DAFTAR DIAGNOSA SESUAI KM

No Nama Diagnosa Kode Umum Kode ICD X

KELOMPOK UMUM

1 TUBERKULOSIS (TB) PARU A70 Tuberkulosis A15

2 TB DENGAN HIV

TB A70 Tuberkulosis A15

HIV B90 HIV-infection/AIDS Z21

3 MORBILI A71 Measles B05.9

4 VARISELA A72 Chickenpox B01.9

5 MALARIA A73 Malaria B54

6 LEPTOSPIROSIS A78 Infection disease other/ NOS A27.9

B74

B74.0
7 FILARIASIS D96 Woms/other parasites
B74.1

B74.2

8 INFEKSI PADA UMBILIKUS A94 Perinatal morbidity other P38

No Nama Diagnosa Kode Umum Kode ICD X

9 KANDIDIASIS MULUT A78 Infectious desease other B37.9

10 LEPRA A78 Infectious disease other/NOS A30

11 KERACUNAN MAKANAN A86 Toxic Effect Non Medical Substance T62.2

12 ALERGI MAKANAN A92 Allergy/ allergic reaction NOS L27.2

13 SYOK K99 Cardiovascular disease other R57.9

14 REAKSI ANAFILAKTIK A92 Allergy/allergic reaction NOS T78.2

15 DEMAM DENGUE DAN DEMAM BERDARAH DENGUE A77 Viral disease other/NOS A90

A91
No Nama Diagnosa Kode Umum Kode ICD X

DARAH, PEMBENTUKAN DARAH DAN SISTEM IMUN

16 ANEMIA DEFISIENSI BESI B80 Iron Deficiency Anaemia B80

17 HIV/AIDS TANPA KOMPLIKASI B90 HIV-infection/AIDS Z21

18 LUPUS ERITEMATOSUS SISTEMIK L99 Systemic Lupus Erythematosus M32

19 LIMFADENITIS L04.9 Acute lymphadenitis, unspecified B70

DIGESTIVE

K12

20 ULKUS MULUT (AFTOSA, HERPES) D83 Mouth / tongue / lip disease K12.0

K12.1

21 REFLUKSGASTROESOFAGEAL D84 Oesphagus disease K21.9

22 GASTRITIS D07 Dyspepsia/indigestion K29.7

23 INTOLERANSI MAKANAN D29 Digestive syndrome/complaint other K90.4

24 MALABSORBSI MAKANAN D29 Digestive syndrome/complaint other K90.9

25 DEMAM TIFOID D70 Gastrointestinal infection A01.0

26 GASTROENTERITIS (KOLERA DAN GIARDIASIS) D73 Gastroenteritis presumed infection A09

27 DISENTRI BASILER DAN DISENTRI AMUBA D70 Gastrointestinal infection A06.0

No Nama Diagnosa Kode Umum Kode ICD X

D14 Haematemesis/vomiting blood K92.2

28 PERDARAHAN GASTROINTESTINAL D15 Melaena K62.5

D16 Rectal Bleeling

29 HEMOROID GRADE 1-2 D95 Anal fissure/perianal abscess I84

30 HEPATITIS A D72 Viral Hepatitis B15

31 HEPATITIS B D72 Viral Hepatitis B16

32 KOLESISTITIS D98 Cholecystitis/cholelithiasis K81.9

33 APENDISITIS AKUT S87 Appendicitis K35.9

34 PERITONITIS D99 Disease digestive system, other K65.9

D71 Mumps
35 PAROTITIS B26
D99 Disease digestive system, other

36 ASKARIASIS (INFEKSI CACING GELANG) D96 Worms/ other parasites B77.9

B76.0
37 ANKILOSTOMIASIS (INFEKSI CACING TAMBANG) D96 Worms/ other parasites
B76.1

B65.9
38 SKISTOSOMIASIS D96 Worms/ other parasites
No Nama Diagnosa Kode Umum Kode ICD X
38 SKISTOSOMIASIS D96 Worms/ other parasites
B65.2

