Lembar Self-Asessment Penanganan Diagnosa Non Spesialistik

Kompetensi 4A di FKTP

NAMA FKTP: UPT PUSKESMAS

GONDANG

Penanganan Tuntas dan Mandiri

Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
MAMPU TIDAK MAMPU
1 Demam tifoid (A01-Typhoid and paratyphoid fevers); (A01.0-
Typhoid fever); (A01.1-Paratyphoid fever A);
(A01.2-Paratyphoid fever B); (A01.3-Paratyphoid √
fever C); (A01.4-Paratyphoid fever, unspecified)

2 Disentri basiler, disentri amuba (A06-Amoebiasis); (A06.0-Acute amoebic

dysentery); (A06.1-Chronic intestinal
amoebiasis); (A06.2-Amoebic nondysenteric
colitis); (A06.3-Amoeboma of intestine); (A06.7-
Cutaneous amoebiasis); (A06.8-Amoebic
infection of other sites); (A06.9-Amoebiasis,
unspecified); (A03-Shigellosis); (A03.0-
Shigellosis due to Shigella dysenteriae); (A03.1- √
Shigellosis due to Shigella flexneri); (A03.2-
Shigellosis due to Shigella boydii); (A03.3-
Shigellosis due to Shigella sonnei); (A03.8-Other
shigellosis); (A03.9-Shigellosis, unspecified)

3 Gastroenteritis (termasuk kolera, (A09-Other gastroenteritis and colitis of

giardiasis) infectious and unspecified origin); (A09.0-Other
and unspecified gastroenteritis and colitis of
infectious origin); (A09.9-Gastroenteritis and
colitis of unspecified origin); (A08-Viral and other
specified intestinal infections); (A08.0-Rotaviral
enteritis); (A08.1-Acute gastroenteropathy due to √
Norwalk agent); (A08.2-Adenoviral enteritis);
(A08.3-Other viral enteritis); (A08.4-Viral
intestinal infection, unspecified); (A08.5-Other
specified intestinal infections); (A02-Other
salmonella infections); (A02.0-Salmonella
enteritis)
4 Tuberkulosis paru tanpa komplikasi (A15-Respiratory tuberculosis, bacteriologically
and histologically confirmed); (A15.0-
Tuberculosis of lung, confirmed by sputum
microscopy with or without culture); (A15.1-
Tuberculosis of lung, confirmed by culture only);
(A15.2-Tuberculosis of lung, confirmed
histologically); (A15.3-Tuberculosis of lung,
confirmed by unspecified means); (A15.4-
Tuberculosis of intrathoracic lymph nodes,
confirmed bacteriologically and histologically);
(A15.5-Tuberculosis of larynx, trachea and
bronchus, confirmed bacteriologically and
histologically); (A15.6-Tuberculous pleurisy,
confirmed bacteriologically and histologically); √
(A15.7-Primary respiratory tuberculosis,
confirmed bacteriologically and histologically);
(A15.8-Other respiratory tuberculosis, confirmed
bacteriologically and histologically); (A15.9-
Respiratory tuberculosis unspecified, confirmed
bacteriologically and histologically); (A16.1-
Tuberculosis of lung, bacteriological and
histological examination not done); (A16.2-
Tuberculosis of lung, without mention of
bacteriological or histological confirmation);
(A16.7-Primary respiratory tuberculosis without
mention of bacteriological or histological
confirmation); (A16.8-Other respiratory
5 Skrofuloderma (A18-Tuberculosis
tuberculosis, withoutof mention
other organs); (A18.4-
of bacteriological Penegakkan diagnosa uji
Tuberculosis
or histologicalofconfirmation);
skin and subcutaneous tissue)
(A16.9-Respiratory √ Tuberculin
tuberculosis unspecified, without mention of
bacteriological or histological confirmation)
6 Leptospirosis (tanpa komplikasi) (A27- Leptospirosis); (A27.0-Leptospirosis
icterohaemorrhagica); (A27.8-Other forms of
leptospirosis); (A27.9-Leptospirosis, unspecified) √
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
7 Lepra (A30-Leprosy [Hansen disease]); (A30.0-
Indeterminate leprosy); (A30.1-Tuberculoid
leprosy); (A30.2-Borderline tuberculoid leprosy);
(A30.3-Borderline leprosy); (A30.4-Borderline
√
lepromatous leprosy); (A30.5-Lepromatous
leprosy); (A30.8-Other forms of leprosy); (A30.9-
Leprosy, unspecified); (B92-Sequelae of leprosy)

8 Tetanus (A35-Other tetanus); (Y58.4-Tetanus vaccine); Persediaan ATS yang

(Z11.2-Special screening examination for other terbatas, Tidak
bacterial diseases); (Z23.5-Need for tersedianya ruang gelap
immunization against tetanus alone); (Z27.1- untuk perawatan pasien
Need for immunization against diphtheria- √ tetanus
tetanus-pertussis, combined [DTP]); (Z27.2-
Need for immunization against diphtheria-
tetanus-pertussis with typhoid-paratyphoid [DTP
+ TAB]); (Z27.3-Need for immunization against
diphtheria-tetanus-pertussis with poliomyelitis
9 Pertusis [DTP + polio]) cough); (A37.0-Whooping cough
(A37-Whooping Bila tidak ada komplikasi
due to Bordetella pertussis); (A37.1-Whooping
cough due to Bordetella parapertussis); (A37.8-
Whooping cough due to other Bordetella √
species); (A37.9-Whooping cough, unspecified)

10 Erisipelas (A46-Erysipelas); (O86.8-Other specified Bila tidak ada komplikasi

√
puerperal infections ) dan indikasi pembedahan
11 Sifilis stadium 1 dan 2 (A51-Early syphilis); (A51.3-Secondary syphilis
of skin and mucous membranes); (A53-Other
and unspecified syphilis); (A53.0-Latent syphilis,
unspecified as early or late); (A53.9-Syphilis, √
unspecified); (A65-Nonvenereal syphilis)

12 Sindrom duh (discharge) genital (A54-Gonococcal infection); (A54.0-Gonococcal

(gonore dan non gonore) infection of lower genitourinary tract without
periurethral or accessory gland abscess);
(A54.3-Gonococcal infection of eye); (A54.5-
Gonococcal pharyngitis); (A54.6-Gonococcal
infection of anus and rectum); (A54.8-Other
gonococcal infections); (A54.9-Gonococcal
infection, unspecified); (A56-Other sexually
transmitted chlamydial diseases); (A56.0- √
Chlamydial infection of lower genitourinary tract);
(A56.2-Chlamydial infection of genitourinary
tract, unspecified); (A56.8-Sexually transmitted
chlamydial infection of other sites); (A64-
Unspecified sexually transmitted disease)

