This document lists ICD-10 diagnosis codes and ICD-9 procedure codes for orthopedic conditions and treatments. It includes codes for various hand injuries and procedures, fractures and trauma, tumors of the bone, arthroscopy of the shoulder and knee, and pediatric orthopedic issues. Residents are required to fully document diagnoses and procedures performed according to the codes listed.

1. Daftar Kode Diagnosis dan Tindakan
INA - CBG BPJS
Orthopaedi
Januari 2014
Residen wajib mengisi lembar RM 1, Lembar Verifikasi dan laporan operasi sesuai
dengan diagnosis dan tindakan yang tertera secara lengkap, setiap selesai operasi

2. DAFTAR DIAGNOSIS (ICD 10) DAN TINDAKAN (ICD 9)
DIVISI ORTHOPAEDI DAN TRAUMATOLOGI
Hand (kelainan dan luka di tangan)
Keterangan ICD 10 Diagnosis ICD 9 Prosedur Plafon
Remove implant S52.90 78.69 removal implant
device from the bone
3.765.791
Luka terbuka di tangan, crush
injury
S67.8 Crushing injury of other and
unspecified parts of wrist and hand
S55.1 injury of radial artery at forearm
level
84.03 amputation through
hand.
14.952.975
Luka kotor /infeksi di jaringan
lunak
M65.8 Synovitis and tenosynovitis 82.04 incision and drainage
of palmar at thenar space,
86.66 homograft to skin
8.403.235
Infeksi jaringan L.02.51 Cutaneus abscess of the hand. 82.04 incision and drainage
of palmar at thenar space,
86.66 homograft to skin
8.403.235
ganglion M67.4 ganglion 82.29 Excision of other lesion
of soft tissue of hand
12.485.355
Fracture pada pergelangan
tangan dan tangan
S62.8 fracture at wrist and hand level 79.34 open reduction of
fracture with internal fixation
, carpals and metacarpals.
12.485.355
Luka berat pada jari, tangan
(perlu amputasi)
S68 traumatic amputasion of wrist
and hand level
S55.1 injury of radial artery at forearm
84.04 amputation and
disarticulation of hand
14.952.971

3. level
Deformitas/ kelainan pada jari M20.0 Deformity of finger 84.03 amputation and
disarticulation of Hand
9099.408
Jepitan pada syaraf/carpal
tunnel syndrome
S64 injury of nerves at wrist and hand
level
05.9 other operation on
nervous system
11.164.055
Syndactili Q70 Syndactili 86.85 correction of
syndactyly
12.485.355
Dislokasi pada jari S63.1 dislocation and sprain of joints
and ligaments at wrist and hand level
79.84 open reduction of
dislocation of hand and
finger
12.485.355
Tumor ganas pada ekstremitas
atas
C40.1 malignant neoplasm of short
bones of upper limb
S55.1 injury of radial artery at forearm
leve
84.03 amputation of through
hand
14.952.975
Infeksi pada sendi M00 Pyogenic infection 81.29 arthhrodesis of other
specified joints
86.66 homograft to skin
8.404.231
Kerusakan sendi krn rematik M05 .38 rheumatoid arthritis with
rheumatoid factor
M65.80 other synovitis and
tenosynovitis
81.29 arthhrodesis of other
specified joints
86.66 homograft to skin
8.403.235
Kerusakan sendi bukan karena
rematik
M06 other rheumatoid arthritis 81.29 arthhrodesis of other
specified joints
86.72 pedicle or flap graft,
not otherwise specified
8.403.235
Deformitas/ kelainan pada jari M20.0 Deformity of finger 82.8 other plastic operation 12.485.355

4. on hand,
kontracture M24.59 contracture unspecified site 82.3 other excision of soft
tissue of hand;
12.485.355
polidactili Q69 polidactyli 84.03 amputation and
disarticulation of finger:
86.66 homograft to skin
8.403.235
Raw surface, defek soft tissue,
sural flap, semua tindakan flap
L98.9 other disorders of skin and
subcutaneous tissue, not elsewhere
82.8 other plastic operation
on hand
86.72 pedicle or flap graft,
not otherwise spesified
8.403.235
Traumatic amputasi perlu
replantasi
S68.9 traumatic amputasion of wrist
and hand level
S55.1 injury of radial artery at forearm
leve
84.22 finger reattachment
86.72 pedicle or flap graft,
not otherwise spesified
8.403.235
Trauma (Fracture)
No Keterangan ICD 10 Diagnosis ICD 9 Prosedur Plafon
1. Non union perlu bone graft M84.90 disorder of continuity of
bone , unspecified
78.69 bone graft
86.66 homograft to skin
8.403.235
2. Fracture clavikula S42 fracture of shoulder and upper
arm
79.30 ORIF,unspecified site 3.835.376
3. Fracture clavikula dengan
cedera kepala
S.06.9 intracranial injury
S42 fracture of shoulder and upper
arm
79.30 ORIF,unspecified site 7.691.543