39 TAENIASIS D96 Worms/ other parasites B68.9

40 STRONGILOIDIASIS D96 Worms/ other parasites B78.9

MATA

41 MATA KERING/DRY EYE F99 Eye/adnexa disease, other H04.1

42 BUTA SENJA F99 Eye/adnexa disease, other H53.6

43 HORDEOLUM F72 Blepharitis/stye/chalazion H00.0

F70 Conjunctivitis infectious F71

44 KONJUNGTIVITIS
H10.9 Conjunctivitis, unspecified H10.1

45 BLEFARITIS F72 Blepharitis/stye/chalazion H01.0

46 PERDARAHAN SUBKONJUNGTIVA F75 Contusion/ haemorrhage eye H57.8

47 BENDA ASING DI KONJUNGTIVA F76 Foreign body in eye T15.9

48 ASTIGMATISME F91 Refractive error H52.2

49 HIPERMETROPIA F91 Refractive error H52.0

50 MIOPIA RINGAN F91 Refractive error H52.1

No Nama Diagnosa Kode Umum Kode ICD X

51 PRESBIOPIA F91 Refractive error H52.4

52 KATARAK PADA PASIEN DEWASA F92 Cataract H26.9

53 GLAUKOMA AKUT F93 Glaucoma H40.2

54 GLAUKOMA KRONIS F93 Glaucoma H40.2

55 TRIKIASIS F99 Eye / adnexa disease, other H02

56 EPISKLERITIS F99 Eye / adnexa disease, other H15.1

57 TRAUMA KIMIA MATA F79 Injury eye other T26

58 LASERASI KELOPAK MATA F79 Injury eye other S01.1

59 HIFEMA F75 Contusion/haemorrhage eye H21.0

60 RETINOPATI DIABETIK F83 Retinopathy H36.0

No Nama Diagnosa Kode Umum Kode ICD X

TELINGA

61 OTITIS EKSTERNA H70 Otitis externa H60.9

H65.0

62 OTITIS MEDIA AKUT H71 Acute otitis media/myringitis H65.1

H66.0

H66.1

63 OTITIS MEDIA SUPURATIF KRONIK H74 Chronic otitis media H66.2

H66.3

64 BENDA ASING DI TELINGA H76 Foreign body in ear T16

65 SERUMEN PROP H81 Excessive ear wax H61.2

KARDIOVASKULER

66 ANGINA PEKTORIS STABIL K74 Ischaemic heart disease with angina I20.9

67 INFARK MIOKARD K75 Acute Myocardial Infarction I21.9

R00.0

68 TAKIKARDIA K79 Paroxysmal Tachicardy I47.1

I47.2
No Nama Diagnosa Kode Umum Kode ICD X

69 GAGAL JANTUNG AKUT DAN KRONIK K77 Heart failure I50.9

70 CARDIORESPIRATORY ARREST K80 cardiac arrhytmiaNOS R09.2

71 HIPERTENSI ESENSIAL K86 Hypertension uncomplicated I10

MUSKULOSKELETAL

72 FRAKTUR TERBUKA L76 fracture other T14

73 FRAKTUR TERTUTUP L76 fracture other T14

74 POLIMIALGIA REUMATIK L99 Musculosceletal disease other M53.3

75 ARTRITIS REUMATOID L99 Musculosceletal disease other M53.3

76 ARTRITIS, OSTEOARTRITIS L91 Osteoarthrosis other M19.9

No Nama Diagnosa Kode Umum Kode ICD X

