iDRG raises the coding standard: from 3 to 5 severity 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 three inpatient severity levels — “I” (Mild), “II” (Moderate), “III” (Severe) — plus code “0” for outpatient care (Permenkes 26/2021). The level depends on whether complications and comorbidities (CC/MCC) are present in the secondary diagnosis. According to the Health Ministry, iDRG expands severity to five categories (InfoPublik, 28 September 2026). Training materials in circulation call this the Complexity Level: code 0 (No CC) through 4 (Catastrophic CC), plus a merge code 9 for cases without a distinct CL. 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. The head of the Health Ministry’s Health Financing Centre has said as much: under iDRG, coding quality and complete clinical documentation determine how accurately claims are grouped and paid.

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 the national trial opened on 1 October 2025 for hospitals partnered with BPJS Kesehatan (InfoPublik, 27 August 2025). By 5 November 2025, 3,075 facilities had joined, and each hospital’s HMS bridging to E-Klaim iDRG was checked against 25 IT checkpoints during onboarding (Health Financing Centre 2025 performance report).

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, which as of 8 November 2026 is still listed as in force and unamended on the Ministry’s legal database. 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.

Update, 8 November 2026 — clarifying the 11 October update. We previously wrote that since September 2026 iDRG had been trialled together with capability-based referral (RBKP) and the standard inpatient class (KRIS). The status needs to be more precise. The Health Ministry and BPJS Kesehatan have started preparing that combined trial in four areas — Bandung city, Tulungagung regency, Makassar city, and Muara Enim regency — involving 94 hospitals and 464 primary-care facilities (ANTARA, 1 October). But according to the Ministry, the 12-month trial only takes effect once a Presidential Regulation is signed (Health Ministry, 2 October 2026). As of 8 November 2026 we have not found that regulation issued. Final iDRG tariffs have not been set either, BPJS Kesehatan says the trial still needs evaluation and refinement, and there is no national go-live date.

Two other points from the Ministry reinforce this article’s argument. iDRG will cover about 57,000 cases that previously had no group or tariff (InfoPublik, 28 September 2026), and the Ministry is drafting an Indonesian Coding Standard (ICS) as the coding guide for iDRG (Health Financing Centre 2025 performance report). We have also removed the national-trial circular number we cited earlier, because we could not find it in any official source.

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.