Overview of Diagnosis Code BPJS Patient Based on ICD-10 at Sengkol Health Center

Abstract

Community health centers (Puskesmas) implement electronic health records, which include diagnostic coding using the ICD-10 system. However, coding inaccuracies frequently trigger financial deficits due to reductions in BPJS reimbursement claims. This study aims to determine the accuracy of the resulting diagnostic codes and medical procedures. This descriptive study utilized a document review approach evaluating BPJS patient medical record files from December 2025. Data collection was conducted through direct observation utilizing a checklist instrument. The results from the analysis of 90 medical record files revealed that 85 files (94.4%) were coded accurately, while 5 files (5.6%) contained inaccurate codes. Variations in coding errors included incomplete or non-specific entry of the final digit character (as observed in Diabetes Mellitus, Calculus of kidney, and URTI), block code selection errors in chronic kidney disease, and inappropriate grouping of combination diagnoses into a non-specific single code for Gastritis and duodenitis cases. The primary factors causing these diagnostic coding inaccuracies include: 1) attending physicians frequently documenting incomplete diagnoses in the medical record files; 2) coders failing to conduct cross-checks or clarifications with the physicians when encountering ambiguous diagnostic entries; and 3) a lack of meticulousness among coding officers who tended to rely on shorthand reference notebooks ("buku pintar") rather than directly consulting the official ICD-10 guidelines.