5. 4. Fracture tibia/fibula S82.21 Fracture of shaft tibia 79.36 ORIF , tibia and fibula 21.963.542
5. Fracture distal tibia S82.2 Fracture of shaft tibia 79.36 ORIF 21.963.542
6. Fracture femur S72.31 fracture shaft femur 79.35 ORIF , femur Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
7. Fracture radius S52.3 fracture shaft radius 79.32 ORIF , radius and ulna 12.485.355
8. Fracture ulna S52.2 fracture shaft ulna 79.32 ORIF , radius and ulna 12.485.355
9. Fr antebrachii S52.7 fracture shaft forearm 79.32 ORIF , radius and ulna 12.485.355
10. Fracture humerus S42.3 fracture shaft humerus 79.31 ORIF humerus 12.485.355
11. Fracture pada tangan,
metacarpal, phalang
S62 fracture at wrist and hand level 79.34 ORIF phalank of hand 12.485.355
12. Fracture subtrochanter femur
perlu ORIF
S72.2 subtrochanteric fracture of
femur
79.35 ORIF , femur Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Hip implant :
6000.000
13. Fracture intercondylar femur, S72 fracture shaft femur 79.35 ORIF , femur Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Knee implant :
6000.000
14. Fracture intertrochanter femur M81.65 Osteoporosis
S72.14 Intertrochanteric fracture of
femure
79.35 ORIF , femur Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183

6. Hip implant :
6000.000
15. Fracture galeazi S52.3 fracture shaft radius 79.32 ORIF , radius and ulna ; 12.485.355
16. Fracture montegia S52.2 shaft ulna 79.32 ORIF , radius and ulna
;,
12.485.355
17. Fracture prksimal humerus,neck
humerus
S42.20 fracture of upper end of
humerus
79.31 ORIF humerus 12.485.355
18. OA Sendi lutut perlu TKR M17.4 other secondary gonarthrosis ,
bilateral
M19.26 secondary of the joint , lower
leg
81.54 Total Knee
Replacement
5.978.592
19. OA Sendi perlu TKR M17.4 other secondary gonarthrosis ,
bilateral
M19.26 secondary of the joint , lower
leg
81.47 other repair of knee Klas 1: 30.748.959
Klas 2:26.353.251
Klas 3: 21.963.542
Knee replacement
3.000.000
20. OA sendi Hip perlu THR M19.26 secondary of the joint , lower
leg
81.51 Total Hip Replacement 5.978.592
21. OA Sendi perlu THR M19.26 secondary of the joint , lower
leg
81.40 Repair of hip, not
elsewhere classified
Klas 1= 8.898.656
Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Hip implant :
22. Fracture collum femur, M81.65 Osteoporosis 81.40 Repair of hip, not Klas 1= 8.898.656

7. S72.0 fracture of head and neck of
femur
elsewhere classified Klas 2 = 7.627.420
Klas 3 = 6 .356.183
Hip implant :
3000.000
23. Fracture plateau tibia S82 Fracture of tibia
)
79.36 ORIF , tibia and fibula 21.963.542
24. Fracture acetabulum S32.4 fracture acetabulum 79.30 ORIF , unspecified site
05.9 other operation on
nervous system
11.164.055
Hip implant :
6000.000
25. Fracture
pedis,metacarpale,ankle
S82.90 Fracture of lower leg ,
including ankle
79.37 ORIF tarsal,metatarsal 8.855.736
26. Fracture patella 822.1 fracture of patella,open 81.44 patellar stabilization 21.963.542
27. Infeksi pada sendi, M01 direct infection of joint in
infectious and parasitic disease
classified elsewhere
81.9 other operation on joint
structure
86.66 homograft to skin
28. Infeksi tulang, tromboemboli M86 Osteomyelitis, 79.6 debridement of open
fracture site ;
86.72 pedicle or flap graft,
not otherwise specified
29. Dislokasi pinggul S73.0 Dislocationand sprain of joint
and ligament of hip
79.75 closed reduction of
dislocation , hip
3481.352
30. Dislokasi bahu S43.0 Dislocation and sprain of joint
and ligament of shoulder
79.71 closed reduction of
dislocation shoulder
1.948.000
31. Dislokasi siku S53.1 Dislocation and sprain of joint
and ligament of elbow
79.72 closed reduction of
dislocation , elbow
1.948.000

