbit
1689 : Other repair of injury of eyeball or orbit
1691 : Retrobulbar injection of therapeutic agent
1692 : Excision of lesion of orbit
1693 : Excision of lesion of eye, unspecified
structure
1698 : Other operations on orbit
1641 : Enucleation of eyeball with synchronous
implant (enukleasi + DFG)
1639 : Other evisceration of eyeball
1272 : Cyclocryotherapy
1229: Other diagnostic procedures on iris, ciliary
body, sclera, and anterior chamber
BIopsi Tumor
Insisi Tumor
Enukleasi tanpa Implantasi dermis fat graft
Enukleasi dengan Implantasi dermis fat graft
Eviserasi tanpa Implantasi dermis fat graft
Eviserasi dengan Implantasi dermis fat graft
Eksenterasi orbita tanpa Bone Removal
Eksenterasi orbita dengan Bone Removal
Orbitotomi tanpa Plate
Orbitotomi dengan Plate
Aspirasi Diagnostik
Implantasi Orbita Sekunder
Eksisi Tumor Kecil
Eksisi Tumor Sedang
 Eksisi Tumor luas dengan Rekonstruksi
2 H-1-30-II PROSEDUR LENSA DAN INTRAOKULER
Double Procedure
Triple Procedure
Paracintesis/Aspirasi
Trabekulektomi
Iridektomi
Repair Bleb
Injeksi Anti VEGF (Intracameral/intravitreal)

