APPENDIX K - REVISED RACE CODING RULES

(Effective with 2004 diagnoses)

 

Race (and ethnicity) is defined by specific physical, hereditary and cultural traditions or origins, not necessarily by birthplace, place of residence, or citizenship. 'Origin' is defined by the US Census Bureau as the heritage, nationality group, lineage, or in some cases, the country of birth of the person or the person’s parents or ancestors before their arrival in the United States.

 

All resources in the facility, including the medical record, face sheet, physician and nursing notes, photographs, and any other sources, must be used to determine race. If a facility does not print race in the medical record but does maintain it in electronic form, the electronic data must also be reviewed.  Recommendation: document how the race code was determined in a text field.

 

Coding Instructions

 

1. Code the primary race(s) of the patient in fields Race 1, Race 2, Race 3, Race 4, and Race 5. The five race fields allow for the coding of multiple races consistent with the Census 2000. Rules 2 - 8 further specify how to code Race 1, Race 2, Race 3, Race 4 and Race 5.

 

2. If a person’s race is a combination of white and any other race(s), code the appropriate other

      race(s) first and code white in the next race field.

 

3. If a person’s race is a combination of Hawaiian and any other race(s), code Race 1 as 07

    Hawaiian and code the other races in Race 2, Race 3, Race 4, and Race 5 as appropriate.

    Example: Patient is described as Japanese and Hawaiian. Code Race 1 as 07 Hawaiian, Race 2

    as 05 Japanese, and Race 3 through Race 5 as 88.

 

4. If the person is not Hawaiian, code Race 1 to the first stated non-white race (02-98).

     Example: Patient is stated to be Vietnamese and Black. Code Race 1 as 10 Vietnamese, Race 2

      as 02 Black, and Race 3 through Race 5 as 88.

     Note: in the following scenarios, only the race code referred to in the example is coded. For

      cases diagnosed after January 1, 2000, all race fields must be coded.

 

5. The fields Place of Birth, Race, Marital Status, Name, Maiden Name, and Hispanic Origin are

     inter-related. Use the following guidelines in priority order:

a. Code the patient’s stated race, if possible. Refer to Appendix "Race and Nationality

Descriptions from the 2000 Census and Bureau of Vital Statistics" for guidance.

Example 1: Patient is stated to be Japanese. Code as 05 Japanese.

Example 2: Patient is stated to be German-Irish. Code as 01 White.

Example 3: Patient is described as Arabian. Code as 01 White.

Exception: When the race is recorded as Oriental, Mongolian, or Asian (coded to 96

Other Asian) and the place of birth is recorded as China, Japan, the Philippines, or

another Asian nation, code the race based on birthplace information.

Example 4: The person’s race is recorded as Asian and the place of birth is recorded as

Japan. Code race as 05 Japanese because it is more specific than 96 Asian, NOS.

Example 5: The person describes himself as an Asian-American born in Laos. Code race as 11 Laotian because it is more specific than 96 Asian, NOS.

 

6. If the patient’s race is determined on the basis of the races of relatives, there is no priority to

    coding race, other than to list the non-white race(s) first.

    Example: The patient is described as Asian-American with Korean parents. Code race as 08

    Korean because it is more specific than 96 Asian [-American].

 

7. If no race is stated in the medical record, or if the stated race cannot be coded, review the

    documentation for a statement of a race category.

     Example 1: Patient described as a black female. Code as 02 Black.

     Example 2: Patient describes herself as multi-racial (nothing more specific) and nursing notes say

     "African-American." Code as 02 Black.

      Example 3: Patient states she has a Polynesian mother and Tahitian father. Code Race 1 as 25

      Polynesian, Race 2 as 26 Tahitian and Race 3 through Race 5 as 88.

 

8. If race is unknown or not stated in the medical record and birth place is recorded, in some cases

    race may be inferred from the nationality. Refer to the Appendix entitled "Race and Nationality

    Descriptions from the 2000 Census and Bureau of Vital Statistics" to identify nationalities from

    which race codes may be inferred.

     Example 1: Record states: "this native of Portugal..." Code race as 01 White per the Appendix.

     Example 2: Record states: "this patient was Nigerian..." Code race as 02 Black per the

     Appendix.

     Exception: If the patient’s name is incongruous with the race inferred on the basis of

     nationality, code Race 1 through Race 5 as 99, Unknown.

     Example 1: Patient’s name is Siddhartha Rao and birthplace is listed as England. Code Race

     1 through Race 5 as 99 Unknown.

     Example 2: Patient’s name is Ping Chen and birthplace is Ethiopia. Code Race 1 through

     Race 5 as 99 Unknown.

 

9. Use of patient name in determining race:

a. Do not code race from name alone, especially for females with no maiden name given.

b. In general, a name may be an indicator of a racial group, but should not be taken as the only indicator of race.

c. A patient name may be used to identify a more specific race code.

Example 1: Race reported as Asian, name is Hatsu Mashimoto. Code race as 05 Japanese.

Example 2: Birthplace is reported as Guatemala and name is Jose Chuicol [name is identified as Mayan]. Code race as 03 Native American

d. A patient name may be used to infer Spanish ethnicity or place of birth, but a Spanish name alone (without a statement about race or place of birth) cannot be used to determine the race code. Refer to ethnicity guidelines for further information.

Example: Alice Gomez is a native of Indiana (implied birthplace: United States). Code  Race 1 through Race 5 as 99 Unknown, because nothing is known about her race.

 

10. Persons of Spanish or Hispanic origin may be of any race, although persons of Mexican, Central American, South American, Puerto Rican, or Cuban origin are usually white. Do NOT code a patient stated to be Hispanic or Latino as 98 Other Race in Race 1 and 88 in Race 2 through Race 5.

      Example: Sabrina Fitzsimmons is a native of Brazil. Code race as 01 White per Appendix.

 

11. When the race is recorded as Negro or African-American, code race as 02 Black.

 

12. Code 03 should be used for any person stated to be Native American or [western hemisphere]

      Indian, whether from North, Central, South, or Latin America. For Central, South, or Latin

      American Indians, see additional ethnicity coding guidelines under Spanish Surname or Origin.

 

13. Death certificate information may be used to supplement antemortem race information only when race is coded unknown in the patient record or when the death certificate information is more specific.

      Example 1: In the cancer record Race 1 through Race 5 are coded as 99 Unknown. The death

      certificate states race as black. Change cancer record for Race 1 to 02 Black and Race 2 through

      Race 5 to 88.

      Example 2: Race 1 is coded in the cancer record as 96 Asian. Death certificate gives birthplace

      as China. Change Race 1 in the cancer record to 04 Chinese and code Race 2 through Race 5 as

      88.

 

Race and nationality descriptions from the 2000 Census and Bureau of Vital Statistics can be found at:

 

http://seer.cancer.gov/manuals/2010/SPCSM_2010_AppendixD.pdf