ASPEK PEMBIAYAAN PELAYANAN NYERI

DI ERA JAMINAN KESEHATAN NASIONAL

DI INDONESIA

dr. Widodo Mardi Santoso Sp.S (K)

POKJA JKN PP PERDOSSI-POKDI Nyeri PERDOSSI
Departemen-SMF Neurologi FKUB RSSA Malang
POKOK BAHASAN
1. Pendahuluan
2. Sistem INA-CBGs Dalam Pembiayaan Kasus Nyeri (Minimal
Intervensi Nyeri)
3. Peran Perhimpunan Profesi
4. Sistem Rujukan dengan Aplikasi HFIS
 PERJALANAN PELAYANAN KESEHATAN
JKN 2014 – 2022
TARIF dan RUJUKAN
KODE CBG ONLINE
MONO
Sistem BERJENJANG
LOYALITAS
PAKET INA
FORNAS SINGLE
CBG
TARIF

2014 2019 2021

DISRUPSI DISRUPSI DISRUPSI DISRUPSI DISRUPSI NEW HOPE ?

2018 2020 2022

DEFISIT
FRAUD PANDEMI
HFIS GLOBAL
KELAS RS KRIS BUDGET
3
 HOT ISSUE PELAYANAN NYERI
DI ERA JKN

KODING PEMBIAYAAN
(REKLASIFIKASI GROUPER) (TARIF PAKET INA CBG)

KOMPETENSI SISTEM RUJUKAN

(HFIS)
TAMPILAN APLIKASI SOFTWARE
INA GROUPER
TAMPILAN APLIKASI SOFTWARE
INA GROUPER

TARIF PAKET
 Rawat jalan di RS Kelas A
Pemerintah Regional I : 377.000
EVALUASI
P P
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D D
O O
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S S
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24
 37 kelompok
Prosedur tindakan 25
 6 kelompok
Prosedur tindakan
PERDOSSI

Reklasifikasi Logic
Koding System
 BAGAIMANA KALAU PROSEDUR TIDAK ADA DALAM ICD 9 CM 2010

Deskripsi Prosedur ICD 9 CM

Injection of other agent 03.92
into spinal canal
Destruction of cranial and peripheral nerves 04.2
Injection of anesthetic into peripheral nerve for 04.81
Dry Needling analgesia
Injection of other agent,
Prolotherapy except neurolytic 04.89
Injection of therapeutic substance into joint or
Injeksi Botulinum ligament 81.92
Injection of therapeutic
dll substance into bursa 83.96

Injection of therapeutic substance into tendon 83.97

Injection of locally-acting therapeutic substance
83.98
into other soft tissue
Injection of steroid 99.23
Other injection of locally-acting therapeutic
substance into soft tissue 82.96
 P-CARE
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9 KONDISI KHUSUS
PENGINPUTAN DATA SPESIALIS DAN
SUBSPESIALIS HARUS BENAR
APLIKASI HFIS DI FKRTL 2
Hal 25
 No Diagnosis Kasus ICD X Prosedur ICD 9 Data Dukung Tarif Keterangan
1. Rawat Jalan.
Klaim naik menjadi
Injection of locally-acting Printout hasil USG bila
83.98 621,400 642.100 bila prosedur
therapeutic substance into 88.79 prosedur dipandu dengan 642.100 dipandu dengan USG
other soft tissue USG.
(Other diagnostic
ultrasound) (88.79)

Injection of steroid 99.23 377,100 Rawat Jalan

Rawat Jalan.
Migraine without aura Klaim tetap 487.400
G 43.0 Injection of anesthetic into
(common migraine) 04.81 mekipun prosedur
peripheral nerve for 88.79 487,400
dipandu dengan USG
analgesia (Other diagnostic
Migraine with aura G 43.1
(classical migraine) ultrasound) (88.79)
Other injection into
Cluster Headache sympathetic nerve or 05.39 Laporan operasi 5,147,300 Rawat Inap
G 44.0
Syndrome ganglion
Injection of neurolytic
agent into sympathetic 05.32 Laporan operasi 5,147,300 Rawat Inap
nerve
Injection of other agent, 04.89 Laporan operasi 5,147,300 Rawat Inap
except neurolytic

Destruction of cranial and 04.2 Laporan operasi 5,147,300 Rawat Inap

peripheral nerves
 No Diagnosis Kasus ICD X Prosedur ICD 9 Data Dukung Tarif Keterangan
2. Injection of locally-acting
therapeutic substance 83.98 621.400 Rawat jalan
into other soft tissue
Other injection into
Trigeminal Neuralgia G 50.0 sympathetic nerve or 05.39 Laporan operasi 8,735,600 Rawat Inap
ganglion
Destruction of cranial 04.2 Laporan operasi 8,735,600 Rawat Inap
and peripheral nerves
3. Adhesive capsulitis of
shoulder M 75.0 377,100 Rawat jalan