13 Gonore (A54-Gonococcal infection); (A54.0-Gonococcal

infection of lower genitourinary tract without
periurethral or accessory gland abscess);
(A54.3-Gonococcal infection of eye); (A54.5-
Gonococcal pharyngitis); (A54.6-Gonococcal √
infection of anus and rectum); (A54.8-Other
gonococcal infections); (A54.9-Gonococcal
infection, unspecified); (A64-Unspecified
sexually transmitted disease)

14 Demam dengue, DHF (A90-Dengue fever [classical dengue]); (A91- Bila tidak jatuh pada
Dengue haemorrhagic fever) √ kondisi Dengue Shock
Syndrome
15 Herpes simpleks tanpa komplikasi (B00-Herpesviral [herpes simplex] infections);
(B00.8-Other forms of herpesviral infection); √
(B00.9-Herpesviral infection, unspecified)
16 Varisela tanpa komplikasi (B01-Varicella [chickenpox]); (B01.9-Varicella
√
without complication)
17 Herpes zoster tanpa komplikasi (B02-Zoster [herpes zoster]); (B02.9-Zoster
√
without complication)
18 Morbili tanpa komplikasi (B05-Measles); (B05.9-Measles without
√
complication)
19 Veruka vulgaris (B07-Viral warts) √
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
20 Moluskum kontagiosum (B08-Other viral infections characterized by skin
and mucous membrane lesions, not elsewhere
classified); (B08.1-Molluscum contagiosum) √

21 Hepatitis A (B15-Acute hepatitis A); (B15.9-Hepatitis A

√
without hepatic coma)
22 Parotitis (B26-Mumps); (B26.9-Mumps without
√
complication)
23 Tinea kapitis (B35-Dermatophytosis); (B35.0- Tinea barbae
√
and tinea capitis)
24 Tinea barbe (B35-Dermatophytosis); (B35.0- Tinea barbae
√
and tinea capitis)
25 Tinea unguium (B35-Dermatophytosis); (B35.1- Tinea unguium)
√

26 Tinea manus (B35-Dermatophytosis); (B35.2-Tinea manuum)

√

27 Tinea pedis (B35-Dermatophytosis); (B35.3- Tinea pedis) √

28 Tinea korporis (B35-Dermatophytosis); (B35.4-Tinea corporis);
√
(B35.5-Tinea imbricata)
29 Tinea kruris (B35-Dermatophytosis); (B35.6-Tinea cruris) √
30 Tinea fasialis (B35-Dermatophytosis); (B35.8-Other
dermatophytoses); (B35.9-Dermatophytosis, √
unspecified)
31 Pitiriasis versikolor (B36-Other superficial mycoses); (B36.0-
Pityriasis versicolor); (B36.1-Tinea nigra);
(B36.2-White piedra); (B36.3-Black piedra); √
(B36.8-Other specified superficial mycoses);
(B36.9-Superficial mycosis, unspecified)
32 Kandidosis mukokutan ringan (B37-Candidal stomatitis); (B37.2-Candidiasis of
skin and nail); (B37.8-Candidiasis of other sites); √
(B37.9-Candidiasis, unspecified)
33 Kandidiasis mulut (B37-Candidiasis); (B37.0-Candidal stomatitis);
√
(B37.9-Candidiasis, unspecified)
34 Skistosomiasis (B65-Schistosomiasis [bilharziasis]); (B65.0-
Schistosomiasis due to Schistosoma
haematobium [urinary schistosomiasis]); (B65.1-
Schistosomiasis due to Schistosoma mansoni
[intestinal schistosomiasis]); (B65.2- √
Schistosomiasis due to Schistosoma
japonicum); (B65.3-Cercarial dermatitis); (B65.8-
Other schistosomiases); (B65.9-
Schistosomiasis, unspecified)

35 Taeniasis (B68-Taeniasis); (B68.0-Taenia solium

taeniasis); (B68.1-Taenia saginata taeniasis); √
(B68.9-Taeniasis, unspecified)
36 Filariasis (B74-Filariasis); (B74.0-Filariasis due to
Wuchereria bancrofti); (B74.1-Filariasis due to
Brugia malayi); (B74.2-Filariasis due to Brugia
Pemeriksaan dilakukan
timori); (B74.3-Loiasis); (B74.4-Mansonelliasis);
√ dengan mikroskop atau
(B74.8-Other filariases); (B74.9-Filariasis, melalui tes kimia khusus
unspecified); (Z11.6-Special screening menggunakan antigen.
examination for other protozoal diseases and
helminthiases)

37 Penyakit cacing tambang (B76-Hookworm diseases); (B76.0- Bila tidak ada komplikasi
Ancylostomiasis); (B76.1-Necatoriasis); (B76.8-
Other hookworm diseases); (B76.9-Hookworm √
disease, unspecified)
38 Cutaneus larva migran (B76-Hookworm diseases); (B76.0-
Ancylostomiasis); (B76.1-Necatoriasis); (B76.8-
Other hookworm diseases); (B76.9-Hookworm
disease, unspecified); (B87.0-Cutaneous √
myiasis); (B87.9-Myiasis, unspecified)

39 Askariasis (B77-Ascariasis); (B77.9-Ascariasis, Diperlukan pemeriksaan

unspecified); (K93.8-Disorders of other specified feces
digestive organs in diseases classified √
elsewhere)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
40 Strongiloidiasis (B78-Strongyloidiasis); (B78.0-Intestinal Untuk penegakkan
strongyloidiasis); (B78.1-Cutaneous diperlukan Aspirasi
strongyloidiasis); (B78.7-Disseminated duodenal, Tes Cairan
strongyloidiasis); (B78.9-Strongyloidiasis, √
tubuh, Tes Antigen, Study
unspecified) sampel feces, dan kultur
sampel feces.
41 Malaria (B85.3-Phthiriasis); (B50-Plasmodium falciparum Hanya konservatif.
malaria); (B50.9-Plasmodium falciparum Keterbatasan
malaria, unspecified); (B51-Plasmodium vivax pemeriksaan penunjang
malaria); (B51.8-Plasmodium vivax malaria with dan obat anti malaria
other complications); (B51.9-Plasmodium vivax
malaria without complication); (B52-Plasmodium
malariae malaria); (B52.8-Plasmodium malariae
malaria with other complications); (B52.9-
Plasmodium malariae malaria without
complication); (B53-Other parasitologically √
confirmed malaria); (B53.0-Plasmodium ovale
malaria); (B53.1-Malaria due to simian
plasmodia); (B53.8-Other parasitologically
confirmed malaria, not elsewhere classified);
(B54-Unspecified malaria)

