<![CDATA[Background: Inaccuracy in diagnostic coding of the top ten outpatient diseases at Puskesmas Ngaglik II Sleman, compromises health data quality. This issue is driven by coding practices that deviate from established policies and suboptimal Standard Operating Procedures (SOP). Methods: This descriptive qualitative study utilized a cross-sectional design to evaluate physicians, medical records staff, and 95 medical records from December 2025, selected via the Slovin formula and simple random sampling. Data were collected through observation, documentation, and interviews, then analyzed using a fishbone diagram (5M framework) and the CARL method for problem prioritization. Results and Discussion: Diagnostic coding was performed directly by healthcare providers without verification by medical records professionals. Coding inaccuracies were attributed to man (competence), method (unspecific (SOP)), machine (incomplete diagnostic codes in the SIMPUS health information system), and money (lack of budget for training). The CARL method successfully determined the primary priority problem requiring immediate intervention. Conclusion: Improving coding accuracy requires enhancing staff competence, refining specific SOP, and conducting regular evaluations and training. Kata kunci: CARL; Codification; Fishbone; ICD-10; Inaccuracy]]>
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