S16 Bruise / Contusion

77 VULNUS S17 Abration / Scratch / Blister T14.1

S18 Laceration / Cut

78 LIPOMA S78 Lipoma D17.9

NEUROLOGI

79 TENSION HEADACHE N95 Tension Headache G44.2

80 MIGREN N89 Migraine G43.9

81 VERTIGO N17 Vertigo/dizziness R42

82 TETANUS N72 Tetanus A35

83 RABIES A77 Viral disease other/NOS A82.9

84 MALARIA SEREBRAL A73 Malaria

85 EPILEPSI N88 Epilepsy G40.9

86 TRANSIENT ISCHEMIC ATTACK (TIA) K89 Transient cerebral ischaemia G45.9

87 STROKE K90 Stroke/cerebrovascular accident I63.9

88 BELLS’ PALSY N91 Facial paralysis/Bells’ palsy G51.0

No Nama Diagnosa Kode Umum Kode ICD X

89 STATUS EPILEPTIKUS N88 Epilepsy G41.9

90 DELIRIUM P71 Organic psychosis other F05.9

91 KEJANG DEMAM N07 Convulsion/Seizure R56.0

92 TETANUS NEONATORUM N72 Tetanus A33

PSIKIATRI

93 GANGGUAN SOMATOFORM P75 Somatization disorder F45

94 DEMENSIA P70 Dementia F03

95 INSOMNIA P06 Sleep disturbance F51

96 GANGGUAN CAMPURAN ANXIETAS DAN DEPRESI P74 Anxiety Disorder (anxiety state) F41.2

97 GANGGUAN PSIKOTIK P98 Psychosis NOS/other F20

RESPIRASI

98 INFLUENZA R80 Influenza J11

99 FARINGITIS AKUT R74 Upper respiratory infection acute J02.9

100 LARINGITIS AKUT R77 Laryngitis/tracheitis acute J04.0

J03
101 TONSILITIS AKUT R76 Tonsillitis acute
J35
No Nama Diagnosa Kode Umum Kode ICD X

102 BRONKITIS AKUT R78 Acute bronckitis /bronchiolitis J20.9

103 ASMA BRONKIAL (ASMA STABIL) R96 Asthma J45

104 STATUS ASMATIKUS (ASMA AKUT BERAT) R03 Wheezing J45.902

105 PNEUMONIA ASPIRASI R99 Respiratory disease other J69.0

J18.0
106 PNEUMONIA, BRONKOPNEUMONIA R81 Pneumonia
J18.9

107 PNEUMOTORAKS R99 Respiratory Disease Other J93.9

108 PPOK (PENYAKIT PARU OBSTRUKTIF KRONIS) R95 Chronic Obstructive Pulmonary Diseases J44.9

109 EPISTAKSIS R06 Nose bleed/epistaxis R04.0

110 BENDA ASING DI HIDUNG R87 Foreign body nose/larynx/bronch T17.1

111 FURUNKEL PADA HIDUNG R73 Boil/abscess nose J34.0

112 RINITIS AKUT R74 Upper respiratory infection acute J00

113 RINITIS VASOMOTOR R97 Allergic rhinitis J30.0

114 RINITIS ALERGI R97 Allergic rhinitis J30.4

J01
115 SINUSITIS (RINOSINUSITIS) R75 Sinusitis acute / chronic
No Nama Diagnosa Kode Umum Kode ICD X
115 SINUSITIS (RINOSINUSITIS) R75 Sinusitis acute / chronic
J32

