Guidelines for coding sex and gender
Additional Info
- 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. And we removed the few Gender identity disorder (F64) codes that had been included up until that point in time.
Current Coding Rules
- Here are the things related to sex and gender that we WILL code:
- Binary sex as indicated in hospital records, coded in the Sex field -- note that as there is no clear rules on how this should be coded for individuals after gender reassignment surgery, this may not necessarily be the same as sex at birth.
- Any gender or sex-related surgical procedures done during the current database record, using CCI codes
- Bilaterial removal of gonads, orchiectomy or oophorectomy, using Past history, removal of organ NOS
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