3 H-4-10-II INFEKSI MATA AKUT MAYOR

H26.2Complicated cataract
Cataract in chronic iridocyclitis
H48.1 Retrobulbar Neuritis
·         A 52.1 late syphilis
·         A 39.8 meningococal infection
·         G 35 Multiple sclerosis
H46 Optic Neuritis
Include :
Optic (neuropathy, except ischaemic, Papilitis)
H46.01 Optic papillitis
H46.9 Unspecified optic neuritis
H46.8 Other optic neuritis
S04.011 Traumatic optic Neuropathy
H46.3 Toxic optic neuropathy
H46.2 Nutritional optic neuropathy
H47.1 Papiloedema
H10.0 Mucopurulent Conjunctivitis
H10.1 Acute Atopic Conjunctivitis
H10.2 Other Acute Conjunctivitis
H10.3 Acute Conjunctivitis, Unspecified
Excl.:
Ophthalmia Neonatorum NOS (P39.1)
H10.4 Chronic Conjunctivitis
H10.8 Other Conjunctivitis
H10.9 Conjunctivitis, Unspecified
H11.0 Pterygium
Excl.:
Pseudopterygium (H11.8)
H11.1 Conjunctival Degeneration and Deposite
Conjunctival
Conjunctival:
• Argyrosis (argyria)
• Concretions
• Pigmentation
• Xerosis NOS
H11.2 Conjunctival Scars
Symblepharon
H11.3 Conjunctival Haemorhage
Subconjunctival Haemorrhage
H11.4 Conjunctival Vascular
Conjunctival:
• Aneurysm
• Hyperaemia
• Oedema
H11.8 Other Specified Disorder of Conjunctiva
Pseudopterygium
H11.9 Disorder of Conjunctiva, Unspecified
H15.0 Scleritis
H15.1 Episcleritis
H15.8 Other Disorders of Sclera
Equatorial Staphyloma
Scleral Ectasia
Excl.:
Degenerative Myopia (H44.2)
H16.0 Corneal Ulcer
Ulcer:
• Corneal
• NOS
• Central
• Marginal
• Perforated
• Ring
• With Hypopyon
• Mooren
H16.1 Other Superficial Keratitis Without
Conjunctivitis
Keratitis:
• Areolar
• Filamentary
• Nummular
• Stellate
• Striate
• Superficial punctate
Photokeratitis
Snow Blindness
H16.2 Keratoconjunctivitis
Keratoconjunctivitis:
• NOS
• Exposure
• Neurotrophic
• Phlyctenular
Ophthalmia nodosa
Superficial keratitis with conjunctivitis
H16.3 Interstitial and Deep Keratitis
H16.8 Other Keratitis
H16.9 Keratitis, Unspecified
H18.2 Other Corneal Oedema
H19.2 Keratitis and Keratoconjunctivitis in Other
Infectious and Parasitic Diseases Classified
 Elsewhere
Epidemic Keratoconjunctivitis (B30.0)
Keratitis and keratoconjunctivitis (Interstitial):
• Acanthamoebiasis
• Measles
• Syphilis
• Tuberculosis
• Zoster
H21.0 Hyphema
Excl.:
Traumatic Hypema (S05.1)
4 H-4-11-II GANGGUAN PERSARAFAN MATA
Ophthalmoplegia :
H52.5 Internal
H51.2 Internuclear
G23.1 Progressive Supranuclear
H49.0 Third Nerve Palsy
H49.1 Fourth Nerve Palsy
H49.2 Six Nerve Palsy
H49.1 Total Nerve Palsy