42 Pedikulosis pubis (B85-Pediculosis and phthiriasis); (B85.0- Dibutuhkan Scabicide

√
Pediculosis due to Pediculus humanus capitis)
43 Pedikulosis kapitis (B85-Pediculosis and phthiriasis); (B85.0- Dibutuhkan Emulsi
Pediculosis due to Pediculus humanus capitis); Gameksan 1%
(B85.1- Pediculosis due to Pediculus humanus √
corporis); (B85.4- Mixed pediculosis and
phthiriasis)
44 Skabies (B86-Scabies) √
45 Lipoma (D17-Benign lipomatous neoplasm); (D17.0-
Benign lipomatous neoplasm of skin and
subcutaneous tissue of head, face and neck);
(D17.1-Benign lipomatous neoplasm of skin and
subcutaneous tissue of trunk); (D17.2-Benign
lipomatous neoplasm of skin and subcutaneous
tissue of limbs); (D17.3-Benign lipomatous √
neoplasm of skin and subcutaneous tissue of
other and unspecified sites); (D17.7-Benign
lipomatous neoplasm of other sites); (D17.9-
Benign lipomatous neoplasm, unspecified)

46 Anemia defisiensi besi (D50-Iron deficiency anaemia); (D50.8-Other

iron deficiency anaemias); (D50.9-Iron
deficiency anaemia, unspecified); (D64-Other √
anaemias); (D64.8-Other specified anaemias);
(D64.9-Anaemia, unspecified)
47 Anemia defisiensi besi pada (D50-Iron deficiency anaemia); (D50.8-Other
kehamilan iron deficiency anaemias); (D50.9-Iron
deficiency anaemia, unspecified); (O99.0- √
Anaemia complicating pregnancy, childbirth and
the puerperium)
48 Diabetes melitus tipe 1 (E10-Insulin-dependent diabetes mellitus); Memerlukan insulin
(E10.9-Insulin-dependent diabetes mellitus √ sintetik
without complications)
49 Diabetes melitus tipe 2 (E11-Non-insulin-dependent diabetes mellitus);
(E11.9-Non-insulin-dependent diabetes mellitus √
without complications)
50 Hipoglikemia ringan (E16-Other disorders of pancreatic internal
secretion); (E16.1-Other hypoglycaemia); √
(E16.2-Hypoglycaemia, unspecified)
51 Malnutrisi energi-protein (E40-Kwashiorkor); (E41-Nutritional marasmus); Memerlukan pemeriksaan
(E42-Marasmic kwashiorkor); (E44-Protein- penunjang serum
energy malnutrition of moderate and mild albumin, kultur bakteri,
degree); (E44.0-Moderate protein-energy tes tusuk kulit untuk
malnutrition); (E44.1-Mild protein-energy √ melihat adanya alergi.
malnutrition); (E46-Unspecified protein-energy
malnutrition); (E64.0-Sequelae of protein-energy
malnutrition)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
52 Defisiensi vitamin (E50-Vitamin A deficiency); (E50.0-Vitamin A
deficiency with conjunctival xerosis); (E50.1-
Vitamin A deficiency with Bitot spot and
conjunctival xerosis); (E50.2-Vitamin A
deficiency with corneal xerosis); (E50.3-Vitamin
A deficiency with corneal ulceration and xerosis);
(E50.4-Vitamin A deficiency with keratomalacia);
(E50.5-Vitamin A deficiency with night
blindness); (E50.6-Vitamin A deficiency with
xerophthalmic scars of cornea); (E50.7-Other
ocular manifestations of vitamin A deficiency);
(E50.8-Other manifestations of vitamin A
deficiency); (E50.9-Vitamin A deficiency,
unspecified); (E51-Thiamine deficiency); (E51.1- √
Beriberi); (E51.8-Other manifestations of
thiamine deficiency); (E51.9-Thiamine
deficiency, unspecified); (E52-Niacin deficiency
[pellagra]); (E53-Deficiency of other B group
vitamins); (E53.0-Riboflavin deficiency); (E53.1-
Pyridoxine deficiency); (E53.8-Deficiency of
other specified B group vitamins); (E53.9-
Vitamin B deficiency, unspecified); (E54-
Ascorbic acid deficiency); (E55-Vitamin D
deficiency); (E55.0-Rickets, active); (E55.9-
Vitamin D deficiency, unspecified); (E56-Other
vitamin deficiencies); (E56.0-Deficiency of
vitamin E); (E56.1-Deficiency of vitamin K);
(E56.8-Deficiency of other vitamins); (E56.9-
53 Defisiensi mineral (E58-Dietary calcium deficiency); (E59-Dietary
selenium deficiency); (E60-Dietary zinc
deficiency); (E61-Deficiency of other nutrient
elements); (E61.0-Copper deficiency); (E61.1-
Iron deficiency); (E61.2-Magnesium deficiency);
(E61.3-Manganese deficiency); (E61.4-
Chromium deficiency); (E61.5-Molybdenum
deficiency); (E61.6-Vanadium deficiency);
(E61.7-Deficiency of multiple nutrient elements);
(E61.8-Deficiency of other specified nutrient
√
elements); (E61.9-Deficiency of nutrient
element, unspecified); (E63-Other nutritional
deficiencies); (E63.0-Essential fatty acid [EFA]
deficiency); (E63.1-Imbalance of constituents of
food intake); (E63.8-Other specified nutritional
deficiencies); (E63.9-Nutritional deficiency,
unspecified)

54 Obesitas (E66-Obesity); (E66.0-Obesity due to excess Bila tidak ada komplikasi

calories); (E66.1-Drug-induced obesity); (E66.8-
Other obesity); (E66.9-Obesity, unspecified) √

55 Dislipidemia (E78-Disorders of lipoprotein metabolism and

other lipidaemias); (E78.0-Pure
hypercholesterolaemia); (E78.1-Pure
hyperglyceridaemia); (E78.2-Mixed
hyperlipidaemia); (E78.3-
Hyperchylomicronaemia); (E78.4-Other
hyperlipidaemia); (E78.5-Hyperlipidaemia, √
unspecified); (E78.6-Lipoprotein deficiency);
(E78.8-Other disorders of lipoprotein
metabolism); (E78.9-Disorder of lipoprotein
metabolism, unspecified)

