NEISS Reverts to Three Sex Codes after No-Gender Order

CPSC has reverted to giving NEISS coders three numbers to process hospitals' descriptions of sex and gender. Those are 1-male, 2-female, and 0-unknown. A revised version of the 2025 NEISS coding manual (bit.ly/3FDCqqr) explains that CPSC has eliminated code 3 (gender diverse and intersex) and renamed the category that contained the code to its pre-2021 name, "sex." This is to comply with a January executive order forbidding federal agencies from recognizing more than a male/female binary and from using the word gender in such distinctions.

The revised manual instructs, "If a patient's sex is not clear in the medical record, code it as 0=unknown." It gives only examples with the unmodified nouns, male and female, and does not advise on interpreting adjectives like transgender and non-binary. It does not mention that the executive order (bit.ly/4kpZ4Cm) dictates that agencies must define female as "a person belonging, at conception, to the sex that produces the large reproductive cell" and male as "a person belonging, at conception, to the sex that produces the small reproductive cell." However, it does contain a link to the executive order although elsewhere than advice for coding sex.

Code 3 began in the 2021 manual (bit.ly/4iRDhlq), which said, "[C]ode the patient's sex based on how it is recorded in the ED record (e.g., 1-male, 2-female, or 3-non-binary/other)."

That was similar to instruction before the inception of code 3. For example, the 2019 version (bit.ly/4hhXDDo) instructed, "If a patient is transgender or intersex, code the patient's sex based on how it is entered in the ED record," followed by the 1-male, 2-female, 0-unknown options. An example coded "transgender male" as male, which if given now would violate the executive order. Such a person would have been designated female at birth and transitioned to male. The 2025 manual, however, does not instruct against this understanding despite the opposing definition demanded by the executive order.

The 2023 manual (bit.ly/3XXYF0o) is where the change of the name of code 3 to "gender diverse and intersex" occurred. It explained that the category included but was not limited to terms like:

"[T]ransgender, male to female; transgender, female to male; transgender, gender nonconforming; gender fluid; genderqueer; polygender/pangender; omnigender; non-binary; bigender; agender; Two-spirit identities; Fa'afafine; Hijras; Khanith; intersex."