Guidelines for coding sex and gender
- SEX refers to a set of biological attributes. It is primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy.
- while biologic sex at birth is (in the absence of various forms of hermaphrodism) relatively simple, it may not remain so -- therapies (e.g. hormone therapy, gender reassignment surgery) can alter hormone levels and function and sexual anatomy, leading to lack of clear definition of sex afterwards.
- GENDER is even more complicated. It refers to socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender identity is not confined to a binary (male/female) nor is it static; it exists along a continuum and can change over time.
- And over time, the diagnoses associated with both sex and gender issues have changed
- Some things that used to be classified as disorders are no longer so classified, and this is a moving target
- While ICD-10 has a number sex and gender-related codes and definitions, things are substantially unclear. For example F64.0 is "Transexualism" defined as "A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex". But it is not clear how this should be coded after such an individual has undegone gender reassignment.
- FOR THESE REASONS -- we decided on September 7, 2022 to exclude from our version of ICD-10 coding all of these entities -- including: Transexualism, Dual-role transvestism, and Gender identity disorders.
- We code binary sex as indicated in hospassigned at birth as documented in the Sex field.
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Coding transsexuality
We don't specifically encode transsexuality. We used to code Gender identity disorder but discontinued coding it.
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Space for any explanation you might want to add. |
We collect some ICD10 codes that for surgical interventions that might happen as part of transitioning. We would code these as any other history of surgery. Specifically:
- Past history, removal of organ NOS for hysterectomy if appropriate. We discussed whether removed testicles should be included in this; if so it needs to be added to that page as well
- Past history, removal of breast (mastectomy) if appropriate
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I think we don't code hormone replacement therapy itself. If there are common side effects that manifest in a way that is ICD10 encodable, would we want to list them here? Ttenbergen 15:39, 2022 September 7 (CDT) |
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