H47 Other Disorders of optic nerve not elsewhere
classified compression of optic nerve
-       Compression of optic nerve
Haemorrhage in optic nerve sheath
G45.3 Amaurosis fugax
G90.2 Horner’s Syndrome
G24.5 Blepharospasm
G35 Multiple sclerosis
G45.9 Transient cerebral ischemic attack,
unspecified (eg. TIA)
G93.2 Benign intracranial hypertension
G43.B0 Ophthalmoplegic migraine, not intractable
G43.B1 Ophthalmoplegic migraine, intractable
G70.00 Myasthenia gravis without (acute)
exacerbation
G70.01 Myasthenia gravis with (acute) exacerbation
351.8 Clonic hemifacial spasm
H47.231 Glaucomatous optic atrophy H46.01 Optic
papillitis
H47.20 Unspecified optic atrophy H47.211 Primary
optic atrophy
H46.9 Unspecified optic neuritis
H47.331 Pseudopapilledema of optic
H47.10 Unspecified papilledema
H47.49 Disorders of optic chiasm H47.42 Disorders
of optic chiasm associated with other neoplasms
H47.43 Disorders of optic chiasm associated with
vascular disorders
H47.41 Disorders of optic chiasm associated with
inflammatory disorders
 H47.091 Other disorders of optic nerve, NOC (eg..
compression of optic
nerve)
H47.22 Hereditary optic atrophy
H47.611 Cortical blindness
H47.2 Optic Atropy
H47.3 Other disorders of optic disc
Drusen of optic disc
Pseudopapilloedema
H47.4 Disorders of optic chiasm
H47.5 Disorders of other visual pathways
Disorders of optic tracts, geniculate nuclei and optic
radiations
H47.6 Disorders of visual cortex
H47.7 Disorder of visual pathways, unspecified
H02.421 Ptosis Myogenic
H02.431 Ptosis Paralytic
W44. Foreign body entering into or through eye or
natural orifice
H33.0 - H33.5 Retinal detachments and breaks
H34.0 - H34.9 Retinal vascular occlusions
H35.0 - H35.9 Other retinal disorders
T85.22XA Displacement of intraocular lens, initial
encounter

H49 Paralytic Strabismus

H49. 0 Third nerve palsy
H49.1 Fourth nerve palsy
H49.2 Sixth nerve palsy
H49.3 Total (external) ophthalmoplegia
H49.4 Progressive External ophthalmoplegia
H49.8 Other Paralytic Strabismus
External ophthalmoplegia NOS
Kearns-Sayre syndrome
H49. 9 Paralytic strabismus, unspecified

5 H-4-12-II GANGGUAN MATA LAIN-LAIN

H02.0 Entropion and trichiasis of eyelid
H02.1 Ectropion of eyelid
H02.2 Lagophthalmos
H02.3 Blepharochalasis
H02.4 Ptosis of eyelid
H02.5 Other disorders affecting eyelid function
Ankyloblepharon
Blepharophimosis
Lid retraction
Excl.:
blepharospasm (G24.5)
 tic (psychogenic) (F95.-)
tic (psychogenic)
 organic (G25.6)