KULIT

116 MILIARIA S92 Sweat gland disease L74.3

117 VERUKA VULGARIS S03 Warts B07

118 HERPES ZOSTER S70 Herpes Zoster B02.9

119 HERPES SIMPLEKS S71 Herpes Simplex B00.9

120 MOLUSKUM KONTAGIOSUM S95 Molluscum contagiosum B08.1

121 REAKSI GIGITAN SERANGGA S12 Insect bite/sting T63.4

122 SKABIES S72 Scabies/other acariasis B86

123 PEDIKULOSIS KAPITIS S73 Pediculosis/skin infestation other B85.0

No Nama Diagnosa Kode Umum Kode ICD X

124 PEDIKULOSIS PUBIS S73 Pediculosis/skin infestation other B85.3

B35

B35.0

B35.1

B35.2

125 DERMATOFITOSIS S74 Dermatophytosis B35.3

B35.4

B35.5

B35.6

B35.8

126 PITIRIASIS VERSIKOLOR/ TINEA VERSIKOLOR S76 Skin infection other B36.0

S84 Impetigo L01

127 PIODERMA S76 Skin infection other L02

L08.0

128 ERISIPELAS S76 Skin infection other A46

No Nama Diagnosa Kode Umum Kode ICD X

129 DERMATITIS SEBOROIK S86 Dermatitis seborrhoeic L21

130 DERMATITIS ATOPIK S87 Dermatitis/atopic eczema L20

131 DERMATITIS NUMULARIS S87 Dermatitis/atopic eczema L20.8

132 LIKEN SIMPLEKS KRONIK (NEURODERMATITIS SIRKUMKRIPTA) S87 Dermatitis/atopic eczema L28.0

133 DERMATITIS KONTAK ALERGIK S88 Dermatitis contact/allergic L23

134 DERMATITIS KONTAK IRITAN S88 Dermatitis contact/allergic L24

135 NAPKIN ECZEMA(DERMATITIS POPOK) S89 Diaper rash L22

136 DERMATITIS PERIORAL S99 Skin disease other L71.0

137 PITIRIASIS ROSEA S90 Pityriasisrosea L42

No Nama Diagnosa Kode Umum Kode ICD X

138 ERITRASMA S76 Skin infection other L08.1

139 SKROFULODERMA A70 Tuberculosis A18.4

140 HIDRADENITIS SUPURATIF S92 Sweat gland disease L73.2

141 AKNE VULGARIS RINGAN S96 Acne L70.0

L50
142 URTIKARIA S98 Urticaria
L50.9

143 EXANTHEMATOUS DRUG ERUPTION S07 Rash generalized L27.0

144 FIXED DRUG ERUPTION A85 Adverse effect medical agent L27.0

145 CUTANEUS LARVA MIGRANS D96 Worms/other parasites B76.9

T30

146 LUKA BAKAR DERAJAT I DAN II S14 burn/scald T31

T32

I83.0
147 ULKUS PADA TUNGKAI S97 Chronic Ulcer Skin
L97

148 SINDROM STEVENS-JOHNSON S99 Skin disease other L51.1

No Nama Diagnosa Kode Umum Kode ICD X

METABOLIK ENDOKRIN DAN NUTRISI

T82 obesity
149 OBESITAS E66.9
T83 overweight

150 TIROTOKSIKOSIS T85 Hipertiroidisme/tirotoksikosis E05.9

151 DIABETES MELLITUS TIPE 2 T90 Diabetes non-insulin dependent E11

152 HIPERGLIKEMIA HIPEROSMOLAR NON KETOTIK A91 Abnormal result invetigation NOS R73.9

153 HIPOGLIKEMIA T87 hypoglycaemia E16.2

E79.0
154 HIPERURISEMIA-GOUT ARTHRITIS T99 Endocrine/metabolic/nutritional disease other
M10
No Nama Diagnosa Kode Umum Kode ICD X