56 Hiperurisemia (E79-Disorders of purine and pyrimidine

metabolism); (E79.0-Hyperuricaemia without
signs of inflammatory arthritis and tophaceous
disease); (E79.1-Lesch-Nyhan syndrome);
(E79.8-Other disorders of purine and pyrimidine √
metabolism); (E79.9-Disorder of purine and
pyrimidine metabolism, unspecified)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
57 Gangguan somatoform (F45-Somatoform disorders); (F45.0-
Somatization disorder); (F45.1-Undifferentiated
somatoform disorder); (F45.2-Hypochondriacal
disorder); (F45.3-Somatoform autonomic
dysfunction); (F45.4-Persistent somatoform pain √
disorder); (F45.8-Other somatoform disorders);
(F45.9-Somatoform disorder, unspecified)

58 Insomnia (F51-Nonorganic sleep disorders); (F51.0-

Nonorganic insomnia); (F51.2-Nonorganic
disorder of the sleep-wake schedule); (F51.8-
Other nonorganic sleep disorders); (G47.0- √
Disorders of initiating and maintaining sleep
[insomnias])

59 Migren (G43-Migraine); (G43.0-Migraine without aura

[common migraine]); (G43.1-Migraine with aura
[classical migraine]); (G43.2-Status
migrainosus); (G43.8-Other migraine); (G43.9- √
Migraine, unspecified); (N94.3-Premenstrual
tension syndrome)
60 Tension headache (G44-Other Headache Syndromes); (G44.1-
Vascular headache, not elsewhere classified);
(G44.2-Tension-type headache); (G44.3-Chronic
post-traumatic headache); (G44.4-Drug-induced √
headache, not elsewhere classified); (G44.8-
Other specified headache syndromes); (R51-
Headache)

61 Bells' palsy (G51-Facial nerve disorders); (G51.0-Bell's Diperlukan fisioterapi

√
palsy)
62 Hordeolum (H00-Hordeolum and chalazion); (H00.0-
Hordeolum and other deep inflammation of √
eyelid)
63 Blefaritis (H01-Other inflammation of eyelid); (H01.0-
√
Blepharitis)
64 Trikiasis (H02-Other disorders of eyelid); (H02.0- Diperlukan tindakan
Entropion and trichiasis of eyelid) Elektrolisis, Reposisi
√ Folikel dan Bulu mata,
atau Crypsurgery
65 Mata kering (H04-Disorders of lacrimal system); (H04.1-
√
Other disorders of lacrimal gland)
66 Konjungtivitis (H10-Conjunctivitis); (H10.0-Mucopurulent
conjunctivitis); (H10.1-Acute atopic
conjunctivitis); (H10.2-Other acute
conjunctivitis); (H10.3-Acute conjunctivitis,
unspecified); (H10.4-Chronic conjunctivitis);
(H10.5-Blepharoconjunctivitis); (H10.8-Other
conjunctivitis); (H10.9-Conjunctivitis,
unspecified); (B30-Viral conjunctivitis); (B30.1- √
Conjunctivitis due to adenovirus ); (B30.2-Viral
pharyngoconjunctivitis); (B30.8-Other viral
conjunctivitis ); (B30.9-Viral conjunctivitis,
unspecified); (H13.1-Conjunctivitis in infectious
and parasitic diseases classified elsewhere)

67 Perdarahan subkonjungtiva (H11-Other disorders of conjunctiva); (H11.3-

Conjunctival haemorrhage); (H57-Other
disorders of eye and adnexa); (H57.8-Other
specified disorders of eye and adnexa); (H57.9- √
Disorder of eye and adnexa, unspecified)

68 Episkleritis (H15-Disorders of sclera); (H15.1-Episcleritis) √ Bila tidak ada komplikasi

69 Hipermetropia ringan (H52-Disorders of refraction and Tidak ada alat dan tenaga
accommodation); (H52.0-Hypermetropia) √ medis yang kompeten

70 Miopia ringan (H52-Disorders of refraction and Tidak ada alat dan tenaga
accommodation); (H52.1-Myopia) √ medis yang kompeten

71 Astigmatism ringan (H52-Disorders of refraction and Tidak ada alat dan tenaga
accommodation); (H52.2-Astigmatism) √ medis yang kompeten
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
72 Presbiopia (H52-Disorders of refraction and Tidak ada alat dan tenaga
accommodation); (H52.4-Presbyopia) √ medis yang kompeten

73 Buta senja (H53-Visual disturbances); (H53.6-Night Tidak ada alat dan tenaga
blindness) √ medis yang kompeten

74 Otitis eksterna (H60-Otitis externa); (H60.0-Abscess of external

ear); (H60.3-Other infective otitis externa);
(H60.5-Acute otitis externa, noninfective);
(H60.8-Other otitis externa); (H60.9-Otitis
externa, unspecified); (H62-Disorders of external
ear in diseases classified elsewhere); (H62.0-
Otitis externa in bacterial diseases classified
elsewhere); (H62.1-Otitis externa in viral
diseases classified elsewhere); (H62.2-Otitis √
externa in mycoses); (H62.3-Otitis externa in
other infectious and parasitic diseases classified
elsewhere); (H62.4-Otitis externa in other
diseases classified elsewhere); (H62.8-Other
disorders of external ear in diseases classified
elsewhere)

75 Serumen prop (H61-Other disorders of external ear); (H61.2-

√
Impacted cerumen)
76 Otitis media akut (H65-Nonsuppurative otitis media); (H65.1-Other Bila tidak ada komplikasi
acute nonsuppurative otitis media); (H65.9-
Nonsuppurative otitis media, unspecified); (H66-
Suppurative and unspecified otitis media);
(H66.0-Acute suppurative otitis media); (H66.4-
Suppurative otitis media, unspecified); (H66.9-
Otitis media, unspecified); (H67-Otitis media in
diseases classified elsewhere); (H67.0-Otitis √
media in bacterial diseases classified
elsewhere); (H67.1-Otitis media in viral diseases
classified elsewhere); (H67.8-Otitis media in
other diseases classified elsewhere)

