OKTOBER 2021

Tgl.
No Pulan RUANGA
. g No. RM Nama Pasien No. Klaim / SEP INACBG N Total Tarif Tarif RS DIAGNOSA
1 Okt 0607R0010921V00205 3.7
1 2021 3350884 H. MATTEP 3 G-4-14-I TERATAI 56.200 3.251.764 Other cerebral infarction(I63.8)
4 Okt 0607R0011021V00003 2.6
2 2021 310248 YUSNA 9 G-4-13-I TERATAI 57.100 4.082.678 Other intracerebral haemorrhage(I61.8)
4 Okt 0607R0011021V00009 3.3
3 2021 3351019 MERI YANTO 5 G-4-11-I TERATAI 22.500 2.156.562 Degenerative disease of nervous system, unspecified(G31.9)
5 Okt 0607R0010921V00223 NUSA 3.8 Pleural effusion, not elsewhere classified(J90), Insertion of intercostal
4 2021 3350862 HARDIYANTO 7 J-4-20-I INDAH 63.300 4.761.209 catheter for drainage(34.04)
8 Okt 0607R0011021V00033 5.1 Malignant neoplasm, colon, unspecified(C18.9), Hypertensive heart
5 2021 3351225 YULIATI 5 K-4-10-I KENANGA 56.200 2.187.918 disease without (congestive) heart failure(I11.9)
12 Okt 0607R0011021V00080 4.4 Communicating hydrocephalus(G91.0), Other epilepsy(G40.8),
6 2021 3343325 RUSDIANA 7 G-4-11-II TERATAI 13.600 3.371.088 Unspecified organic or symptomatic mental disorder(F09)
13 Okt 0607R0011021V00076 5.2
7 2021 3351539 NAMSIHA 2 G-4-14-I TERATAI 58.600 3.406.622 Other cerebral infarction(I63.8)
Other cerebral infarction(I63.8), Electrographic
monitoring(89.54), Injection or infusion of other therapeutic
18 Okt 0607R0011021V00105 TERATAI , 3.7 or prophylactic substance(99.29), Injection or infusion
8 2021 3351729 NURHAYATI 2 G-4-14-I ICU 56.200 8.586.254 of electrolytes(99.18), High flow nasal canule oxygenation (IM)(93.960)
20 Okt 0334948 MUSMULYAD 0607R0011021V00130 1.2
9 2021 0 I 3 K-4-18-I TERATAI 53.800 2.922.020 DysphagiaR13
30 Okt 0607R0011021V00213 3.7
10 2021 3350142 EMA DALIYA 8 G-4-14-I TERATAI 56.200 2.938.931 Other cerebral infarction(I63.8)
37.1 3
Total 93.700 7.665.046
 Sep-21

