Table 6P.1k - List of ICD-10-CM diagnosis code and ICD-10-PCS procedure code combinations with data analysis by MS-DRG - Bilateral Cases FY 2020											
Bilateral Cases in MS-DRG 515 - (Percutaneous Approaches )											
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 
Bilateral - A	515	S32.19XA	"Other fracture of sacrum, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach				1		
				0QS334Z	"Reposition left pelvic bone with internal fixation device, percutaneous approach"				1		
						1	11.0	"$30,306 "	2		
Total Bilateral	515					1	11.0	"$30,306 "	2		
											
Bilateral Cases in MS-DRG 516 - (Open Approaches )											
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 
Bilateral - 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		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1			2	7.0	"$22,266 "
Bilateral - B	516	S32.10XA	"Unspecified fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1			2	5.0	"$16,012 "
						2	6.0	"$19,139"	4		
Bilateral - C 	516	S32.119A	"Unspecified Zone I fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1	8.0	"$33,932 "	2		
Bilateral - D	516	S32.129A	"Unspecified Zone II fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1	5.0	"$14,651 "	2		
Bilateral - E	516	S32.139A	"Unspecified Zone III fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1	12.0	"$24,099 "	2		
Bilateral - F	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		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1	4.0	"$19,543 "	2		
Total Bilateral	516					6	6.83	"$21,751 "	12		
											
Bilateral Cases in MS-DRG 517 - (Open Approaches )											
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 
Bilateral - A	517	S32.119A	"Unspecified Zone I fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1	2.0	"$10,103 "	2		
Total Bilateral	517					1	2.0	"$10,103 "	2		
											
											
Bilateral Cases in MS-DRG 907 - (Percutaneous Approaches )											
Case ID	MS-DRG 	ICD-10-CM Code Reported as Secondary Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Bilateral - A	907	S32.120A	"Nondisplaced Zone II fracture of sacrum, initial encounter for closed fracture"	0QS234Z	Reposition right pelvic bone with internal fixation device percutaneous approach				1		
				0QS334Z	"Reposition left pelvic bone with internal fixation device, percutaneous approach"				1		
						1	7.0	"$25,724 "	2		
Total Bilateral	907					1	7.0	"$25,724 "	2		
											
Bilateral Cases in MS-DRG 907 - (Open Approaches )											
Case ID	MS-DRG 	ICD-10-CM Code Reported as Secondary Diagnosis 	Description 	ICD-10-PCS Code Reported for Procedure 	Description 	Case Count	Average Length of Stay 	Average Costs 	Procedure Count 	Length of Stay 	Cost 
Bilateral - A	907	S32.14XA	"Type 1 fracture of sacrum, initial encounter for closed fracture"	0QS204Z	"Reposition right pelvic bone with internal fixation device, open approach"				1		
				0QS304Z	"Reposition left pelvic bone with internal fixation device, open approach"				1		
						1	3.0	"$14,669 "	2		
Total Bilateral	907					1	3.0	"$14,669 "	2		
