Lampiran Data Verifikasi Paska Klaim Ritl Bulan Pelaksanaan Oktober 2023 Bahan Verifikasi Paska Klaim Grouper Biaya DU DS

Bahan Verifikasi Paska Klaim
No. Kantor Cabang SEP Nama Faskes

Grouper Biaya DU DS
1 Kudus 0160R0030723V005119 RSI Hadlirin Jepara I-4-10-II 6,568,300 I21.1 I48
2 Kudus 0160R0030723V005278 RSI Hadlirin Jepara P-8-13-III 11,520,400 P39.9 P61.0
3 Kudus 0160R0030723V005680 RSI Hadlirin Jepara M-1-80-I 7,002,300 E11.5 -
4 Kudus 0160R0030823V000083 RSI Hadlirin Jepara K-1-14-I 4,910,800 K40.3 -
5 Kudus 0160R0030823V000363 RSI Hadlirin Jepara J-4-16-I 3,613,600 J18.0 -
6 Kudus 0160R0030823V000738 RSI Hadlirin Jepara W-1-10-I 2,999,400 O72.2 -
8 Kudus 0160R0030823V001615 RSI Hadlirin Jepara W-1-10-I 2,574,600 O72.2 -
9 Kudus 0160R0030823V002827 RSI Hadlirin Jepara L-1-40-I 4,008,400 D36.7 -

11 Kudus 0160R0030823V005716 RSI Hadlirin Jepara I-4-17-I 2,097,400 I10 -
12 Kudus 0160R0030823V005105 RSI Hadlirin Jepara I-4-15-I 4,621,000 E115 -

LA
han Verifikasi Paska Klaim

PROC Grouper Biaya DU DS PROC
99.18;90.59;89.52;87.44 I-4-10-I 4,046,300 I21.1 - 99.18;90.59;89.52;87.44
99.18;90.59;96.6;93.96;88.19;93.57;9 99.18;90.59;96.6;93.96;88.19;93.57;9
9.04;87.44 P-8-13-I 5,410,300 P61.0 P39.9 9.04;87.44
84.01;99.18;90.59;93.57;93.96;89.52 M-1-30-I 6,826,500 E11.5 - 84.11;99.18;90.59;93.57;93.96;89.52

53.00;87.44;99.18;90.59;89.52 K-1-12-I 4,744,800 K40.3 - 53.9;87.44;99.18;90.59;89.52
99.18;90.59;87.44;89.52 J-4-17-I 3,266,900 J440 - 99.18;90.59;87.44;89.52
69.51;99.18;90.59;88.76 W-1-11-I 2,763,000 O72.2 - 69.02;99.18;90.59;88.76
84.01;99.18;90.59;93.96;93.57;89.52 M-1-30-I 6,826,500 E11.5 - 84.11;99.18;90.59;93.96;93.57;89.52
69.51;99.18;90.59;88.78 W-1-11-I 2,371,700 O72.2 - 69.02;99.18;90.59;88.78
86.3;99.18;90.59;89.52;93.57;93.96 C-4-14-I 3,803,400 D36.7 - 86.04;99.18;90.59;89.52;93.57;93.96
84.01;99.18;90.59;89.52;93.57;93.96 M-1-30-I 6,826,500 E11.5 - 84.11;99.18;90.59;89.52;93.57;93.96

5794 - Insertion of indwelling urinary 5794 - Insertion of indwelling urinary
catheter;8744 - Routine chest x-ray, catheter;8744 - Routine chest x-ray,
so described;9059 - Other so described;9059 - Other
microscopic examination of microscopic examination of
blood;9396 - Other oxygen N-3-14-0 382,000 I10 - blood;9396 - Other oxygen
enrichment;966 - Enteral infusion of enrichment;966 - Enteral infusion of
concentrated nutritional concentrated nutritional
substances;9918 - Injection or substances;9918 - Injection or
infusion of electrolytes infusion of electrolytes
9059 - Other microscopic examination 9059 - Other microscopic examination

of blood;9918 - Injection or infusion N-3-14-0 382,000 E115 - of blood;9918 - Injection or infusion
of electrolytes of electrolytes
LAMPIRAN DATA VERIFIKASI PASKA KLAIM RITL
BULAN PELAKSANAAN OKTOBER 2023
Temuan Verifikasi Paska Klaim