155 LIPIDEMIA T93 Lipid disorder E78.5

156 MALNUTRISI ENERGI PROTEIN (MEP) T91 Vitamin/nutritional deficiency E46

GINJAL DAN SALURAN KEMIH

157 INFEKSI SALURAN KEMIH U71 Cystitis/urinary infection others N39.0

158 PIELONEFRITIS TANPA KOMPLIKASI U70 Pyelonephritis / pyelitis N10

159 FIMOSIS Y81 Phimosis N47

160 PARAFIMOSIS Y81 Paraphimosis N47.2

KESEHATAN WANITA

161 KEHAMILAN NORMAL W90 Uncomplicated labour/delivery livebirth O80.9

162 HIPEREMESIS GRAVIDARUM (MUAL DAN MUNTAH PADA KEHAMILAN) W05 Pregnancy vomiting/nausea O21.0

163 ANEMIA DEFISIENSI BESI PADA KEHAMILAN B80 Irondeficiency anaemia D50

164 PRE-EKLAMPSIA W81 Toxaemia of pregnancy O14.9

165 EKLAMPSI W81 Toxaemia of pregnancy O15.9

O03.9
166 ABORTUS W82 Abortion spontaneous
O06.4

167 KETUBAN PECAH DINI (KPD) W92 Complicated labour/delivery livebirth O42.9
No Nama Diagnosa Kode Umum Kode ICD X

W92 Life Birth

168 PERSALINAN LAMA O63.9
W93 Still birth

169 PERDARAHAN POST PARTUM / PENDARAHAN PASCASALIN W17 Post partum bleeding O72.1

170 RUPTUR PERINEUM TINGKAT 1-2 W92 Complicated labour/delivery livebirth O70.0

171 MASTITIS X21 Breast symptom/complaint female other N61

W95 Breast disorder in pregnancy other O92.02

172 INVERTED NIPPLE
X20 Nipple symptom/complaint female O92.03

W95 Breast disorder in pregnancy other O92.12

173 CRACKED NIPPLE
X20 Nipple symptom/complaint female O92.13
No Nama Diagnosa Kode Umum Kode ICD X

PENYAKIT KELAMIN

X14 vaginal discharge

X71 gonore pada wanita

174 FLUOR ALBUS / VAGINAL DISCHARGENON GONORE X72 urogenital candidiasis pada wanita N98.9

X73 trikomoniasis urogenital pada wanita

X92 klamidia genital pada wanita

175 SIFILIS Y70 Syphilis male A51

X70 Syphilis female A51.0

A52

A53.9

X71 Gonorrhoea female

176 GONORE A54.9
Y71 Gonorrhoea male

177 VAGINITIS X84 Vaginitis N76.0

178 VULVITIS X84 Vaginitis/Vulvitis N76.0

DAFTAR DIAGNOSA SESUAI KMK 514/2015

Kode ICD X Level Alasan Tidak Dapat Ditangani

Respiratory tuberkulosis, bacteriologically and histologically confirmed 4A Obat program P2 TB Paru Ada di Pusk

Respiratory tuberkulosis, bacteriologically and histologically confirmed 3A Sarana Lab

Asymptomatic human immunodeficiency virus ARV tersedia Di Klinik VCT Puskesmas dan atau RSU, Privacy Pasien
(HIV) infection status

Measles without complication (Measles NOS) 4A

Varicella without complication (Varicella NOS) 4A

Unspecified malaria 4A

Leptospirosis, unspecified 4A

Filariasis

Filariasis due to Wuchereria bancrofti

4A
Filariasis due to Brugia malayi

Filariasis due to Brugia timori

Omphalitis of newborn with or without mild haemorrhage 4A

 Kode ICD X Level Alasan Tidak Dapat Ditangani

Candidiasis unspecified 4A

Leprosy [Hansen disease] 4A

Other Ingested (parts of plant(s) 4A

Dermatitis due to ingested food 4A

Shock, unspecified 3B

Anaphylactic shock, unspecified 4A

Dengue fever
4A
Dengue haemorrhagic fever Yang Grade II - III harus di RI Di RSU
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Iron Deficiency Anaemias 4A

Asymptomatic Human Immunodeficiency Virus (HIV) infection status 4A Sarana lab dan ARV

Systemic Lupus Erythematosus 3A Obat dan Sarana Lab

Lymphadenitis Acute 4A

Stomatitis and related lesions

Recurrent oral aphtae 4A

Other form of stomatitis

Gastro-oesophageal reflux disease without oesophagitis 4A

Gastritis, unspecified 4A

Malabsorption due to intolerance 4A

Intestinal malabsorbtion, unspecified 3A

Typhoid fever 4A

Diarrhoea and gastroenteritis of presumed infection origin 4A

Acute amoebic dysentery 4A

 Kode ICD X Level Alasan Tidak Dapat Ditangani

Gastrointestinal haemorrhage, unspecified Kompetensi Alat

Haemorrhage of anus and rectum 3B Kompotensi Alat

Haemorrhoids 4A

Acute Hepatitis A 4A Sarana RI, harus di rawat di RSU

Acute Hepatitis B 3B Sarana RI, harus di rawat di RSU

Cholecystitis, unspecified 3B Sarana Alat (USG)

