III.2.9 Race and Ethnicity

Beginning with cases diagnosed January 1, 2000, four race fields were added to the data set in addition to the existing race field. These four fields were added so patients who belong to more than one racial category can be coded with multiple races, consistent with the 2000 Census.

Coding Resources:

• 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.

• Photographs of patients may be used but only with extreme caution. Photographs are often misleading and unreliable.  

• Use this source only when all other options are exhausted and there is no conflicting information.  

• If a photograph is used, documentation must be present in the abstract text explaining the use of the photograph.

Coding Guidelines:

1. 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.

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

Exception Example:

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.

2. If the patient's race is determined on the basis of the races of relatives, there is no priority for coding race, other than to list the non-white race(s) first.

3. 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.

Examples:

• 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.

4. 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.

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

Guideline Exception Example:

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

5. 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.

• 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.

6. 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.

Example:

Miss Sabrina Fitzsimmons is a native of Brazil. Code race as 01 White per Appendix W.

Note: Race and ethnicity are coded independently.

7. 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.

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

• 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.

Coding Instructions:

• Use the codes found in Section III.2.9.1  to code the appropriate race of the patient.

• All race fields must be coded. This applies to cases diagnosed after January 1, 2000 and forward.

Note: Per 2004 SEER guidelines, races previously coded to 09 – Asian Indian were to be coded to 96 - Other Asian.  For consistency, the CCR created a new code, code 90 for Other South Asian that includes Bangladeshi, Bhutanese, Nepalese, Sikkimese, Sri Lankan (Ceylonese). Cases are converted from 90 to 96 for Calls for Data.

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

• 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:

• Use Codes 01 – 97 (Specific Race Fields)

• Code 88 (No Further Race Documented) is not to be used for coding the first race field (Race 1). It may only be used to document Race fields 2 through 5 when there are less than five races identified.

• Code 98 (Other) is not to be used if the Face Sheet states "other" or "other race." **  

• Code 98 is to be used only in the event a specified race is identified with no corresponding CCR/SEER Race code.

• It is encouraged to use 99 before considering the use of code 98.

• If the only information available is “other” or “other race”, 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.

• 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.

• Use code 99 in the following scenarios:

• Race code 99 is entered in the Race 1 field code 99 must be entered in the remaining race fields (Race 2 through Race 5).  

• Information about the patient's race or races is not given in any portion of the medical record.

• When the patient’s race is reported differently by two or more sources within the medical record, code race using the following sources in the following priority order:

• The patient’s self-declared identification.

• Documentation in the medical record.

• Dictated reports

• Nurses’ notes

• Death Certificate

• If the patient has multiple tumors, each tumor must have the same race codes assigned to each abstract.

1. 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.

2. 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.

3. Code ONLY the specific race when both a specific race code and a non-specific race code apply (DO NOT CODE 96, 97, or 98 for “multi-racial”:

1. Codes 04 – 17, 90* take priority over code 96

2. Codes 16 – 17 take priority over code 15

3. Codes 20 – 32 take priority over code 97

4. Codes 01**-32, 90*, and 69-97 take priority over code 98

*California uses code 90 too (Other South Asian, Bangladeshi, Bhutanese, Nepalese, Sikkimese, and Sri Lankan – changed to 96 for submissions).

**Unlike SEER, California gives code 01 priority over 98

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.

<< Prev.       Next >>