77 Hipertensi esensial (I10-Essential (primary) hypertension) √

78 Hemoroid grade 1-2 (I84-Haemorrhoids); (I84.2-Internal
haemorrhoids without complication); (I84.5-
External haemorrhoids without complication); √
(I84.9-Unspecified haemorrhoids without
complication)
79 Limfadenitis (I88-Nonspecific lymphadenitis); (I88.0-
Nonspecific mesenteric lymphadenitis); (I88.1-
Chronic lymphadenitis, except mesenteric);
(I88.8-Other nonspecific lymphadenitis); (I88.9-
Nonspecific lymphadenitis, unspecified); (L04-
Acute lymphadenitis); (L04.0-Acute
lymphadenitis of face, head and neck); (L04.1- √
Acute lymphadenitis of trunk); (L04.2-Acute
lymphadenitis of upper limb); (L04.3-Acute
lymphadenitis of lower limb); (L04.8-Acute
lymphadenitis of other sites); (L04.9-Acute
lymphadenitis, unspecified)

80 Rhinitis akut (J00-Acute nasopharyngitis [common cold]) √

81 Faringitis (J02-Acute pharyngitis); (J02.0-Streptococcal
pharyngitis); (J02.8-Acute pharyngitis due to
other specified organisms); (J02.9-Acute
pharyngitis, unspecified); (J31-Chronic rhinitis, √
nasopharyngitis and pharyngitis); (J31.1-Chronic
nasopharyngitis); (J31.2-Chronic pharyngitis)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
82 Tonsilitis (J03-Acute tonsillitis); (J03.0-Streptococcal
tonsillitis); (J03.8-Acute tonsillitis due to other
specified organisms); (J03.9-Acute tonsillitis,
unspecified); (J35-Chronic diseases of tonsils
and adenoids); (J35.0-Chronic tonsillitis); (J35.1-
√
Hypertrophy of tonsils); (J35.8-Other chronic
diseases of tonsils and adenoids); (J35.9-
Chronic disease of tonsils and adenoids,
unspecified)

83 Laringitis (J04-Acute laryngitis and tracheitis); (J04.0-

Acute laryngitis); (J37-Chronic laryngitis and √
laryngotracheitis); (J37.0-Chronic laryngitis)
84 Influenza (J10-Influenza due to other identified influenza
virus); (J10.0-Influenza with pneumonia, other
influenza virus identified); (J10.1-Influenza with
other respiratory manifestations, other influenza
virus identified); (J10.8-Influenza with other
manifestations, other influenza virus identified);
(J11-Influenza, virus not identified); (J11.0-
Influenza with pneumonia, virus not identified); √
(J11.1-Influenza with other respiratory
manifestations, virus not identified); (J11.8-
Influenza with other manifestations, virus not
identified); (A49.2-Haemophilus influenzae
infection, unspecified site)

85 Pneumonia, bronkopneumonia (J12-Viral pneumonia, not elsewhere classified); Bila tidak ada
(J12.0-Adenoviral pneumonia); (J12.1- komplikasi/infeksi
Respiratory syncytial virus pneumonia); (J12.2- sekunder
Parainfluenza virus pneumonia); (J12.3-Human
metapneumovirus pneumonia); (J12.8-Other
viral pneumonia); (J12.9-Viral pneumonia,
unspecified); (J13-Pneumonia due to
Streptococcus pneumoniae); (J14-Pneumonia
due to Haemophilus influenzae); (J15-Bacterial
pneumonia, not elsewhere classified); (J15.0-
Pneumonia due to Klebsiella pneumoniae);
(J15.1-Pneumonia due to Pseudomonas);
(J15.2-Pneumonia due to staphylococcus);
(J15.3-Pneumonia due to streptococcus, group √
B); (J15.4-Pneumonia due to other streptococci);
(J15.5-Pneumonia due to Escherichia coli);
(J15.6-Pneumonia due to other aerobic Gram-
negative bacteria); (J15.7-Pneumonia due to
Mycoplasma pneumoniae); (J15.8-Other
bacterial pneumonia); (J15.9-Bacterial
pneumonia, unspecified); (J16-Pneumonia due
to other infectious organisms, not elsewhere
classified); (J16.0-Chlamydial pneumonia);
(J16.8-Pneumonia due to other specified
infectious organisms); (J17-Pneumonia in
diseases classified elsewhere); (J17.0-
Pneumonia in bacterial diseases classified
elsewhere); (J17.1-Pneumonia in viral diseases
86 Bronkitis akut (J20-Acute bronchitis); (J20.0-Acute bronchitis
due to Mycoplasma pneumoniae); (J20.1-Acute
bronchitis due to Haemophilus influenzae);
(J20.2-Acute bronchitis due to streptococcus);
(J20.3-Acute bronchitis due to coxsackievirus);
(J20.4-Acute bronchitis due to parainfluenza
virus); (J20.5-Acute bronchitis due to respiratory
syncytial virus); (J20.6-Acute bronchitis due to
rhinovirus); (J20.7-Acute bronchitis due to
echovirus); (J20.8-Acute bronchitis due to other
specified organisms); (J20.9-Acute bronchitis,
unspecified); (J40-Bronchitis, not specified as √
acute or chronic); (J41-Simple and mucopurulent
chronic bronchitis); (J41.0-Simple chronic
bronchitis); (J41.1-Mucopurulent chronic
bronchitis); (J41.8-Mixed simple and
mucopurulent chronic bronchitis); (J42-
Unspecified chronic bronchitis)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
87 Rhinitis vasomotor (J30-Vasomotor and allergic rhinitis); (J30.1-
√
Vasomotor rhinitis)
88 Rhinitis alergika (J30-Vasomotor and allergic rhinitis); (J30.2-
Allergic rhinitis due to pollen); (J30.3-Other
seasonal allergic rhinitis); (J30.4- Other allergic
rhinitis); (J30.5-Allergic rhinitis, unspecified); √
(J45.0-Predominantly allergic asthma)

89 Furunkel pada hidung (J34-Other disorders of nose and nasal sinuses);

(J34.0-Abscess, furuncle and carbuncle of nose) √

90 Asma bronkial (J45-Asthma); (J45.0-Predominantly allergic

asthma); (J45.1-Nonallergic asthma); (J45.8- √
Mixed asthma); (J45.9-Asthma, unspecified)
91 Ulkus mulut (aptosa, herpes) (K12-Stomatitis and related lesions); (K12.0-
Recurrent oral aphthae); (K12.1-Other forms of
stomatitis); (K12.2-Cellulitis and abscess of √
mouth); (K12.3-Oral mucositis (ulcerative))
92 Refluks gastroesofagus (K21-Gastro-oesophageal reflux disease);
(K21.9-Gastro-oesophageal reflux disease √
without oesophagitis)
93 Gastritis (K29-Gastritis and duodenitis); (K29.1-Other
acute gastritis); (K29.2-Alcoholic gastritis);
(K29.5-Chronic gastritis, unspecified); (K29.6-
Other gastritis); (K29.7-Gastritis, unspecified); √
(K30-Functional dyspepsia); (R10.1-Pain
localized to upper abdomen)

