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Nama Paket : CVA Infark

Koding DP : i63.3 DS : g81.2, dll


Koding TX :
Kelas Perawatan : 3
Lama Perawatan : 7 Hari
HARGA
UNIT NAMA LAYANAN QTY
SATUAN
Total

IGD
Handschoon 3
IV Cannul 18 1
infus set 1
Tegaderm 1
Gelang pasien pink 1
gelang pasien kuning 1
pemeriksaan dokter umum IGD 1
pasang oksigen 1
tindakan ecg 1
tindakan ngt 1
tindakan kateter 1
NGT 1
otsu wi 1
Kateter 1
urobag 1
inf pct 1
inj citicolin 250mg 1
inj piracetam 1
inj ranitidin 1
cairan NS 1
spuit 10 cc 2
spuit 5 cc 3
nasal cannul oksigen 1
Patient monitor 1
Laboratorium IGD DL
ureum
creatinin
ecg
ct scan
thorax
gda
OBAT IRNA
cairan NS 5
Folley Cateter 16 1
Otsu WI 2
Spuit 10 cc one mad 2
Spuit 5 cc one mad 2
piracetam inj 5
pct inf 2
ranitidin inj 1
citicolin inj 250mg 1
U pad non steril 2
aspilet 7
cpg 7
candesartan 7
sewa oksigen 7
Tindakan TTV 21
visite dokter DPJP 6

Laboratorium ruangan

Gizi konsul gizi (H1 dan H7) 2x


Gizi Makan 21
Konsul multidisiplin Dpjp KFR 2x
Dpjp Jantung 1x
Dpjp interna 1x
Fisioterapi 4x

Tindakan KRS Lepas infus 1x


lepas cateter 1x
lepas ngt 1x

Obat KRS candesartan 5


cpg 5
aspilet 5

Total semua biaya


INA CBGS
Sisa
Nama Paket : APPENDICTOMY TINDAKAN LYSIS OF PERINEAL ADHESIONS
Koding DP : K35.2
Koding TX : 54.59
Lama Perawatan : 4 Hari

HARGA
UNIT NAMA LAYANAN QTY TOTAL
SATUAN
IGD
Blood Transfusi Set 1
IV cannul 20 1
Tegaderm 1
Gelang dewasa 1
Gelang kuning dewasa 1
CAIRAN RL 1
pasang cateter 1
cateter 1
urobag 1
spuit 3cc 1
spuit 5cc 1
spuit 10cc 1
pemeriksaan dokter umum IGD 1
ketorolac inj 1
ranitidin inj 1
ondansetron inj 1
pasang infus 1
Handschoon maxter exam XS 1
Laboratorium igd DL 1
PPT 1
KPTT 1
BNO 1
OBAT RUANGAN
RL B Braun 12
RANITIDIN inj 1
ondansetron inj 1
ceftriaxon inj 8
Spuit 10 cc one mad 10
Spuit 3cc one mad 14
Spuit 1 cc one mad 1
Cairan Otsu WI 25ml 3
Oxyflow Dewasa 1
Folley Cateter 1
Handschoon maxter exam XS 4
ketorolac inj 6
Spuit 5cc one mad 1
U-PAD NON STERIL 60X90
OM 2
Visite DPJP bedah 3
DPJP anastesi 1

Laboratorium ruangan usg abdomen

IKO
Kasa steril 40
Savlon 30
Hypafix 4
Masker 13
Handschoon non steril 10
Hansaplast 1
U Pad On Steril 2
U Pad Steril 2
Nurse Cap 10
Daryantulle 1
T-Mono 3-0 1
T-SILK 2-0 S.25 1
T Vio 2-0 V12 1
Plain 2-0 1 meter
Betadhine / 10 cc 30
NS B Braun 500ml 1
Handchoon mas steril 7 4
Handchoon mas steril 6,5 2
Oksigen 2
Bunascan 1
Ephedrin 1
Mess No 10 1
naCL 6
Lidodex 1
Miloz 1
Pethidin 1
T-LENE 3-0 1
WATER INJECT 25ML 1
Anestesi
Remopain inj 3% 1
Spuit 3 cc terumo 2
Spuit 5 cc terumo 1
Spinocain 27 1
Decain 1
Total BHP dan Obat
OK
Sewa Ruang OK 1
Perawatan Alat 1
Sewa Ruang Recovery 1

Jasa Tim OK
Dokter operator
Asisten Operator
Anestesi
Asisten Anestesi
Instrument
Onlop
Gizi Visite gizi 2x
Gizi makan 9x

Obat KRS asam mefenaat 10


Cefixime 200mg 10
onoiwa albumin oral 10

Tindakan KRS Lepas Infus 1


lepas cateter 1
rawat luka 1

Grand total
INA CBG's
Selisih

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