Tgl
No Sep Pulang Nama Inacbg Tarif Rs Los Kelas Ctscan Ruangan DIAGNOSA
17 Sep 5.0 3.4
1 0607R0010921V001168 2021 YASAN 21.700 72.203 1 III 1.000.000 Anggrek Other cerebral infarction(I63.8) , Left ventricular failure(I50.1)
NYIMAS
8 Sep HABSAH 4.6 4.7 Vascular parkinsonism(G21.4) , Non-insulin-dependent diabetes mellitus
2 0607R0010921V000266 2021 ARYANTI 51.600 11.189 4 I 1.000.000 Anggrek without complications(E11.9)
24 Sep 4.5 2.2
3 0607R0010921V001554 2021 KAMARUDIN 07.400 75.872 2 III 1.000.000 Nusa Indah Other cerebral infarction(I63.8)
18 Sep 3.9 3.0 Obstructive hydrocephalus(G91.1) , Intracranial space-occupying
4 0607R0010921V001061 2021 NAWAWI 87.100 08.237 3 II 1.000.000 Nusa Indah lesion(R90.0)
18 Sep 2.5 3.0
5 0607R0010921V001148 2021 SALIYEM 30.100 70.151 3 III 1.000.000 Nusa Indah Transient cerebral ischaemic attack, unspecified(G45.9)
8 Sep 6.4 3.4
6 0607R0010921V000450 2021 MARYOTO 85.100 94.607 1 II 1.000.000 Nusa Indah Obstructive hydrocephalus(G91.1)
28 Sep 3.7 2.7
7 0607R0010921V001939 2021 MISDATINAH 56.200 45.261 1 III 1.000.000 Nusa Indah Other cerebral infarction(I63.8)
20 Sep MANDALA 2.8 3.0
8 0607R0010921V001237 2021 SATYA B 23.900 85.296 3 I 1.000.000 Kenanga Cerebral oedema(G93.6)
16 Sep ANINDYA 3.2 2.2
9 0607R0010921V000978 2021 SYAKILLAH 01.900 40.029 2 III 1.000.000 Kenanga Superficial injury of head, part unspecified(S00.9)
Hyperplasia of prostate(N40), Non-insulin-dependent diabetes mellitus
2 Sep MUHAMMAD 14.1 12.3 without complications(E11.9), Other cerebral infarction(I63.8) , Other
10 0607R0010821V001487 2021 ZAZILI TAHA 71.400 66.778 7 I 1.000.000 Cempaka prostatectomy(60.69)
9 Sep 3.3 8.2
11 0607R0010821V001911 2021 MAHYUDIN 76.800 59.213 9 III 1.000.000 Cempaka Hyperplasia of prostateN40 , Other prostatectomy(60.69)
Other intracerebral haemorrhage(I61.8) , Injection or infusion of other
25 Sep 2.2 6.9 Therapeutic or prophylactic substance(99.29) , Injection or infusion
12 0607R0010921V001732 2021 SUPARTI 14.200 81.571 2 I 1.000.000 Icu of electrolytes(99.18), Other oxygen enrichment(93.96)
Obstructive hydrocephalus(G91.1) , Electrographic monitoring(89.54),
25 Sep SURYA 9.0 6.5 Injection or infusion of other therapeutic or prophylactic substance(99.29),
13 0607R0010921V001749 2021 HANAPI 79.100 55.966 1 III 1.000.000 Icu Injection or infusion of electrolytes(99.18), Other oxygen enrichment(93.96)
Obstructive hydrocephalus(G91.1) , Electrographic monitoring(89.54),
9 Sep 9.0 6.8 Injection or infusion of other therapeutic or prophylactic substance(99.29),
14 0607R0010921V000634 2021 MEGAWATI 79.100 89.313 1 III 1.000.000 Icu Injection or infusion of electrolytes(99.18), Other oxygen enrichment(93.96)
23 Sep 3.7 2.4
15 0607R0010921V001463 2021 SUHARDI 56.200 41.700 2 III 1.000.000 Teratai Other cerebral infarction(I63.8)
25 Sep SITI 3.7 4.9
16 0607R0010921V001505 2021 KOMARIAH 56.200 37.590 4 III 1.000.000 Teratai Other cerebral infarction(I63.8)
20 Sep AHMAD 2.6 3.9 Other intracerebral haemorrhage(I61.8) , Non-insulin-dependent diabetes
17 0607R0010921V001232 2021 SIROD 57.100 08.859 3 III 1.000.000 Teratai mellitus without complications(E11.9), Essential (primary) hypertension(I10)
23 Sep MARLIYATU 3.7 4.3
18 0607R0010921V001449 2021 N 56.200 92.836 3 III 1.000.000 Teratai Other cerebral infarction(I63.8)
 11 Sep 3.7 2.4
19 0607R0010921V000636 2021 MOLIANA 56.200 08.394 2 III 1.000.000 Teratai Other cerebral infarction(I63.8)
13 Sep 1.5 3.2
20 0607R0010921V000711 2021 OKTARINI 88.200 41.120 3 II 1.000.000 Teratai Benign paroxysmal vertigo(H81.1) , Pure hypercholesterolaemia(E78.0)
29 Sep 4.5 3.4
21 0607R0010921V001918 2021 AJIB SERING 07.400 23.119 2 II 1.000.000 Teratai Other cerebral infarction(I63.8)
29 Sep 4.2 5.6 Stroke, not specified as haemorrhage or infarction(I64),
22 0607R0010921V001943 2021 AMRAN 96.800 98.157 2 I 1.000.000 Vip Non-insulin-dependent diabetes mellitus without complications(E11.9)
18 Sep 5.2 4.4
23 0607R0010921V001167 2021 SUDAN 58.600 69.768 2 I 1.000.000 Vip Other cerebral infarction(I63.8)

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