94 Intoleransi makanan (K90-Intestinal malabsorption); (K90.4-

Malabsorption due to intolerance, not elsewhere √
classified)
95 Impetigo (L01-Impetigo); (L01.0-Impetigo [any organism]
[any site]); (L01.1-Impetiginization of other √
dermatoses)
96 Furunkel, karbunkel (L02-cutaneous abscess, furuncle and
carbuncle); (L02.0-Cutaneous abscess, furuncle
and carbuncle of face); (L02.1-Cutaneous
abscess, furuncle and carbuncle of neck);
(L02.2-Cutaneous abscess, furuncle and
carbuncle of trunk); (L02.3-Cutaneous abscess,
furuncle and carbuncle of buttock); (L02.4-
Cutaneous abscess, furuncle and carbuncle of
limb); (L02.8-Cutaneous abscess, furuncle and
carbuncle of other sites); (L02.9-Cutaneous
abscess, furuncle and carbuncle, unspecified);
(H04.0-Dacryoadenitis ); (H60.0-Abscess of
external ear ); (H04.3-Acute and unspecified √
inflammation of lacrimal passages ); (N76.4-
Abscess of vulva); (N48.2- Other inflammatory
disorders of penis); (N49.2-Inflammatory
disorders of scrotum); (N49.8-Inflammatory
disorders of other specified male genital
organs ); (N49.9-Inflammatory disorder of
unspecified male genital organ); (N61-
Inflammatory disorders of breast)

97 Abses folikel rambut atau kelenjar (L02-Cutaneous abscess, furuncle, and

sebasea carbuncle); (L02.0-Cutaneous abscess, furuncle
and carbuncle of face); (L02.1-Cutaneous
abscess, furuncle and carbuncle of neck);
(L02.2-Cutaneous abscess, furuncle and
carbuncle of trunk); (L02.3-Cutaneous abscess,
furuncle and carbuncle of buttock); (L02.4- √
Cutaneous abscess, furuncle and carbuncle of
limb); (L02.8-Cutaneous abscess, furuncle and
carbuncle of other sites); (L02.9-Cutaneous
abscess, furuncle and carbuncle, unspecified)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
98 Impetigo ulseratif (ektima) (L08-Other local infections of skin and
subcutaneous tissue); (L08.0-Pyoderma);
(L08.8-Other specified local infections of skin
and subcutaneous tissue); (L08.9-Local infection √
of skin and subcutaneous tissue, unspecified)

99 Eritrasma (L08-Other local infections of skin and

√
subcutaneous tissue); (L08.1-Erythrasma)
100 Dermatitis atopik (kecuali recalcitrant) (L20-Atopic dermatitis); (L20.0-Besnier prurigo);
(L20.8-Other atopic dermatitis); (L20.9-Atopic √
dermatitis, unspecified)
101 Dermatitis seboroik (L21-Seborrhoeic dermatitis); (L21.0-Seborrhoea
capitis); (L21.1-Seborrhoeic infantile dermatitis);
(L21.8-Other seborrhoeic dermatitis); (L21.9- √
Seborrhoeic dermatitis, unspecified)

102 Napkin eczema (L22-Diaper [napkin] dermatitis) √

103 Dermatitis kontak iritan (L24-Irritant contact dermatitis); (L24.0-Irritant
contact dermatitis due to detergents); (L24.1-
Irritant contact dermatitis due to oils and
greases); (L24.2-Irritant contact dermatitis due to
solvents); (L24.3-Irritant contact dermatitis due
to cosmetics); (L24.4-Irritant contact dermatitis
due to drugs in contact with skin); (L24.5-Irritant
contact dermatitis due to other chemical
products); (L24.6-Irritant contact dermatitis due
to food in contact with skin); (L24.7-Irritant
contact dermatitis due to plants, except food);
(L24.8-Irritant contact dermatitis due to other
agents); (L24.9-Irritant contact dermatitis,
unspecified cause); (L25-Unspecified contact √
dermatitis); (L25.0-Unspecified contact
dermatitis due to cosmetics); (L25.1-Unspecified
contact dermatitis due to drugs in contact with
skin); (L25.2-Unspecified contact dermatitis due
to dyes); (L25.3-Unspecified contact dermatitis
due to other chemical products); (L25.4-
Unspecified contact dermatitis due to food in
contact with skin); (L25.5-Unspecified contact
dermatitis due to plants, except food); (L25.8-
Unspecified contact dermatitis due to other
agents); (L25.9-Unspecified contact dermatitis,
unspecified cause)

104 Exanthematous drug eruption, fixed (L27-Dermatitis due to substances taken Bila tidak ada infeksi
drug eruption internally); (L27.0-Generalized skin eruption due sekunder
to drugs and medicaments); (L27.1-Localized
skin eruption due to drugs and medicaments); √
(R21-Rash and other nonspecific skin eruption)

105 Alergi makanan (L27-Dermatitis due to substances taken

internally); (L27.2-Dermatitis due to ingested
food); (L27.8-Dermatitis due to other substances
taken internally); (L27.9-Dermatitis due to
unspecified substance taken internally); (T78.1- √
Other adverse food reactions, not elsewhere
classified); (T78.4-Allergy, unspecified); (K52.2-
Allergic and dietetic gastroenteritis and colitis)

106 Dermatitis numularis (L30-Other dermatitis); (L30.0-Nummular

dermatitis); (L30.8-Other specified dermatitis); √
(L30.9-Dermatitis, unspecified)
107 Pitiriasis rosea (L42-Pityriasis rosea); (L30.5-Pityriasis alba) √
108 Urtikaria akut (L50-Urticaria); (L50.0-Allergic urticaria); (L50.2-
Urticaria due to cold and heat); (L50.3-
Dermatographic urticaria); (L50.4-Vibratory
urticaria); (L50.6-Contact urticaria); (L50.9-
Urticaria, unspecified); (L56.3-Solar urticaria);
(L29-Pruritus); (L29.0-Pruritus ani); (L29.1- √
Pruritus scroti); (L29.2-Pruritus vulvae); (L29.3-
Anogenital pruritus, unspecified); (L29.8-Other
pruritus); (L29.9-Pruritus, unspecified); (T80.6-
Other serum reactions)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
109 Akne vulgaris ringan (L70-Acne); (L70.0-Acne vulgaris); (L70.1-Acne
conglobata); (L70.2-Acne varioliformis); (L70.3-
Acne tropica); (L70.4-Infantile acne); (L70.5-
Acné excoriée des jeunes filles); (L70.8-Other √
acne); (L70.9-Acne, unspecified); (L71-
Rosacea); (L71.1-Rhinophyma); (L71.8-Other
rosacea); (L71.9-Rosacea, unspecified)