H02.6 Xanthelasma of eyelid

H02.7 Other degenerative disorders of eyelid and
periocular area
Chlo
asma
Mad of
arosis eyelid
Vitili
go

H02.8 Other specified disorders of eyelid

Hypertrichosis of eyelid
Retained foreign body in eyelid
H02.9 Disorder of eyelid, unspecified

H04.0 Dacryoadenitis
Chronic enlargement of lacrimal gland

H04.1 Other disorders of lacrimal gland

Dacryops

H04.2 Epiphora

H04.3 Acute and unspecified inflammation of

lacrimal passages

Dacryocystitis
(phlegmonous) acute,
Dacryopericystit subacute or
is unspecified
Lacrimal
canaliculitis

Excl.:
neonatal dacryocystitis (P39.1)

H04.4 Chronic inflammation of lacrimal passages

c
Dacryoc hronic
ystitis
 Lacrima
l:
c
analiculitis
m
ucocele

H04.5 Stenosis and insufficiency of lacrimal

passages
Dacryolith
Eversion of lacrimal punctum
Stenosis of lacrimal:

 canaliculi
 duct
 sac

H04.6 Other changes in lacrimal passages

Lacrimal fistula

H04.8 Other disorders of lacrimal system

H04.9 Disorder of lacrimal system, unspecified

Squamous Papilloma

Basal Cell Carcinoma

Squamous Cell Carcinoma

Sebaceus Adenoma

Sebaceus Carcinoma

Kista Dermoid

Ocular Surface Squamous Neoplasia

Melanoma Maligna

Hemangioma

Celullitis

XXanthelasma

Sebbhoroic Keratosis
Actinic Keratosis

Tumor Jinak Orbita

Tumor Ganas Orbita

Melanocytic Nevus

Nonspesific Orbital Inflammation

Tyroid Eye Disease

Neoplasia Glandula Lacrimal

Pleomorphic Adenoma

Adenoid Cystic Adenoma

Lymphoma

Lymphangioma

Rhabdomyosarcoma

Neurofibroma

Fibrous Dysplasia

Glioma

Meningioma

Adenocarcinoma

Proptosis

Exophthalmus

Enophthalmus

Disorder of Orbit, Unspecified

H52.0 Hypermetropia

H52.1 Myopia
Excl.:
degenerative myopia (H44.2)

H52.2 Astigmatism

H52.3 Anisometropia and aniseikonia

H52.4 Presbyopia

H52.5 Disorders of accommodation

Internal ophthalmoplegia (complete)(total)

P
of
aresis
accommodation
S
pasm

H52.6 Other disorders of refraction

H52.7 Disorder of refraction, unspecified

H53.0 Amblyopia ex anopsia

Amblyopia:

 anisometropic
 deprivation
 strabismic

H53.1 Subjective visual disturbances

Asthenopia
Day blindness
Hemeralopia
Metamorphopsia
Photophobia
Scintillating scotoma
Sudden visual loss
Visual halos
Excl.:
visual hallucinations (R44.1)

H53.2 Diplopia
Double vision

H53.3 Other disorders of binocular vision

Abnormal retinal correspondence
Fusion with defective stereopsis
Simultaneous visual perception without
fusion
Suppression of binocular vision

H53.5Colour vision deficiencies

 Achromatopsia
Acquired colour vision deficiency
Colour blindness
Deuteranomaly
Deuteranopia
Protanomaly
Protanopia
Tritanomaly
Tritanopia
Excl.:
day blindness (H53.1)

H53.6 Night blindness

Excl.:
due to vitamin A deficiency (E50.5)

H53.8 Other visual disturbances

H53.9 Visual disturbance, unspecified

H54.0 Blindness, binocular

Visual impairment categories 3,4,5 in both
eyes

H54.1 Severe visual impairment, binocular

Visual impairment category 2.

