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  On a peaceful Sunday just weeks away from spring, an estimated 70,000 people recently crossed the Edmund Pettus Bridge that spans the Alabama River, connecting Selma with the state’s capital, Montgomery – they were there to mark the 50th anniversary of the “Bloody Sunday” incident of 1965 and to herald what many have come to see as a new era of race relations in the United States.

Those who gathered here also commemorated the 56-mile trek civil rights activists took to demonstrate for equal voting rights. Upon crossing the bridge on March 7, 1965, the marchers were clubbed and beaten in full view of photographers who snapped images that seared a nation’s collective conscience.

Yet no sooner had the solemnity of the anniversary commemoration been documented than cell phone footage of two members of the Sigma Alpha Epsilon fraternity at the University of Oklahoma surfaced, revealing them to be singing a racist chant. University President David Boren, a former Oklahoma governor and U.S. senator, subsequently shut down the fraternity and expelled the two fraternity members, Parker Rice and Levi Pettit.

Then, early last Thursday morning, gunshots rang out on the beleaguered streets of Ferguson, Mo. Two police officers were shot and wounded during a protest rally that had been nearing its end. Since then, a suspect has been arrested. Still, Ferguson remains a symbol for racial unrest ever since the shooting of an unarmed black teenager, Michael Brown, by a white police officer, Darren Wilson, last August.

Tensions flared up again two weeks ago with the release of the U.S. Department of Justice’s report that made the case for racial bias and abusive behavior by Ferguson’s police department and court system, both of which were found to be disproportionately targeting African-American residents.

Although there is no diagnosis for racism, could there be ICD-10 codes for psychosocial problems?

“Racism is not a biological problem, as we are all of the human race, but rather (it is) social and psychological,” wrote psychiatrist H. Steven Moffic in an email to ICD10monitor, citing ICD-10 code Z64 (“problems related to certain psychosocial circumstances.”)

Moffic said that racism could prevent our right to “life, liberty, and pursuit of happiness.”

“Though different in intensity and implications, fear of the other is at the base of both racism and the resistance to change to ICD-10,” Moffic said. “The 50th anniversary of Selma may have been a psychological trigger that elicited the subconscious racism in Ferguson, the SAE fraternity, and, indeed, across the United States.”

As mentioned above, there is no code for racism; though this coder feels it is a disorder of sorts and therefore, perhaps it should. As Dr. Moffic points out, the root of racism is fear. And when you look up “fear of” in the ICD-10-CM index, the index instructs you to “see phobia.”

The code selection for phobias in ICD-10-CM all lead you to category F40. There are a few phobias that, if diagnosed by a qualified healthcare provider, could be used for someone who is diagnosed with racism – or, if I may go out on a limb, “fear of a person due to race or ethnicity.”

Code Z40.298 – Other specified phobia


F40.10 – Social phobia

From a coding perspective, it is important to code from the documentation of the provider; therefore, it is important for the mental health or other qualified healthcare provider to diagnose the patient’s condition.

The above scenario is a hypothetical scenario, and final coding should always be based on the provider’s documentation.

About the Authors

Chuck Buck is the publisher of ICD10monitor and the executive producer and program host of Talk-Ten-Tuesday.

Kathy Pride, CPC, RHIT, CCS-P, is vice president of professional services for Panacea Healthcare Solutions. Kathy has extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits and education. She is also an approved ICD-10 Trainer through the American Health Information Management Association (AHIMA) and a previous member of the AAPC National Advisory Board (1998 – 2000).

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