Deskripsi Singkat Temuan
AF I48 manifestasi klinis dx Stemi I211 sehingga tdk di kode terpisah cukup I211---> https://www.ncbi.nlm.nih.gov/pmc/article
revisi DU Transient neonatal thrombocytopenia P61.0---> sesuai fokus on treatment tranfusi TC ,acrosyanosis
revisi kode tindakan 8401 mjd Amputation of toe 84.11---> amputasi jari kaki , Berita Acara Kesepakatan Bersama Panduan Pe
revisi kode tindakan 53.00 mjd Other hernia repair 53.9
pd resume medis PPOK dengan Pneumoni ---> sesuai BA kesepakatan,aspek koding no.80 lebih tepat menggunakan kode kom
(except influenza) mengarah pada kode chronic obstructive pulmonary disease with acute lower respiratory infection (J44.0)
revisi kode tindakan 6951 mjd Dilation and curettage following delivery or abortion 69.02
revisi kode tindakan 6951 mjd Dilation and curettage following delivery or abortion 69.02
revisi kode tindakan 863 mjd Other incision with drainage of skin and subcutaneous tissue 86.04--->eksisi/insisi tumor gluteus
Inap dirujuk kurang dari 6 jam seharusnya ditagihkan rawat jalan
Inap dirujuk kurang dari 6 jam seharusnya ditagihkan rawat jalan
TOTAL
selisih
2,522,000
6,110,100
175,800
166,000
346,700
236,400
175,800
202,900
205,000
175,800
1,715,400
4,239,000
16,270,900
LAMPIRAN
BULA
Bahan Verifikasi Paska Klaim

No. Kantor Cabang SEP Nama Faskes
Grouper Biaya DU DS
G560 - Carpal
1 Kudus 0160R0030823V000107 RSI Hadlirin Jepara Z-3-12-0 169,100 Z508
tunnel syndrome
G560 - Carpal
tunnel syndrome
G560 - Carpal
tunnel syndrome
M199 - Arthrosis,
unspecified
M199 - Arthrosis,
unspecified
M199 - Arthrosis,
unspecified
M531 -
7 Kudus 0160R0030823V002988 RSI Hadlirin Jepara Z-3-12-0 169,100 Z873 Cervicobrachial
syndrome
M199 - Arthrosis,
unspecified
G510 - Bell's
palsy
G510 - Bell's
palsy
G510 - Bell's
palsy
G560 - Carpal
tunnel syndrome
G510 - Bell's
palsy
G510 - Bell's
palsy
G510 - Bell's
palsy
G510 - Bell's
palsy
G510 - Bell's
palsy
G510 - Bell's
palsy
G510 - Bell's
palsy
M199 - Arthrosis,
unspecified
O601 - Preterm
21 Kudus 0160R0030823V003761 RSI Hadlirin Jepara Z-3-25-0 323,800 Z875 labour with
preterm delivery
O601 - Preterm
22 Kudus 0160R0030823V000231 RSI Hadlirin Jepara Z-3-25-0 323,800 Z875 labour with
preterm delivery
O821 - Delivery
by emergency
caesarean
section
O722 - Delayed
and secondary
postpartum
haemorrhage
O641 -
Obstructed
25 Kudus 0160R0030823V005605 RSI Hadlirin Jepara Z-3-25-0 323,800 Z875 labour due to
breech
presentation
O720 - Third-
26 Kudus 0160R0030823V003149 RSI Hadlirin Jepara Z-3-25-0 323,800 Z875 stage
haemorrhage
LAMPIRAN DATA VERIFIKASI PASKA KLAIM RJTL
BULAN PELAKSANAAN OKTOBER 2023
fikasi Paska Klaim Temuan Verifikasi Paska Klaim

PROC Grouper Biaya DU DS PROC
9335 - Other heat 9335 - Other heat therapy;9339 -

therapy;9339 - Other Other physical therapy;93.34
G560 - Carpal tunnel
physical therapy;9389 - M-3-16-0 134,300 Z508 (Ultrasound,shortwave
syndrome
Rehabilitation, not diathermy,microwave
elsewhere classified diathermy(diathermy)
9327 - Stretching of muscle or