H54.2 Moderate visual impairment, binocular

Visual impairment category 1

H54.3 Mild or no visual impairment, binocular

Visual impairment category 0.

H54.4 Blindness, monocular

Visual impairment categories 3, 4, 5 in one
eye and categories 0, 1, 2 or 9 in the other
eye.

H54.5 Severe visual impairment, monocular

Visual impairment category 2 in one eye and
categories 0, 1 or 9 in other eye.

H54.6 Moderate visual impairment, monocular

Visual impairment category 1 in one eye and
categories 0 or 9 in other eye.

H54.9 Unspecified visual impairment (binocular)

 Visual impairment category 9

capsular glaucoma with pseudoexfoliation of lens

(H40.1)
H25.0Senile incipient cataract
Senile cataract:
• coronary
• cortical
• punctate
Subcapsular polar senile cataract (anterior)
(posterior)
Water clefts
H25.1Senile nuclear cataract
Cataracta brunescens
Nuclear sclerosis cataract
H25.2Senile cataract, morgagnian type
Senile hypermature cataract
H25.8Other senile cataract
Combined forms of senile cataract
H25.9Senile cataract, unspecified

congenital cataract (Q12.0)

H26.0Infantile, juvenile and presenile cataract
H26.1Traumatic cataract
Use additional external cause code (Chapter XX), if
desired, to identify cause.
H26.2Complicated cataract
Cataract in chronic iridocyclitis
Cataract secondary to ocular disorders
Glaucomatous flecks (subcapsular)
H26.3Drug-induced cataract
Use additional external cause code (Chapter XX), if
desired, to identify drug.
H26.4After-cataract
Secondary cataract
Soemmerring ring
H26.8Other specified cataract
H26.9Cataract, unspecified

congenital lens malformations (Q12.-)

mechanical complications of intraocular lens (T85.2)
pseudophakia (Z96.1)
H27.0Aphakia
H27.1Dislocation of lens
H27.8Other specified disorders of lens
H27.9Disorder of lens, unspecified
H28.0*Diabetic cataract (E10-E14 with common
fourth character .3†)
H28.1*Cataract in other endocrine, nutritional and
metabolic diseases
Cataract in hypoparathyroidism (E20.-†)
Malnutrition-dehydration cataract (E40-E46†)
H28.2*Cataract in other diseases classified
elsewhere
Myotonic cataract (G71.1†)
H28.8*Other disorders of lens in diseases classified
elsewhere
Glaukoma Dolarosa
Glaukoma Neovaskular
H51.0 Palsy of conjugate gaze
H51.2 Internuclear ophthalmoplegia
H51.8 Other specified disorders of binocular
movement
H51.9 Disorder of binocular movement, unspecified
H53.1Subjective visual disturbances
Asthenopia
Day blindness
Hemeralopia
Metamorphopsia
Photophobia
Scintillating scotoma
Sudden visual loss
Visual halos
Excl.:
visual hallucinations (R44.1)
H53.2 Diplopia
Double vision
H53.3 Other disorders of binocular vision
Abnormal retinal correspondence
Fusion with defective stereopsis
Simultaneous visual perception without fusion
Suppression of binocular vision
H53.4 Visual field defects
Enlarged blind spot
Generalized contraction of visual field
Hemianop(s)ia (heteronymous)(homonymous)
Quadrant anop(s)ia
Scotoma:
·         arcuate
·         Bjerrum
·         central
·         ring
H53.5 Colour vision deficiencies
Achromatopsia
Acquired colour vision deficiency
Colour blindness
Deuteranomaly
Deuteranopia
Protanomaly
Protanopia
Tritanomaly
Tritanopia
Excl.:
day blindness (H53.1)
H53.6 Night blindness
Excl.:
due to vitamin A deficiency (E50.5)
H53.8 Other visual disturbances
H53.9 Visual disturbance, unspecified
H57.0 Anomalies of pupillary function
H57.1 Ocular pain
H57.8 Other specified disorders of eye and adnexa
H57.9 Disorder of eye and adnexa, unspecified
H57.02 Anisocoria
H05.111 Granuloma of orbit (eg. Pseudotumor
(inflammatory) of orbit)
H57.051 Tonic pupil
D35.2 Benign neoplasm of pituitary gland
D31.61 Benign neoplasm of unspecified site of orbit
F44.6 Conversion disorder with sensory symptom or
deficit
D32.0 Benign neoplasm of cerebral meninges
H57.11 Ocular pain
M31.6 Other giant cell arteritis
H57.051 Tonic Pupil
H53.19 Other subjective visual disturbances (eg.
Visual halos)
I63.9 Cerebral infarction, unspecified (eg. Stroke)
G45.9 Transient cerebral ischemic attack,
unspecified (eg. TIA)
C69.61 Malignant neoplasm of orbit
H49.41 Progressive external ophthalmoplegia
H30.011 Focal chorioretinal inflammation,
juxtapapillary
H533.52 Acquired color vision deficiency
H53.421 Scotoma of blind spot
H34.211 Partial retinal atery occlusion (eg.
Hollenhorst’s plaque)
G51.0 Palsy (spasm) of conjugate gaze
H53.2Diplopia (Double vision)
H05.0 Acute Inflammation of Orbit
Abscess
of Orbit
Cellulitis
Osteomyelitis
Periostitis
Tenonitis
H05.1 Chronic Inflammatory Disorders of Orbit
Granuloma of Orbit
H05.2 Exophthalmic Conditions
Displacement of Globe (Lateral) NOS
Haemorrhage
of Orbit
Oedema

