The distinction between MBL and CLL also has several other practical ramifications. First, MBL does not currently have a specific ICD-9 code for billing purposes which forces clinicians to choose between coding individuals with MBL as lymphocytosis (ICD-9 code 288.8) or CLL (ICD-9 code 204.1) either of which creates potential problems. While the classification of “lymphocytosis” correctly identifies the non-malignant nature of MBL, it may create difficulties with insurance coverage for evaluation and care provided by a hematologist or diagnostic testing, particularly in some European countries. In contrast, in the U.S. health care system, a diagnosis of CLL could have implications for insurability as a pre-existing condition when individuals change their health care provider and may impact an individual’s ability to obtain life insurance. This distinction also has repercussions to insurance policies that provide specific benefits after a diagnosis of “cancer” causing some patients to lobby for the CLL code rather than the lymphocytosis code. These challenges illustrate some of the reasons why a new ICD-9 code specific to MBL is needed.