110 Dermatitis perioral (L71-Rosacea); (L71.0-Perioral dermatitis) √

111 Folikulitis superfisialis (L72-Follicular cysts of skin and subcutaneous
tissue); (L72.0-Epidermal cyst); (L72.1-
Trichilemmal cyst); (L72.2-Steatocystoma
multiplex); (L72.8-Other follicular cysts of skin
and subcutaneous tissue); (L72.9-Follicular cyst
of skin and subcutaneous tissue, unspecified);
(L08-Other local infections of skin and
subcutaneous tissue); (L08.0-Pyoderma);
(L08.8-Other specified local infections of skin √
and subcutaneous tissue); (L08.9-Local infection
of skin and subcutaneous tissue, unspecified);
(L66.2-Folliculitis decalvans ); (L66.3-
Perifolliculitis capitis abscedens ); (L66.4-
Folliculitis ulerythematosa reticulata)

112 Hidradenitis supuratif (L73-Other follicular disorders); (L73.0-Acne Bila tidak ada
keloid); (L73.1-Pseudofolliculitis barbae); (L73.2- komplikasi/infeksi
Hidradenitis suppurativa); (L73.8-Other specified √ sekunder
follicular disorders); (L73.9-Follicular disorder,
unspecified)
113 Miliaria (L74-Eccrine sweat disorders); (L74.0-Miliaria
rubra); (L74.1-Miliaria crystallina); (L74.2-Miliaria
profunda); (L74.3-Miliaria, unspecified); (L74.8-
Other eccrine sweat disorders); (L74.9-Eccrine √
sweat disorder, unspecified)

114 Ulkus pada tungkai (L97-Ulcer of lower limb, not elsewhere

classified); (I83-Varicose veins of lower
extremities); (I83.0-Varicose veins of lower
extremities with ulcer); (I83.1-Varicose veins of
lower extremities with inflammation); (I83.2- √
Varicose veins of lower extremities with both
ulcer and inflammation); (I83.9-Varicose veins of
lower extremities without ulcer or inflammation)

115 Pielonefritis tanpa komplikasi (N10-Acute tubulo-interstitial nephritis); (N12- Bila tidak ada
Tubulo-interstitial nephritis, not specified as √ komplikasi/infeksi
acute or chronic) sekunder
116 Infeksi saluran kemih (N39-Other disorders of urinary system); (N39.0-
Urinary tract infection, site not specified);
(N39.8-Other specified disorders of urinary
system); (N39.9-Disorder of urinary system,
unspecified); (O08.8-Other complications √
following abortion and ectopic and molar
pregnancy); (N37.8-Other urethral disorders in
diseases classified elsewhere)

117 Infeksi saluran kemih bagian bawah (N39-Other disorders of urinary system); (N39.0-
Urinary tract infection, site not specified);
(N39.8-Other specified disorders of urinary
system); (N39.9-Disorder of urinary system,
unspecified); (O08.8-Other complications √
following abortion and ectopic and molar
pregnancy); (N37.8-Other urethral disorders in
diseases classified elsewhere)

118 Fimosis (N47-Redundant prepuce, phimosis and

√
paraphimosis)
119 Parafismosis (N47-Redundant prepuce, phimosis and
√
paraphimosis)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
120 Mastitis (N61-Inflammatory disorders of breast); (O91- Bila tidak ada
Infections of breast associated with childbirth); komplikasi/infeksi
(O91.0-Infection of nipple associated with sekunder
childbirth); (O91.1-Abscess of breast associated √
with childbirth); (O91.2-Nonpurulent mastitis
associated with childbirth)

121 Salpingitis (N70-Salpingitis and oophoritis); (N70.0-Acute

salpingitis and oophoritis); (N70.1-Chronic
salpingitis and oophoritis); (N70.9-Salpingitis √
and oophoritis, unspecified)
122 Vaginitis (N76-Other inflammation of vagina and vulva);
(N76.0-Acute vaginitis); (N76.1-Subacute and
chronic vaginitis); (N76.6-Ulceration of vagina); √
(N76.8-Other specified inflammation of vagina
and vulva)
123 Vaginosis bakterialis (N76-Other inflammation of vagina and vulva);
(N76.0-Acute vaginitis); (N76.1-Subacute and
chronic vaginitis); (N76.6-Ulceration of vagina);
(N76.8-Other specified inflammation of vagina
and vulva); (N77-Vulvovaginal ulceration and
inflammation in diseases classified elsewhere);
(N77.1-Vaginitis, vulvitis and vulvovaginitis in √
infectious and parasitic diseases classified
elsewhere); (N77.8-Vulvovaginal ulceration and
inflammation in other diseases classified
elsewhere)

124 Vulvitis (N76-Other inflammation of vagina and vulva);

(N76.2-Acute vulvitis); (N76.3-Subacute and
chronic vulvitis); (N76.4-Abscess of vulva); √
(N76.6-Ulceration of vulva); (N76.8-Other
specified inflammation of vagina and vulva)
125 Aborsi spontan komplit (O03-Spontaneous abortion); (O03.9-Complete Bila tidak ada
or unspecified, without complication); (O04- komplikasi/infeksi
Medical Abortion); (O04.9-Complete or sekunder
unspecified, without complication); (O05-Other
Abortion); (O05.9-Complete or unspecified, √
without complication); (O06-Unspecified
abortion); (O06.9-Complete or unspecified,
without complication)

126 Ruptur perineum tingkat 1-2 (O70-Perineal laceration during delivery);

(O70.0-First degree perineal laceration during
delivery); (O70.1-Second degree perineal √
laceration during delivery)
127 Kehamilan normal (O80-Single spontaneous delivery); (O80.0-
Spontaneous vertex delivery); (O80.1-
Spontaneous breech delivery); (O80.8-Other
single spontaneous delivery); (O80.9-Single
spontaneous delivery, unspecified); (O26.8- √
Other specified pregnancy-related conditions);
(O26.9-Pregnancy-related condition,
unspecified)