8. 32. Fracture neglected M84.9 disorder of continuity of
bone,unspesified
78.4 other repair of plastic
operation of bone
78.70 osteoclasis,unspecified
site
86.66 homograft to skin
33. Ruptur Tendon Achilles
Paediatrik (kelainan dan fracture pada anak < 15 th)
No Keterangan ICD 10 Diagnosis ICD 9 Prosedur Plafon
1. Reposisi dan pasang gip
ekstremitas atas dengan GA
S62.80 fracture at wrist and hand
level
79.04 closed reduction of
fracture without internal
fixation
1.948.000
2 Reposisi dan pasang gip
ekstremitas bawah dengan GA
S82.7 fracture of lower leg 79.07 closed reduction of
fracture without internal
fixation
1.948.000
3 Rekonstruksi ibu jari kaki , halux
valgus
M20.1 halux valgus/acquired 82.89 other plastic operation
on hand
77.51 other buninectomy
8.855.731
4 Fracture neglected M84.9 disorder of continuity of
bone,unspesified
78.4 other repair of plastic
operation of bone
78.70 osteoclasis,unspecified
site
86.66 homograft to skin
5 Kelainan congenital,CTEV,Blount Q66.3 other congenital varus 78.4 other repair of plastic 12.485.355

9. disease deformities of feet, operation of bone
6 Pemanjangan tulang Q66.3 other congenital varus
deformities of feet,
78.3 limb lengthening
procedure
21.953.542
Tumor Tulang
No Keterangan ICD 10 Diagnosis ICD 9 Prosedur plafon
1. Biopsi tumor D21.9 other benign neoplasm and
other soft tissue
80.31 biopsy of joint
structure
2.049.737
2 Eksisi tumor C40.9 malignant neoplasm of bone
and articular cartilage of limb,.
82.29 excision of other
lesion of hand
12.485.355
3 Amputasi tumor di atas
lutut(above knee)
C40.9 malignant neoplasm of bone
and articular cartilage of limb,. S85.0
injury of popliteal artery
84.17 amputation above
knee/transfemoral
9.099.400
4 Amputasi tumor di bawah lutut
(below knee)
C40.9 malignant neoplasm of bone
and articular cartilage of limb,. S85.0
injury of popliteal artery
84.15amputation below knee 9.099.400
5 Eksisi luas (wide eksisi) D49.2 neoplasm of unspecified
behavior of bone , soft tissue , skin
S85.0 injury of popliteal artery
77.60 local excision of lesion
or tissue of bone unspecified
site
86.66 homograft to skin
12.485.355
6 Fraktur dengan tumor tulang C40.9 malignant neoplasm of bone
and articular cartilage of limb,.
79.3 ORIF
86.66 homograft to skin
7. Operasi tumor ganas C40.9 malignant neoplasm of bone
and articular cartilage of limb,. S85.0
injury of popliteal artery
78.4 other repair of plastic
operation of bone;
86.72 pedicle or flap graft,
not otherwise spesified
8.403.235

10. 8 Ganti sendi pada kasus tumor
tulang/AMP
C79.9 secondary malignant neoplasm
of unspecified site
81.40 repair of hip 8.403.235
Arthroscopy , Shoulder (bahu) dan Knee (lutut)
No Keterangan ICD 10 Diagnosis ICD 9 Prosedur plafon
1. Infeksi sendi lutut, M17.9 Gonarthrosis , unspecified
M01.56 arthritis in other bacterial
disease lower leg
M35.4 diffuse fasciitis
81.47 other repair of knee 21.000.000
2 Bahu kaku/frozen shoulder/
adhesive capsulitis
M75.0 adhesive capsulitis of shoulder
M35.4 diffuse fasciitis
80.21 arthroscopy shoulder 7.691.547
3 Mengeluarkan benda asing di
lutut/loose bodies
M25.68 stiffness of joint
M65.26 calcific tendinitis
81.47 other repair of knee 21.000.000
4
5 Debridement shoulder M25.68 stiffness of joint
M65.26 calcific tendinitis M35.4
diffuse fasciitis
80.21 arthroscopy shoulder; Klas 3 = 7.691.547
Klass 2 =9226.000
Klass1: 10.768.160
6
7 Rotator cuff tear M75.1 complete rotator cuff tear or
rupture not specified as traumatic
80.21 arthroscopy shoulder;
80.49 division of joint,
9.229.852