9327 - Stretching of
tendon;9335 - Other heat
muscle or tendon;9335 -
G560 - Carpal tunnel therapy;93.34
Other heat therapy;9389 - M-3-16-0 134,300 Z866
syndrome (Ultrasound,shortwave
Rehabilitation, not
diathermy,microwave
elsewhere classified
diathermy(diathermy)

syndrome

M199 - Arthrosis, therapy;93.34
unspecified (Ultrasound,shortwave
Rehabilitation, not
diathermy,microwave

M199 - Arthrosis, therapy;93.34
unspecified (Ultrasound,shortwave
Rehabilitation, not
diathermy,microwave

M199 - Arthrosis,
unspecified

therapy;9339 - Other M531 - Other physical therapy;93.34
physical therapy;9389 - M-3-16-0 134,300 Z873 Cervicobrachial (Ultrasound,shortwave
Rehabilitation, not syndrome diathermy,microwave
9327 - Stretching of 9327 - Stretching of muscle or
muscle or tendon;9339 - tendon;9339 - Other physical
Other physical M199 - Arthrosis, therapy;93.34
therapy;9389 - M-3-16-0 134,300 Z508 unspecified (Ultrasound,shortwave

therapy;93.34
Other heat therapy;9389 - M-3-16-0 134,300 Z866 G510 - Bell's palsy
(Ultrasound,shortwave
Rehabilitation, not
diathermy,microwave

Other physical therapy;93.34
therapy;9389 - M-3-16-0 134,300 Z508 G510 - Bell's palsy (Ultrasound,shortwave

physical therapy;9389 - M-3-16-0 134,300 Z508 G510 - Bell's palsy (Ultrasound,shortwave

syndrome

therapy;93.34
Rehabilitation, not
diathermy,microwave



physical therapy;9389 - M-3-16-0 134,300 Z508 G510 - Bell's palsy (Ultrasound,shortwave

therapy;93.34
Rehabilitation, not
diathermy,microwave


M199 - Arthrosis,
unspecified
8878 - Diagnostic O601 - Preterm

8878 - Diagnostic ultrasound of
ultrasound of gravid Q-5-44-0 196,100 Z875 labour with preterm
gravid uterus
uterus delivery
8878 - Diagnostic O601 - Preterm
ultrasound of gravid Q-5-44-0 196,100 Z875 labour with preterm
gravid uterus
uterus delivery
8878 - Diagnostic O821 - Delivery by

ultrasound of gravid Q-5-44-0 196,100 Z392 emergency
gravid uterus
uterus caesarean section
O722 - Delayed and
8878 - Diagnostic
secondary 8878 - Diagnostic ultrasound of
ultrasound of gravid Q-5-44-0 196,100 Z875
postpartum gravid uterus
uterus
haemorrhage
8878 - Diagnostic O641 - Obstructed

ultrasound of gravid Q-5-44-0 196,100 Z875 labour due to
gravid uterus
uterus breech presentation
8878 - Diagnostic
O720 - Third-stage 8878 - Diagnostic ultrasound of
ultrasound of gravid Q-5-44-0 196,100 Z875
haemorrhage gravid uterus
uterus
TOTAL
Paska Klaim
selisih
Deskripsi Singkat Temuan
Koding—Prosedur rehabilitasi medik seharusnya

dikode secara jelas dan spesifik jenisnya (BA
Kesepakatan Kemenkes)---> revisi kode tindakan
9389 - Rehabilitation, not elsewhere classified mjd 34,800
Diathermy 93.34 (Ultrasound,shortwave
diathermy,microwave diathermy(diathermy)


9389 - Rehabilitation, not elsewhere classified mjd















USG post persalinan tanpa indikasi tidak dijamin 127,700

1,183,800

Lampiran Data Verifikasi Paska Klaim Ritl Bulan Pelaksanaan Oktober 2023 Bahan Verifikasi Paska Klaim Grouper Biaya DU DS

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Bahan Verifikasi Paska Klaim

