III.2.9 Race and Ethnicity

The CCR requires that race code documentation must be supported by text documentation for those cases where there is conflicting information. Outlined below are examples of when text documentation would be required. A text statement indicating patient’s race, i.e., “Pt is Japanese”, is required for conflicting types of cases. Such remarks must be entered in either the physical exam or remarks text fields.

Examples

Note: These examples are not intended to demonstrate all possible scenarios.

Scenarios Demonstrating Conflicting Race Information:

Cases with conflicting information, that lack supporting text documentation, will be returned as queries and counted as discrepancies.

While race code documentation is only required when there is conflicting information, CCR recognizes the importance of race code documentation and strongly recommends that registrars document race in the physical exam or remarks fields. Remember to search beyond the face-sheet for the most definitive race and/or ethnicity information.

Race and ethnicity are defined by specific physical, heredity and cultural traditions, not by birthplace or place of residence. Beginning with cases diagnosed January 1, 2000, four race fields were added to the data set in addition to the existing race field. These fields were added so that patients who belong to more than one racial category can be coded with multiple races, consistent with the 2000 Census. The codes for all five fields are identical with the exception of Code 88 - No further race documented. Code 88 is not to be used for coding the first race field.

Code 98 (Other) is not to be used if the Face Sheet states "other" or "other race."  If the only information available are these statements, carefully review the medical record in search of a specific race.  If no other information is available to code a specific race, use code 99.  Use code 99 before considering the use of code 98. Code 98 is to be used only in the event a specified race is identified with no corresponding code.

Code 99 is to be used for coding the second through fifth race field if the first race field is unknown. If information about the patient's race or races is not given on the face-sheet of the medical record, the physical examination, history, or other sections may provide race information.

January 1, 2004 and Forward

Effective with cases diagnosed January 1, 2004 forward, apply the following SEER race coding guideline:

Race (and ethnicity) is defined by specific physical, heredity and cultural traditions or origins, not necessarily by birthplace, place of residence, or citizenship. 'Origin' is defined by the 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.
• Record 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. See the editing guidelines that follow for further instructions. If a person's race is a combination of white and any other race(s), code to the appropriate other race(s) first and code white in the next race field.
• • 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.

If the person is not Hawaiian, code Race 1 to the first stated non-white race (using race codes 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.

The fields Place of Birth, Race, Marital Status, Name, Maiden Name, and Hispanic Origin are inter-related. Use the following guidelines in order:

Code the patient's stated race, if possible. Refer to Appendix W, "Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics" for guidance.

Examples

Patient is stated to be Japanese. Code as 05 Japanese.

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

Patient is described as Arabian. Code as 01 White.

Exception:  When the race is recorded as Oriental, Mongolian, or Asian (codable 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.

Examples

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.

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

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.

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

Patient described as a black female. Code as 02 Black.

Patient describes herself as multi-racial (nothing more specific) and nursing notes say "African-American." Code as 02 Black.

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

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 Appendix W "Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics" to identify nationalities from which race codes may be inferred.

Example

Record states: "This native of Portugal." Code race as 01 White per the Appendix W.

Record states: "This patient was Nigerian." Code race as 02 Black per the Appendix W.

Exception: If the patient's name is incongruous with the inferred race, code Race 1 through Race 5 as 99, Unknown.

Example

Patient's name is Siddhartha Rao and birthplace is listed as England. Code Race 1 through Race 5 as 99 Unknown.

Patient's name is Ping Chen and birthplace is Ethiopia. Code Race 1 through Race 5 as 99 Unknown

Use of patient name in determining race

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

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

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

Examples

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

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

• 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.

Example

Alice Gomez is a native of Indiana (implied birthplace: United States).

Code Race 1 through Race 5 as 99 Unknown, because we know nothing about her race.

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

Miss Sabrina Fitzsimmons is a native of Brazil

Code race as 01 White per Appendix W.

Note:  Race and ethnicity are coded independently.

When the race is recorded as African-American, code race as 02.

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.

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.

Examples

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.

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.

Code as white (01) when the race is described as white (01) but the place of birth is Hawaii.

Prior to January 1, 2000

For cases diagnosed prior to January 1, 2000, only the first race field is to be completed and patients of mixed parentage are to be classified according to the race or ethnicity of the mother.

After January 1, 2000

For cases diagnosed January 1, 2000 and later, this no longer applies. Enter each race given.

Prior to January 1, 2004

For cases diagnosed prior to January 1, 2004, no "primary" race is designated, and multiple races may be listed in any order, consistent with the 2000 Census. When any of the race fields are coded as Other Asian - Code 96, Pacific Islander, NOS - Code 97, or Other - Code 98" and a more specific race is given which is not included in the list of race codes, this more specific race must be entered in the Remarks field. (When a patient is described as Asian or Oriental and the birthplace is recorded as a specific Asian country, use the birthplace if possible to assign a more specific code.) If there is no information on race in the medical record, a statement documenting that there is no information must be entered in the Remarks Field.

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