Acute appendicitis 3B Segera di tangani dengan Pembedahan (CITO)

Peritonitis, unspecified 3B Diperlukan Antibiotika Parenteral di RSU

Mumps 4A

Ascariaris unspecified 4A

Ankylostomiasis
4A
Necatoriasis

Skistosomiasisunspecified
4A
 Kode ICD X Level Alasan Tidak Dapat Ditangani
4A
Schistomiasis due to S. japonicum

Taeniasis 4A

Strongyloidiasis 4A

Otherdisorders of lacrimal gland 4A Untuk kasus

Night blindness 4A

Hordeolum and other deep inflammation of eyelid 4A

Conjunctivitis allergic
4A
Acute atopic conjunctivitis

Blepharitis 4A

Other specified disorders of eye and adnexa 4A

Foreign body on external eye, part unspecified 4A

Astigmatisme 4A

Hypermetropia ringan 4A

Myopia 4A
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Presbyopia 4A

Cataract, unspecified 2

Primary angle-closure glaucoma 3B

Primary angle-closure glaucoma 3B

Entropion and trichiasis of eyelid 4A

Episcleritis 4A

Burn and corrosion confined to eye and adnexa 3A

Open wound of eyelid and periocular area 3B

Hyphaema 3A

Diabetic retinopathy 2
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Otitis externa, unspecified 4A

Acute serous otitis media

Other acure nonsuppurative otitis media 4A

Acute suppurative otitis media

Chronic tubotympanic suppurative otitis media

Chronic atticoantral suppurative otitis media 3A

Other chronic suppurative otitis media

Foreign body in ear 3A

Impacted cerumen 4A

Angina pectoris, unspecified 3B

Acute Myocardial Infarction, Unspecified 3B

Tachicardy Unspecified

Supraventicular Tachicardy 3B

Ventricular Tachicardy
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Heart failure, unspecified 3B & 3A

Respiratory arrest/ Cardiorespiratory failure 3B

Essential (primary) hypertension 4A

fracture of unspecified body 3B

fracture of unspecified body 3B

Polymyalgia rheumatica 3A

Polymyalgia rheumatica 3A

Osteoarthrosis other 3A
 Kode ICD X Level Alasan Tidak Dapat Ditangani

4A

Open wound of unspecified body region 3B

Benign lipomatous neoplasm 4A

Tension–type headache 4A

Migraine, Unspecified 4A

Dizziness and giddiness 4A

Other Tetanus 4A

Rabies, Unspecified 3B

Plasmodium falciparum with cerebral complication 3B

Epilepsy, unspecified 3A

Transient cerebral ischaemic attack, unspecified 3B

Cerebral infarction, unspecified 3B

Bells’ palsy 4A
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Status epilepticus, unspecified 3B

Delirium, unspecified 3A

Febrile convulsions 4A

Tetanus Neonatorum 3B

Somatization disorder 4A

Unspecified dementia 3A

Insomnia non organik pada psikiatri 4A

Mixed Anxiety and Depression Disorder 3A

Chronic Psychotic Disorder 3A

Influenza, virus not identified 4A

Acute pharyngitis, unspecified 4A

Acute laryngitis 4A

Acute tonsillitis
4A
Chronic tonsilitis
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Acute bronchitis, unspecified 4A