11. M35.4 diffuse fascitis ligament or cartilage of other
specified site
8 Rupture meniscus M23.2 dearrangement of meniscus
due to old tear or injury
81.47 other operation of
knee
21.000.000
9 Osteoarthritis lutut derajat
ringan (1-2)/ artroscopy
debridement
S83.2 tear of meniscus,current
M35.8 other specified systemic
involvement connective tissue
81.47 other operation of
knee
21.000.000
10
11 Ligament ACL/PCL lutut putus M23.61 other spontaneous disruption
of ligament of knee, ACL /Anterior
horn medial meniscus
81.47 other operation of
cruciate ligament
Klas 3= 21.963.542
Klas 2= 26.356.251
Klas 1= 30.748.959
Implant knee :
6000.000
12
13 Ganti sendi lutut/ total knee
arthroplasty/osteoarthritis
derajat berat
M17 osteoartritis of knee
)
81.47 other operation of
knee
Klas 1: 30.748.959
Klas 2:26.353.251
Klas 3: 21.963.542
Knee replacement
3.000.000
14 Rematik di lutut derajat berat
perlu ganti sendi
M05.661 rhaumatoid arthritis of left
knee with involvement of other organ
and system
81.47 other operation of
knee
Klas 1: 30.748.959
Klas 2:26.353.251
Klas 3: 21.963.542
Knee replacement
3.000.000
15

12. Spine/ Tulang Belakang
No Keterangan ICD 10 Diagnosis ICD 9 Prosedur plafon
1. scoliosis M41.55 scoliosis
S25.9 injury of unspecified blood
vessel of thorax
M43.54 vertebral subluxation
81.60 , 360 degree spinal
fusion, single incision
approach
83.74 reattachment of
muscle
77.31 other division of
scapula, clavicle,and thorax
(rib and sternum)
34.590.151
2 Spondilolisthesis, canal stenosis M43.15 spondilolisthesis; M48.05
spinal stenosis
M48.54 collapse vertebrae
S25.8 injury of other blood vessel of
thorax
03.09 other exploration and
decompression of spinal
canal
84.51 insertion of other
spinal device;
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
3. Tumor tulang belakang C41.2 malignant neoplasm of
vertebral column ; M48.05 spinal
stenosis
M48.54 collapse vertebrae
S25.8 injury of other blood vessel of
thorax
03.09 other exploration and
decompression of spinal
canal
84.51 insertion of other
spinal device;
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
4 HNP/canal stenosis di cervical
dengan tetraparese dengan
implan
M50.1 cervical disc disorder;
M48.05 spinal stenosis
M48.54 collapse vertebrae
03.09 other exploration and
decompression of spinal
canal
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390

13. G82.4 flaccid tetraplegia 84.51 insertion of other
spinal device;
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
5 HNP/canal stenosis di
thorakal/lumbal dengan implan
M51.1 thoraxic , thoracolumbal and
lumbosacral intervertebral disc
disorder;
M48.05 spinal stenosis
M48.54 collapse vertebrae
S25.8 injury of other blood vessel of
thorax
03.09 other exploration and
decompression of spinal
canal
84.51 insertion of other
spinal device;
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390
6 HNP/Canal stenosis di cervical
tetraparese tanpa implan
M50.1 cervical disc disorder;
M48.02 spinal stenosis
M48.52 collapse vertebrae
G82.4 flaccid tetraplegia
03.09 other exploration and
decompression of spinal
canal
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
25.165.278
7 HNP/canal stenosis di
thorakal/lumbal tanpa implant
M51.1 thoraxic , thoracolumbal and
lumbosacral intervertebral disc
disorder;
M48.05 spinal stenosis
M48.54 collapse vertebrae
03.09 other exploration and
decompression of spinal
canal
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
19.950.055
8 Fraktur tulang belakang dengan
implan
S32.7 fracture of lumbar spine and
pelvis;
M48.0 spinal stenosis
M48.54 collapse vertebrae
S25.8 injury of other blood vessel of
thorax
03.09 other exploration and
decompression of spinal
canal
84.51 insertion of other
spinal device;
81.62 fusion of 2-3 vertebrae
81.04 Dorsal fusion
Klass 3= 25.165.278
Klass 2= 30.000.000
Klass 1 = 35.231.390