Table 6P.1i - List of ICD-10-CM diagnosis code and ICD-10-PCS procedure code combinations with data analysis by MS-DRG - Single Cases FY 2020											
Single Cases in MS-DRG 515											
Case ID 	MS-DRG 	ICD-10-CM Code Reported as Principal Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Single - A	515	S32.119A	"Unspecified Zone I fracture of sacrum, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach	1	8.0	"$53,301 "	1	8.0	"$53,301 "
Single - B	515	S32.139A	"Unspecified Zone III fracture of sacrum, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach	1	16.0	"$12,807 "	1	16.0	"$12,807 "
Single - C 	515	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach	1	6.0	"$9,849 "	1	6.0	"$9,849 "
Single - D	515	S32.302A	"Unspecified fracture of left ilium, initial encounter for closed fracture"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"	1	8.0	"$14,797 "	1	8.0	"$14,797 "
Single - E	515	S32.392A	"Other fracture of left ilium, initial encounter for closed fracture"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1	5.0	"$5,540 "
Single - F	515	S32.392A	"Other fracture of left ilium, initial encounter for closed fracture"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1	7.0	"$7,842 "
						2	6.0	"$6,691 "			
 Total Single	515					6	8.33	"$17,356 "	6		
											
Single cases in MS-DRG 516											
Case ID 	MS-DRG 	ICD-10-CM Code Reported as Principal Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Single - A	516	S32.10XA	"Unspecified fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1	3.0	"$8,064 "
Single - B	516	S32.10XA	"Unspecified fracture of sacrum, initial encounter for closed fracture"	0QS334Z	"Reposition left pelvic bone with internal fixation device, percutaneous approach"				1	2.0	"$33,342 "
						2	2.5	"$20,703 "			
Single - C 	516	S32.110A	"Nondisplaced Zone I fracture of sacrum, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach				1	4.0	"$5,844 "
Single - D	516	S32.110A	"Nondisplaced Zone I fracture of sacrum, initial encounter for closed fracture"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1	3.0	"$15,515 "
						2	3.5	"$10,679 "			
Single - E	516	S32.119A	"Unspecified Zone I fracture of sacrum, initial encounter for closed fracture"	0QS334Z	"Reposition left pelvic bone with internal fixation device, percutaneous approach"	1	2.0	"$4,726 "	1	2.0	"$4,726 "
Single - F	516	S32.19XA	"Other fracture of sacrum, initial encounter for closed fracture"	0QS334Z	"Reposition left pelvic bone with internal fixation device, percutaneous approach"	1	5.0	"$12,919 "	1	5.0	"$12,919 "
Single - G	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1	5.0	"$9,850 "
Single - H	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1	6.0	"$47,031 "
Single - I	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1	5.0	"$17,324 "
Single - J	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1	5.0	"$9,579 "
Single - K	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1	9.0	"$21,875 "
Single - L	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1	9.0	"$14,372 "
						6	6.5	"$20,005 "			
Single - M	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach				1	2.0	"$12,535 "
Single - N	516	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach				1	7.0	"$11,315 "
						2					
						8	6.0	"$17,895 "			
Single - O	516	S32.301B	"Unspecified fracture of right ilium, initial encounter for open fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1		
Single - P	516	S32.301K	"Unspecified fracture of right ilium, subsequent encounter for fracture with nonunion"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1		
Single - Q	516	S32.311A	"Displaced avulsion fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1		
Single - R	516	S32.391A	"Other fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1			1		
Single - S	516	S32.392K	"Other fracture of left ilium, subsequent encounter for fracture with nonunion"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1	4.0	"$7,961 "
Single - T	516	S32.392K	"Other fracture of left ilium, subsequent encounter for fracture with nonunion"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1	2.0	"$7,399 "
						2					
Total Single 	516					20	4.35	"$14,163 "	20		
											
Single cases in MS-DRG 517											
Case ID 	MS-DRG 	ICD-10-CM Code Reported as Principal Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Single - A	517	S32.301A	"Unspecified fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1	5.0	"$11,555 "	1	5.0	"$11,555 "
Single - B	517	S32.301K	"Unspecified fracture of right ilium, subsequent encounter for fracture with nonunion"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1	1.0	"$4,733 "	1	1.0	"$4,733 "
Single - C 	517	S32.391B	"Other fracture of right ilium, initial encounter for open fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1	1.0	"$6,782 "	1	1.0	"$6,782 "
Single - D	517	S32.392A	"Other fracture of left ilium, initial encounter for closed fracture"	0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"	1	3.0	"$17,476 "	1	3.0	"$17,476 "
Total Single	517					4	2.5	"$10,136 "	4		
											
Single cases in MS-DRG 907											
Case ID 	MS-DRG 	ICD-10-CM Code Reported as Principal Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Single - A	907	S32.10XA	"Unspecified fracture of sacrum, initial encounter for closed fracture"	0SG704Z	"Fusion of right sacroiliac joint with internal fixation device, open approach"	1	25.0	"$97,151 "	1	25.0	"$97,151 "
Total Single	907					1	25.0	"$97,151 "			
											
Single cases in MS-DRG 908											
Case ID 	MS-DRG 	ICD-10-CM Code Reported as Principal Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Single - A	908	S32.311A	"Displaced avulsion fracture of right ilium, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"	1	6.0	"$19,741 "	1	6.0	"$19,741 "
Total Single 	908					1	6.0	"$19,741 "			