Asthma 4A

Unspecified asthma with status asthmaticus 3B

Pneumonitis due to food and vomit 3B

Bronchopneumonia, unspecified
4A
Pneumonia, unspecified

Respiratory Disease other 4A

Chronic Obstructive Pulmonary Diseasesm unspecified 3B

Epistaxis 4A

Foreign body in nostril 4A

Abscess, furuncle and carbuncle of nose 4A

Acute nasopharyngitis (common cold) 4A

Vasomotor rhinitis 4A

Allergic rhinitis, unspecified 4A

Acute sinusitis 4A
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Chronic sinusitis 3A

Miliaria, unspecified 4A

Viral warts 4A

Zoster without complication 4A

Herpesviral infection, unspecified 4A

Molluscum contagiosum 4A

Venom of other arthropods 4A

Scabies 4A

Pediculosis due to Pediculus humanus capitis 4A

 Kode ICD X Level Alasan Tidak Dapat Ditangani

Pthiriasis 4A

Dermatophytosis

Tinea barbae and tinea capitis

Tinea unguium

Tinea manuum

Tinea pedis 4A

Tinea corporis

Tinea imbricate

Tinea cruris

Other dermatophytoses

Pityriasis versicolor 4A

Impetigo

Cutaneous abscess, furuncle and carbuncle 4A

Pyoderma

Erysipelas 4A
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Seborrhoeic dermatitis 4A

Atopic dermatitis 4A

Other atopic dermatitis 4A

Lichen simplex chronicus 3A

Allergic contact dermatitis 3A

Irritant contact dermatitis 4A

Diaper (napkin) dermatitis 4A

Perioral dermatitis 4A

Pityriasisrosea 4A
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Erythrasmay 4A

Tuberculosis of skin and subcutaneous tissue 4A

Hidradenitis suppurativa 4A

Acne vulgaris 4A

Urticaria 4A

Urticaia, unspecified 3A

Generalized skin eruption due to drugs and medicament 4A

Generalized skin eruption due to drugs and medicaments 4A

Hookworm disease, unspecified 4A

burn and corrosion, body region unspecified

burns classified according to extent of body surface involved 4A

corrosions classified according to extent of body surface involved

aricose veins of lower extremities with ulcer

4A
Ulcer of lower limb, notelsewhere classified

Bullous erythema multiforme 3B

 Kode ICD X Level Alasan Tidak Dapat Ditangani

obesity unspecified 4A

Tirotoksikosis unspecified 3B

Non-insulin-dependent diabetes mellitus 4A

Hyperglycaemia unspecified 3B

hypoglycaemia unspecified 4A

Hyperuricemia without signs of inflammatory arthritis and tophaceous disease

4A
Gout
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Hiperlipidemia 4A

Unspecified protein-energy malnutrition 4A

Urinary tract infection, site not specified 4A

Acute tubulo-interstitial nephritis (applicable to: acute pyelonephritis) 4A

Phimosis 4A

Paraphimosis 4A

Single spontaneous delivery, unspecified 4A

Mild hyperemis gravidarum 3B

Iron deficiency anaemia 4A

Pre-eclampsia, unspecified 3B

Eclampsia, unspecified as to time period 3B

Unspecified abortion, complete, without complication 4A

Unspecified abortion, incomplete, without complication 3B

Premature rupture of membrane, unspecified 3A

 Kode ICD X Level Alasan Tidak Dapat Ditangani

Long Labour 3B

Other Immediate Postpartum haemorrhage 3B

First degree perineal laceration during delivery 4A

Inflammatory disorders of breast 4A

Retracted nipple associated with the puerperium

4A
Retracted nipple associated with lactation

Cracked nipple associated with the puerperium

4A
Cracked nipple associated with lactation
 Kode ICD X Level Alasan Tidak Dapat Ditangani

Complication associated with artificial fertilization, unspecified 4A

Early syphilis

Primary genital syphilis

3A
Late syphilis

Syphilis, unspecified

Gonococcal infection, unspecified 4A

AcuteVaginitis 4A

AcuteVaginitis 4A
Kode ICD X Level Alasan Tidak Dapat Ditangani

Tandatangan,

...................................................................