TARIF INA-CBG REHABILITASI MEDIK

NO TINDAKAN ICD IX CM TARIF RS

1 TENS/ES 93.39
2 SWD 93.34
3 USD 93.34
4 USD PHONOPORESIS 93.89
5 LASER 93.89
6 EXERCISE (Lat.Assistif) 93.11
7 Latihan Pernafasan 93.13
8 Taping 93.53
9 Icing 99.81
10 Korset Lumbosacral 93.23
11 Infrared 93.35
 TARIF REHBILITASI MEDIK
RS DR ETTY ASHARTO

1. PasienRawatJalanUmum

Paket dasar per kunjunganpasien :Rp. 225.000,00/kunjungan meliputibiaya DPJP + penggunaan 1-2
alat modalitas, exercise), bila tindakan lebihdari itu akan mendapatkan biaya tambahan sesuai tarif
di bawah ini :
tambahan sesuai tarif
NO DIAGNOSA KODE ICD
1 LOW BACK PAIN (LBP) M54.5

2 CEREBRAL PALSY (CP) G 80.9

3 STROKE J.64
4 OSTEOARTRITIS (OA ) M19.9

5 RHEUMATOID ARTHRITIS (RA) R41.2

6 PENYAKIT PARU OBSTRUKSI
KRONIK ( PPOK) J 44.9
7 BELL’S PALSY G51.0

8 FROZEN SHOULDER M75.0

9 CERVICAL ROOT SYNDROME M50.1

(CRS)

10 CARPAL TUNNEL SYNDROME

(CTS)
11 DE QUERVAIN TENOSYNOVITIS M65.4
12 CEDERA PLEKSUS BRAKHIALIS S14.3

13 TRIGGER FINGER M65.30

14 CEDERA SARAF PERIFER G56

15 PLANTAR FASCIITIS M72.2

16 SINUSITIS MAXILLARIS J32.0

17 Fraktur M84
 DIAGNOSA BANDING
Low Back Strain/Sprain
Hernia Nucleus Pulposus
Spondylosis/Spondyloarthrosis
Spondylolisthesis
Sindroma myofacial dan Fibromyalgia
Stenosis Spinalis
Fraktur kompresi
Osteoporosis
Spondilitis TB
Ankylosing Spondylitis
Tumor Spinal
Low Back post operative
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RA
      

  Gout artritis

Septic arthritis
Osteoarthritis

Asthma Bronchiale
1.Tumor pada cerebelopontin angle
yang menekan saraf fasialis
2.Ramsay Hunt syndrome

3. Infeksi telinga tengah atau sinus mastoideus

4.Patah tulang dasar tengkorak
1. Osteoarthritis glenohumeral
2.Rotator cuff tear
3. Cervical syndrome
1. Neuromuskular :
·         Brachial plexophaty
·         Peripheral nerve entrapment
2. Muskuloskeletal :
·         Shoulder disease
·         Nyeri myofascial
3. Thoracic outlet syndrome
·    Sindroma canal of guyon
·    Pronator teres syndrome
·            Carpal joint arthritis
·            Radial nerve injury
·            Ganglion cyst
·            Cervical radiculopathy
·            Scaphoid fracture
• Extensor policis longus tenosynovitis
·      Thoracic Outlet Syndrome
·      Brachial Plexus Traction Injury
·     Carpal Tunnel Syndrome
·     De Quervain tenosynovitis
·     Rhematoid Arthritis
·      Thoracic Outlet Syndrome
·      Brachial Plexus Injury
Inflamasi
-      Juvenile rheumatoid arthritis
-      Rheumatoid arthritis
-      Ankylosing spondylitis
-      Reiter’s syndrome
-      Gout (pirai)
-      Diffuse idiopathic skeletal hyperostosis
Metabolik
-      Migratory osteoporosis
-      Osteomalacia
Degeneratif
-      Osteoarthritis
-      Atrophy of the heel fat pad
Nerve Entrapment
-      Tarsal tunnel syndrome
-      Entrapment of the medial calcaneal branch
of the posterior tibial nerve
Diagnosa lain
-      Tumors
-      Vascular compromise
-      Infeksi
Rhinosinusitis
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