iDRG raises the coding standard: from 4 levels to 5 complexity levels

Hospitals today are working through the right checklist: SATUSEHAT connected, NIK complete, e-signature certificates underway. But there’s a layer underneath all of that which rarely makes the meeting agenda, even though it directly decides how much a claim is worth: diagnosis and procedure coding. JKN claims today are computed through the INA-CBG grouper from ICD-10 codes (diagnosis) and ICD-9-CM codes (procedures) — and its successor, iDRG, will demand more precision, not less.

Why the standard just went up

INA-CBG has 4 severity-level codes: “0” for outpatient care, then “I” (Mild), “II” (Moderate), “III” (Severe) for inpatient care — determined by whether complications and comorbidities (CC/MCC) are present in the secondary diagnosis. iDRG replaces this with a more granular Complexity Level scale: code 0 (No CC) through 4 (Catastrophic CC), plus a merge code 9 for cases without a distinct CL — five numeric levels in total. A secondary diagnosis that goes unrecorded, or recorded but never coded, means a severity level lower than the actual clinical condition — and a tariff lower than it should be, or a claim the verifier flags for dispute.

Weak spots that often go unnoticed

1. Incomplete secondary diagnoses. A physician records the primary diagnosis, but comorbidities (e.g. diabetes, chronic kidney disease) that affect severity aren’t always written down or coded — yet those are exactly what CC/MCC is built from.
2. ICD-9-CM procedure codes out of sync with the operative note. A procedure documented in the surgical report but not matching the code entered into the claims system creates a mismatch that BPJS verifiers flag.
3. Reliance on a single coder. Small-to-medium hospitals often have only one or two coders; one person’s leave or resignation and coding discipline immediately slips.
4. No internal claim audit before submission. Coding errors only surface after BPJS rejects or disputes the claim — not before submission, while they’re still cheap to fix.
5. The EMR and the coding system run apart. Coders retype from paper or printed PDFs instead of reading directly from a structured EMR — slow, and prone to transcription errors.

What can be prepared now

The timeline, as far as we can source it: initial pilots ran from March 2025 in five cities — Medan, Semarang, Balikpapan, Denpasar, and Makassar — before testing opened nationally in October 2025 under Health Ministry Circular No. HK.02.02/MENKES/936/2025 on the national trial of iDRG at advanced referral facilities partnered with BPJS Kesehatan.

What has not changed: there is still no official national go-live date fully replacing INA-CBG, and JKN claim tariffs still rest on Health Ministry Regulation No. 3 of 2023. The iDRG cost-weight and base-rate figures in circulation remain draft/simulation and can still change — so treat any revenue simulation presented as final numbers with caution.

Because that is where things stand, the safest move is to fix what stays relevant under either scheme: the quality and completeness of clinical documentation (especially CC/MCC), disciplined ICD-10/ICD-9-CM coding, and a routine of internal claim audits. That investment isn’t wasted regardless of the final timeline.

Our honest position

Adievia doesn’t replace a coder’s expertise — that’s clinical-administrative skill that stays with the hospital. What we provide is the E-Klaim INA-CBG flow, which pulls ICD-10/ICD-9-CM codes directly from EMR documentation (not separate re-entry from paper), the INA-CBG grouper, and a disruption-tolerant outbox queue so claims aren’t lost when the network drops. That foundation — coding born from the EMR, not from paper — is the same one needed to face iDRG’s grouper format down the line. Full transition details are in our iDRG guide.