H05.3 Deformity of Orbit

Atrophy
of Orbit
Exostosis

H05.4 Enophthalmos
H05.5 Retained (Old) Foreign Body Following
Penetrating Wound of Orbit Retrobulbar Foreign
Body
H05.8 Other Disorders of Orbit
Cyst of Orbit
H05.9 Disorder of Orbit, Unspecified

H50 Other Strabismus

H50.0 Convergent concomitant strabismus
Exotropia (alternating) (monocular), except
intermittent
H50.1 Divergent concomitant strabismus
Exotropia (alternating) (monocular), except
intermittent
H50.2 Vertical Strabismus
Hypertropia
Hypotropia
H50.3 Intermittent Heterotropia
Intermittent:
Esotropia
Exotropia
H50.4 Other and unspecified heterotropia
Concomitant strabismus NOS
Cyclotropia
Microtropia
Monofixation Syndrome
H50.5 Heterophoria
Alternating Hyperphoria
Esophoria
Exophoria
H50.6 Mechanical Strabismus
Brown sheath syndrome
Strabismus due to adhesions
Traumatic limitation of duction of eye muscle
H50.8 Other specified strabismus
Duane Syndrome
H50.9 Strabismus, unspecified

H51Other disorders of binocular movement

 H51.0 Palsy of conjugate gaze
H51.1 Convergence insufficiency and excess
H51.2 Internuclear ophthalmoplegia
H51.8 Other specified disorders of binocular
movement
H51.9 Disorder of binocular movement, unspecified
6 H-2-21-0 PROSEDUR BESAR PADA MATA EKSTERNAL
0824 : Excision of major lesion of eyelid, full-
thickness
0825 : Destruction of lesion of eyelid
0851 : Canthotomy
0861 : Recontruction of eyelid with skin flap or graft
0862 : Recontruction of eyelid with mucous
membrane flap or graft
0863 : Recontruction of eyelid with hair follicle graft
0864 : Recontruction of eyelid with tarsoconjunctival
flap
0869 : Other recontruction of eyelid with flaps or
grafts
0873 : Reconstruction of eyelid involving lid margin,
full thickness
0874 : Other recnstruction of eyelid, full-thickness
0884 : Repair of laceration involving lid margin, full-
thickness
0885 : Other repair of laceration of eyelid, full-
thickness
0922 : Other partial dacryoadenectomy
0923 : Total dacryoadenectomy
0930 : Other operations on lacrimal gland
0944 : Intubation of nasolacrimal duct
0949 : Other manipulation of lacrimal passage
0981 : Dacryocystorhinostomy (DCR)
7 H-2-22-0 PROSEDUR SEDANG PADA MATA EKSTERNAL
0802 : Severing of blepharorrhaphy
0823 : Excision of major lesion of eyelid, partial-
thickness
0831 : Repair of blepharoptosis by frontalis muscle
technique with suture
0832 : Repair of blepharoptosis by frontalis muscle
technique with fascial sling
0833 : Repair of blepharoptosis by resection or
advancement of levator muscle or aponeurosis
0834 : Repair of blepharoptosis by other levator
muscle techniques
0835 : Repair of blepharoptosis by tarsal technique
0836 : Repair of blepharoptosis by other techniques
0837 : Reduction of overcorrection of ptosis
0838 : Correction of lid retraction
0841 : Repair of entropion or ectropion by
thermocauterization
 0842 : Repair of entropion or ectropion by suture
technique
0843 : Repair of entropion or ectropion by wedge
resection
0844 : Repair of entropion or ectropion with lid
recontruction
0849 : Other repair of entropion or ectropion
0852 : Blepharorrhaphy
0859 : Other adjustment of lid position
0870 : Other recontructioon of eyelid, not otherwise
specified
0871 : Reconstruction of eyelid involving lid margin,
partial-thickness
0872 : Other reconstruction of eyelid, partial-
thickness
0881 : Linear repair of laceration of eyelid or
eyebrow
0882 : Repair of laceration involving lid margin,
partial thickness
0883 : Other repair of laceration of eyelid, partial
thickness
0886 : Lower eyelid rhytidectomy
0887 : Upper eyelid rhytidectomy
0889 : Other eyelid repair
0891 : Electrosurgical epilation of eyelid
0892 : Cryosurgical epilation of eyelid
0899 : Other operations on eyelids
0900 : Incision of lacrimal gland
0920 : Excision of lacrimal gland, not otherwise
specified
0921 : Excision of lesion of lacrimal gland
0951 : Incision of lacrimal punctum
0952 : Incision of lacrimal canaliculi
0953 : Incision of lacrimal sac
0959 : Other incision of lacrimal passages
0960 : Excision of lacrimal sac and passage
0972 : Other repair of punctum
0973 : Repair of canaliculus
0991 : Obliteration of lacrimal punctum
0999 : Other operations on lacrimal system
Angkat Jahitan
Releasable Suture
821 Excision of Chalazion
101 Conjunctival Incision NEC
1021 Conjunctival Biopsy
1131 Transposition of Pterygium
1139 Pterygium Excision
8 H-2-23-0 PROSEDUR KECIL PADA MATA EKSTERNAL
0801 : Incision of lid margin
0809 : other incision of eyelid
 0820 : Removal of lesion of eyelid, not otherwise
specified
0893 : Other epilation of eyelid
0941 : Probing of lacrimal punctum
0942 : Probing of lacrimal canaliculi
0943 : Probing of nasolacrimal duct
0971 : Correction of everted punctum
1091 Subconjunctival Inject
9 H-2-31-0 PROSEDUR BESAR PADA SEGMEN ANTERIOR
MATA
Argion Laser Trabeculoplasty
Laser Periferal Iridectomy