No. Kantor Cabang SEP Nama Faskes

1 Kudus 0160R0030723V005119 RSI Hadlirin Jepara I-4-10-II 6,568,300 I21.1 I48

2 Kudus 0160R0030723V005278 RSI Hadlirin Jepara P-8-13-III 11,520,400 P39.9 P61.0

3 Kudus 0160R0030723V005680 RSI Hadlirin Jepara M-1-80-I 7,002,300 E11.5 -

4 Kudus 0160R0030823V000083 RSI Hadlirin Jepara K-1-14-I 4,910,800 K40.3 -

5 Kudus 0160R0030823V000363 RSI Hadlirin Jepara J-4-16-I 3,613,600 J18.0 -

6 Kudus 0160R0030823V000738 RSI Hadlirin Jepara W-1-10-I 2,999,400 O72.2 -

7 Kudus 0160R0030823V001012 RSI Hadlirin Jepara M-1-80-I 7,002,300 E11.5 -

8 Kudus 0160R0030823V001615 RSI Hadlirin Jepara W-1-10-I 2,574,600 O72.2 -

9 Kudus 0160R0030823V002827 RSI Hadlirin Jepara L-1-40-I 4,008,400 D36.7 -

10 Kudus 0160R0030823V005058 RSI Hadlirin Jepara M-1-80-I 7,002,300 E11.5 -

12 Kudus 0160R0030823V005105 RSI Hadlirin Jepara I-4-15-I 4,621,000 E115 -

han Verifikasi Paska Klaim

99.18;90.59;89.52;87.44 I-4-10-I 4,046,300 I21.1 - 99.18;90.59;89.52;87.44

84.01;99.18;90.59;93.57;93.96;89.52 M-1-30-I 6,826,500 E11.5 - 84.11;99.18;90.59;93.57;93.96;89.52

99.18;90.59;87.44;89.52 J-4-17-I 3,266,900 J440 - 99.18;90.59;87.44;89.52

69.51;99.18;90.59;88.76 W-1-11-I 2,763,000 O72.2 - 69.02;99.18;90.59;88.76

84.01;99.18;90.59;93.96;93.57;89.52 M-1-30-I 6,826,500 E11.5 - 84.11;99.18;90.59;93.96;93.57;89.52

69.51;99.18;90.59;88.78 W-1-11-I 2,371,700 O72.2 - 69.02;99.18;90.59;88.78

86.3;99.18;90.59;89.52;93.57;93.96 C-4-14-I 3,803,400 D36.7 - 86.04;99.18;90.59;89.52;93.57;93.96

84.01;99.18;90.59;89.52;93.57;93.96 M-1-30-I 6,826,500 E11.5 - 84.11;99.18;90.59;89.52;93.57;93.96

9059 - Other microscopic examination 9059 - Other microscopic examination

Temuan Verifikasi Paska Klaim

Inap dirujuk kurang dari 6 jam seharusnya ditagihkan rawat jalan

Bahan Verifikasi Paska Klaim

fikasi Paska Klaim Temuan Verifikasi Paska Klaim

9335 - Other heat 9335 - Other heat therapy;9339 -

9327 - Stretching of muscle or

9335 - Other heat 9335 - Other heat therapy;9339 -

9327 - Stretching of muscle or

9327 - Stretching of muscle or

9335 - Other heat 9335 - Other heat therapy;9339 -

9335 - Other heat 9335 - Other heat therapy;9339 -

9327 - Stretching of muscle or

9327 - Stretching of 9327 - Stretching of muscle or

9335 - Other heat 9335 - Other heat therapy;9339 -

9335 - Other heat 9335 - Other heat therapy;9339 -

9327 - Stretching of muscle or

9327 - Stretching of 9327 - Stretching of muscle or

9327 - Stretching of 9327 - Stretching of muscle or

9335 - Other heat 9335 - Other heat therapy;9339 -

9327 - Stretching of muscle or

9327 - Stretching of 9327 - Stretching of muscle or

9335 - Other heat 9335 - Other heat therapy;9339 -

8878 - Diagnostic O601 - Preterm

8878 - Diagnostic O821 - Delivery by

8878 - Diagnostic O641 - Obstructed

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya

Koding—Prosedur rehabilitasi medik seharusnya