128 Inverted nipple (O92-Other disorders of breast and lactation Bila tidak diperlukan
associated with childbirth); (O92.0-Retracted √ invered nipple corrective
nipple associated with childbirth) surgery
129 Cracked nipple (O92-Other disorders of breast and lactation
associated with childbirth); (O92.1-Cracked
nipple associated with childbirth); (N64-Other √
disorders of breast); (N64.0-Fissure and fistula
of nipple)
130 Infeksi pada umbilikus (P38-Omphalitis of newborn with or without mild
√
haemorrhage)
131 Epistaksis (R04-Haemorrhage from respiratory passages); Bila Epistaksis Anterior
√
(R04.0-Epistaxis)
132 Mabuk perjalanan (R11-Nausea and vomiting); (T75.3-Motion
√
sickness)
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
133 Vertigo (Benign paroxysmal positional (R42-Dizziness and giddiness); (H81-Disorders Bila tidak ada komplikasi
vertigo) of vestibular function); (H81.1-Benign atau faktor pemberat
paroxysmal vertigo); (H81.3-Other peripheral
vertigo); (H81.4-Vertigo of central origin); (H82- √
Vertiginous syndromes in diseases classified
elsewhere); (T75.2-Effects of vibration)

134 Kejang demam (R56-Convulsions, not elsewhere classified);

(R56.0-Febrile convulsions); (R56.8-Other and √
unspecified convulsions)
135 Vulnus laseratum, vulnus punctum (T00-Superficial injuries involving multiple body
regions); (T00.0-Superficial injuries involving
head with neck); (T00.1-Superficial injuries
involving thorax with abdomen, lower back and
pelvis); (T00.2-Superficial injuries involving
multiple regions of upper limb(s)); (T00.3-
Superficial injuries involving multiple regions of
lower limb(s)); (T00.6-Superficial injuries
involving multiple regions of upper limb(s) with
lower limb(s)); (T00.8-Superficial injuries
√
involving other combinations of body regions);
(T00.9-Multiple superficial injuries, unspecified);
(T14-Injury of unspecified body region); (T14.0-
Superficial injury of unspecified body region);
(T14.1-Open wound of unspecified body region);
(T14.8-Other injuries of unspecified body
region); (T14.9-Injury, unspecified)

136 Benda asing di konjungtiva (T15-Foreign body on external eye); (T15.1-

Foreign body in conjunctival sac); (T15.8-
Foreign body in other and multiple parts of √
external eye); (T15.9-Foreign body on external
eye, part unspecified)
137 Benda asing (T17-Foreign body in respiratory tract); (T17.1-
√
Foreign body in nostril)
138 Luka bakar derajat 1 dan 2 (T30.0-Burn of unspecified body region,
unspecified degree); (T30.1-Burn of first degree,
body region unspecified); (T30.2-Burn of second
degree, body region unspecified); (T30.4-
Corrosion of unspecified body region,
unspecified degree); (T30.5-Corrosion of first
degree, body region unspecified); (T30.6-
Corrosion of second degree, body region
unspecified); (T21-Burn and corrosion of trunk);
(T21.0-Burn of unspecified degree of trunk);
(T21.1-Burn of first degree of trunk); (T21.2-Burn
of second degree of trunk); (T21.4-Corrosion of
unspecified degree of trunk); (T21.5-Corrosion of
first degree of trunk); (T21.6-Corrosion of √
second degree of trunk); (T22-Burn and
corrosion of shoulder and upper limb, except
wrist and hand); (T22.0-Burn of unspecified
degree of shoulder and upper limb, except wrist
and hand); (T22.1-Burn of first degree of
shoulder and upper limb, except wrist and hand);
(T22.2-Burn of second degree of shoulder and
upper limb, except wrist and hand); (T22.4-
Corrosion of unspecified degree of shoulder and
upper limb, except wrist and hand); (T22.5-
Corrosion of first degree of shoulder and upper
limb, except wrist and hand); (T22.6-Corrosion
of second degree of shoulder and upper limb,
except wrist and hand); (T23-Burn and corrosion
 Penanganan Tuntas dan Mandiri
Keterangan
No. Nama Penyakit Kode dan Nama Kode Diagnosa ICD 10
(Bila Tidak Mampu)
139 Keracunan makanan (T62-Toxic effect of other noxious substances
eaten as food); (T62.0-Ingested mushrooms);
(T62.1-Ingested berries); (T62.2-Other ingested
(parts of) plant(s)); (T62.8-Other specified
noxious substances eaten as food); (T62.9-
Noxious substance eaten as food, unspecified);
(T61-Toxic effect of noxious substances eaten as
seafood); (T61.0-Ciguatera fish poisoning);
(T61.1-Scombroid fish poisoning); (T61.2-Other
fish and shellfish poisoning); (T61.8-Toxic effect
√
of other seafoods); (T61.9-Toxic effect of
unspecified seafood); (K52-Other noninfective
gastroenteritis and colitis); (K52.1-Toxic
gastroenteritis and colitis); (K52.8-Other
specified noninfective gastroenteritis and colitis);
(K52.9-Noninfective gastroenteritis and colitis,
unspecified)

140 Reaksi gigitan serangga (T63-Toxic effect of contact with venomous

√
animals); (T63.4- Venom of other arthropods)
141 Reaksi anafilaktik (T78-Adverse effects, not elsewhere classified);
(T78.2-Anaphylactic shock, unspecified); (T80.5-
Anaphylactic shock due to serum); (T78.0-
Anaphylactic shock due to adverse food √
reaction); (T88.6-Anaphylactic shock due to
adverse effect of correct drug or medicament
properly administered)

142 Kekerasan tajam (X99-Assault by sharp object); (X78-Intentional Bila tidak ada penyulit
self-harm by sharp object); (Y28-Contact with
sharp object, undetermined intent); (Y35.4-Legal
intervention involving sharp objects); (W22- √
Striking against or struck by other objects);
(W26.9-Contact with unspecified sharp object(s))

143 Kekerasan tumpul (Y00-Assault by blunt object); (X79-Intentional Bila tidak ada komplikasi
self-harm by blunt object); (Y29-Contact with dan tanda rupture Organ
blunt object, undetermined intent); (Y35.3-Legal
intervention involving blunt objects); (W22- √
Striking against or struck by other objects)

144 HIV AIDS tanpa komplikasi (Z21-Asymptomatic human immunodeficiency Bila kondisi pasien stabil
virus [HIV] infection status); (R75-Laboratory dan hanya memerlukan
evidence of human immunodeficiency virus tindakan konservatif
[HIV]); (Z11.4-Special screening examination for
human immunodeficiency virus [HIV]); (Z20.6- √
Contact with and exposure to human
immunodeficiency virus [HIV]); (Z71.7-Human
immunodeficiency virus [HIV] counselling)

Mojokerto, September 2019

( dr.IRSYAD HERMINOFA )