H34.0 - H34.9 Retinal vascular occlusions

95.12 Fluorescein angiography or angioscopy of
eye
95.03 Extended ophthalmologic work-up

H35.0 - H35.9 Other retinal disorders

95.12 Fluorescein angiography or angioscopy of
eye
95.03 Extended ophthalmologic work-up
1121 Corneal Incision
1122 Corneal Biopsy
1501 Biopsy of EOM or tendon
1511 Recession of 1 EOM
1512 Advancement of 1 EOM
1513 Resection of 1 EOM
1519 Other Op on 1 EOM involving temporary
detachment from globe
1521 Lengthening procedure on 1 EOM
1522 Shortening procedure on 1 EOM
1529 Other Operations on 1 EOM
153 Operations on 2/more EOM, involving
temporary detachment from globe
154 Other operations on 2/more EOM, 1/both eyes
155 Transposition of EOM
156 Revision of EOM
157 Repair of injury of EOM
10 H-2-32-0 PROSEDUR SEDANG PADA SEGMEN
ANTERIOR MATA

11 H-2-33-0 PROSEDUR KECIL PADA SEGMEN ANTERIOR

MATA

12 H-2-34-0 PROSEDUR BESAR PADA SEGMEN

POSTERIOR MATA
14.0 Removal of foreign body from posterior
segment of eye
14.3 Repair of retinal tear
 Repair of retinal tear by diathermy
Repair of retinal tear by cryotherapy
Repair of retinal tear by xenon arc photocoagulation
Repair of retinal tear by laser photocoagulation
Repair of retinal tear by photocoagulation of
unspecified type
Other repair of retinal tear

14.4 Repair of retinal detachment with scleral

buckling and implant
Scleral buckling with implant
"Other scleral buckling
Scleral buckling with:
air tamponade
resection of sclera
vitrectomy"

14.5 Other repair of retinal detachment

Injeksi ANTI VEGF (tidak ada di ICD 9)
Injeksi ANTI VEGF (tidak ada di ICD 9)
14.2 Destruction of lesion of retina and choroid
14.24 Destruction of chorioretinal lesion by laser
photocoagulation
14.6 Removal of surgically implanted material from
posterior segment of eye
13 H-2-35-0 PROSEDUR KECIL PADA SEGMEN POSTERIOR
MATA
T85.22XA Displacement of intraocular lens, initial
encounter

H35.0 - H35.9 Other retinal disorders

H34.0 - H34.9 Retinal vascular occlusions

W44. Foreign body entering into or through eye or

natural orifice

H33.0 - H33.5 Retinal detachments and breaks

14 H-2-36-0 PROSEDUR OPERASI KATARAK

1311 Intracapsular extraction of lens by temporal
inferior route Temp-inf intrcap lens ex
1319 Other intracapsular extraction of lens
Intracapsul lens ext NEC
132 Extracapsular extraction of lens by linear
 extraction technique Linear extracap lens ext
133 Extracapsular extraction of lens by simple
aspiration (and irrigation) technique Simpl aspir lens
extract
1341 Phacoemulsification and aspiration of cataract
Catarac phacoemuls/aspir
1342 Mechanical phacofragmentation and
aspiration of cataract by posterior route Post
catarac frag/aspir
1343 Mechanical phacofragmentation and other
aspiration of cataract Cataract frag/aspir NEC
1351 Extracapsular extraction of lens by temporal
inferior route Temp-inf xtracap lens ex
1359 Other extracapsular extraction of lens
Extracap lens extrac NEC
1364 Discission of secondary membrane [after
cataract] After-catar discission
1365 Excision of secondary membrane [after
cataract] After-cataract excision
1366 Mechanical fragmentation of secondary
membrane [after cataract] After catar fragmntation
1369 Other cataract extraction Cataract extraction
NEC
1370 Insertion of pseudophakos, not otherwise
specified Insert pseudophakos NOS
1371 Insertion of intraocular lens prosthesis at time
of cataract extraction, one-stage
Insert lens at catar ext
1372 Secondary insertion of intraocular lens
prosthesis Secondary insert lens
138 Removal of implanted lens Implanted lens
removal
1390 Operation on lens, not elsewhere classified
Operation on lens NEC
15 H-2-37-0 PROSEDUR PHOTOKOAGULASI DAN
KRIOTHERAPI PADA RETINA
H35.0 - H35.9 Other retinal disorders
14.23 Destruction of chorioretinal lesion by xenon
arc photocoagulation
14.24 Destruction of chorioretinal lesion by laser
photocoagulation
14.25 Destruction of chorioretinal lesion by
photocoagulation of unspecified type