4. Adhesive capsulitis of 99.23 Printout hasil USG bila prosedur 377.100

M 75.0 Injection of steroid Rawat jalan
shoulder 88.79 dipandu dengan USG. 642.100
Injection of therapeutic 83.96 Printout hasil USG bila prosedur 621.400 Rawat jalan
Periarthritis of wrist, M 77.21 substance into bursa dipandu dengan USG.
88.79 642.100
shoulder region
Injection of therapeutic 83.97 Printout hasil USG bila prosedur 621.400
Rotator cuff syndrome M 75.1 substance into tendon 88.79 dipandu dengan USG. 642.100 Rawat jalan
Injection of therapeutic 81.92 Printout hasil USG bila prosedur 621.400
Impingement syndrome of substance into joint or
M 75.4 ligament 88.79 dipandu dengan USG. 642.100 Rawat jalan
shoulder
Injection of locally-acting 83.98
88.79 Printout hasil USG bila prosedur
Neuralgia and neuritis, Rawat jalan
M 79.21 therapeutic substance into dipandu dengan USG.
621.400
unspecified, shoulder region other soft tissue 642.100
5. Printout hasil USG bila prosedur
Peripheral nerve injection, 04.80 487.000 Rawat jalan
Carpal Tunnel Syndrome G 56.0 not otherwise specified dipandu dengan USG.
88.79 487.000
No Diagnosis Kasus ICD X Prosedur ICD 9 Data Dukung Tarif Keterangan
6. Radial styloid tenosynovitis [de Printout hasil USG bila
Injection of therapeutic 83.97 621.400
M65.44 prosedur dipandu
quervain], hand substance into tendon 88.79 642.100 Rawat jalan
dengan USG.
7. Printout hasil USG bila
Injection of therapeutic 83.97 621.400
Trigger finger, hand M65.34 prosedur dipandu
substance into tendon 88.79 642.100 Rawat jalan
dengan USG.
8. Low back pain, lumbosacral M5457 Injection of therapeutic
region substance into joint or ligament Laporan operasi 6,446,500 Rawat inap
81.92
Injection of other agent into 03.92 Laporan operasi 6,446,500 Rawat inap
spinal canal
Spinal stenosis, Injection of other agent,
lumbosacral region M4807 except neurolytic 04.89 Laporan operasi 6,446,500 Rawat inap

Lumbar and other

intervertebral disc M511 Destruction of cranial and 04.2 Laporan operasi 6,446,500 Rawat inap
disorders with peripheral nerves
radiculopathy
9. Injection of other agent Laporan operasi
Lumbosacral root disorders, not G54.4 into spinal canal 03.92 Hasil EMNG 8,735,600 Rawat inap
elsewhere classified
Injection of other agent, Laporan operasi 8,735,600
except neurolytic 04.89 Rawat inap
Hasil EMNG
Destruction of cranial and Laporan operasi 8,735,600
04.2 Rawat inap
peripheral nerves Hasil EMNG
No Diagnosis Kasus ICD X Prosedur ICD 9 Data Dukung Tarif Keterangan
10. 99.23 Printout hasil USG bila prosedur 377.100
Patellar tendinitis. Injection of steroid Rawat jalan
88.79 dipandu dengan USG. 642.100
M76.5
Other bursitis of knee, M70.50 Injection of therapeutic 83.96 Printout hasil USG bila prosedur 621.400 Rawat jalan
substance into bursa 88.79 dipandu dengan USG. 642.100
multiple sites.
Injection of therapeutic 83.97 Printout hasil USG bila prosedur 621.400
Other internal M23.89 substance into tendon 88.79 dipandu dengan USG. 642.100 Rawat jalan
derangements of knee,
Injection of therapeutic 81.92 Printout hasil USG bila prosedur 621.400
unspecified ligament or substance into joint or
unspecified meniscus. ligament 88.79 dipandu dengan USG. 642.100 Rawat jalan

Gonarthrosis, unspecified M17.9

Injection of locally-acting
83.98 Printout hasil USG bila prosedur
Rawat jalan
therapeutic substance into 621.400
Other enthesopathies of M76.89 88.79 dipandu dengan USG.
other soft tissue 642.100
lower limb, excluding foot,
site unspecified
TERIMA KASIH