H34.0 - H34.9 Retinal vascular occlusions

14.23 Destruction of chorioretinal lesion by xenon
arc photocoagulation
14.24 Destruction of chorioretinal lesion by laser
photocoagulation
14.25 Destruction of chorioretinal lesion by
 photocoagulation of unspecified type

16 H-3-10-0 PROSEDUR LASER SEDANG PADA MATA

H35.0 - H35.9 Other retinal disorders
14.23 Destruction of chorioretinal lesion by xenon
arc photocoagulation
14.24 Destruction of chorioretinal lesion by laser
photocoagulation
14.25 Destruction of chorioretinal lesion by
photocoagulation of unspecified type

H34.0 - H34.9 Retinal vascular occlusions

14.23 Destruction of chorioretinal lesion by xenon
arc photocoagulation
14.24 Destruction of chorioretinal lesion by laser
photocoagulation
14.25 Destruction of chorioretinal lesion by
photocoagulation of unspecified type

17 H-3-11-0 PROSEDUR KECIL PADA EKSTRAOKULER

Injeksi Intra Lesi
18 H-3-12-0 PROSEDUR LAIN-LAIN PADA MATA
Angkat Jahitan
Forced Duction Test
Cover Test
Cover – Uncover Test
Krimsky Test
Prisma Cover Test
Synophtophore Test
Worth Four Dots Test
Maddox Rod Test
Stereo Test
Faden Procedure
Jensen Procedure
Adjustable Suture
Plikasi
19 H-3-13-0 PROSEDUR DIAGNOSTIK & IMAGING PADA
MATA
0811 : Biopsy of eyelid
0819 : Other diagnostic procedures on eyelid
0911 : Biopsy oof lacrimal gland
0912 : Biopsy of lacrimal sac
0919 : Other diagnostic procedures on lacrimal
system
1622 : Diagnostic aspiration of orbit
1623 : Biopsy of eyeball and orbit
1629 : Other diagnostic procedures on orbit and
eyeball
Magnetic resonance imaging (MRI) orbita tanpa
kontras
Magnetic resonance imaging (MRI) orbita dengan
kontras
Computed Tomography Scan (CT-Scan) orbita
tanpa kontras
Computed Tomography Scan (CT-Scan) orbita
dengan kontras
Tonometri Aplanasi Goldman
Tonometri Schiotz
Non Contact Tonometri
Gonioskopi
Funduskopi Direct/Indirect
Keratometri
Biometri
USG
Perimetri humphrey
OCT
Foto Fundus
Slit Lamp
Tensilon test
Ice Pack Test
Apraklonidin Test
Pemeriksaan Cranial Nerve I-XII
MRI
Humphrey
OCT
FFA
95.01 Limited eye examination
95.02 Comprehensive eye examination
95.04 Eye examination under anesthesia
95.05 Visual field study
95.06 Color vision study
95.07 Dark adaptation study
95.09 Eye examination, not otherwise specified
95.10 Examinations of form and structure of eye
95.11 Fundus photography
95.12 Fluorescein angiography or angioscopy of
eye
95.13 Ultrasound study of eye
95.15 Ocular motility study
95.21 Electroretinogram
95.22 Electro-oculogram
95.23 Visual Evoked Potential
95.24 Electronystacmogram
95.25 Electromyogram of Eye (EMG)
95.26 Tonography, provocative test and other
glaucoma testing
95.31 Fitting dispensing of spectacles
95.32 Prescription, fitting and dispensing of contact
lens
95.33 Dispensing of other low vision aids
95.34 Ocular prosthetics
95.35 Orthoptic training
95.36 Ophthalmologic counselling and intruction