ICD-10: C91.11

Chronic lymphocytic leukemia (CLL) is a type of cancer that primarily affects the blood and bone marrow, characterized by the accumulation of abnormal B-lymphocytes. The ICD-10 code C91.11 specifically refers to "Chronic lymphocytic leukemia of B-cell type in remission." Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description of C91.11

Definition and Characteristics

Chronic lymphocytic leukemia (CLL) is a hematological malignancy that arises from the clonal proliferation of B-lymphocytes. It is typically characterized by:
- Slow progression: CLL often progresses slowly, and many patients may remain asymptomatic for years.
- Lymphocytosis: A hallmark of CLL is an elevated number of lymphocytes in the blood, often exceeding 5,000 cells per microliter.
- Bone marrow infiltration: The disease can lead to the infiltration of the bone marrow, affecting normal hematopoiesis and potentially leading to anemia, thrombocytopenia, or neutropenia.

Staging and Remission

The term "in remission" indicates that the disease is currently not active or has significantly decreased in severity. Remission can be classified into:
- Complete remission: No evidence of disease is detectable, and blood counts return to normal.
- Partial remission: There is a reduction in the number of cancer cells, but some abnormalities may still be present.

Symptoms

Patients with CLL may experience a variety of symptoms, including:
- Fatigue
- Unexplained weight loss
- Frequent infections
- Swollen lymph nodes (lymphadenopathy)
- Splenomegaly (enlarged spleen)

Diagnosis

Diagnosis of CLL typically involves:
- Blood tests: Complete blood count (CBC) showing elevated lymphocyte levels.
- Bone marrow biopsy: To assess the extent of infiltration by leukemic cells.
- Immunophenotyping: To confirm the B-cell lineage and identify specific markers (e.g., CD5, CD23).

Treatment

Treatment options for CLL may include:
- Watchful waiting: For asymptomatic patients with early-stage disease.
- Chemotherapy: Such as fludarabine, cyclophosphamide, and rituximab.
- Targeted therapies: Including BTK inhibitors (e.g., ibrutinib) and BCL-2 inhibitors (e.g., venetoclax).
- Immunotherapy: Such as monoclonal antibodies.

Coding and Billing Considerations

The ICD-10 code C91.11 is used for billing and coding purposes to indicate a diagnosis of chronic lymphocytic leukemia of B-cell type that is currently in remission. Accurate coding is essential for proper reimbursement and tracking of patient outcomes.

Related Codes

• C91.10: Chronic lymphocytic leukemia of B-cell type, not in remission.
• C91.12: Chronic lymphocytic leukemia of B-cell type, in relapse.

Conclusion

ICD-10 code C91.11 is crucial for identifying patients with chronic lymphocytic leukemia of B-cell type who are in remission. Understanding the clinical characteristics, diagnostic criteria, and treatment options for CLL is essential for healthcare providers to manage this condition effectively. Proper coding ensures that patients receive appropriate care and that healthcare systems can track treatment outcomes and resource utilization effectively.

Chronic lymphocytic leukemia (CLL) is a type of cancer that primarily affects B-lymphocytes, a kind of white blood cell. The ICD-10 code C91.11 specifically refers to "Chronic lymphocytic leukemia of B-cell type in remission." Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for effective diagnosis and management.

Clinical Presentation

Definition and Overview

Chronic lymphocytic leukemia is characterized by the accumulation of functionally incompetent B-lymphocytes in the blood, bone marrow, and lymphoid tissues. The "in remission" designation indicates that the disease is currently not active, which can be determined through clinical evaluation and laboratory tests.

Patient Characteristics

Patients with CLL typically present with the following characteristics:

• Age: CLL is most commonly diagnosed in older adults, with a median age of diagnosis around 70 years. It is rare in individuals under 40[1].
• Gender: There is a higher prevalence in males compared to females, with a male-to-female ratio of approximately 2:1[2].
• Ethnicity: CLL is more common in Caucasians than in other ethnic groups, although the reasons for this disparity are not fully understood[3].

Signs and Symptoms

Common Symptoms

Patients with CLL may experience a variety of symptoms, which can vary in severity. In the remission phase, symptoms may be minimal or absent, but some common symptoms prior to remission include:

• Fatigue: A common complaint due to anemia or the body's response to the disease[4].
• Lymphadenopathy: Swelling of lymph nodes, particularly in the neck, armpits, or groin, is often noted during physical examinations[5].
• Splenomegaly: Enlargement of the spleen can occur, leading to discomfort or a feeling of fullness[6].
• Infections: Patients may have a history of recurrent infections due to compromised immune function, although this may improve during remission[7].

Signs During Remission

In the remission phase, many of the symptoms may resolve, but some signs may still be monitored:

• Normal Blood Counts: Hematological evaluations may show normalized white blood cell counts, indicating effective disease control[8].
• Stable Lymph Nodes: Lymph nodes may remain enlarged but stable, without signs of further progression[9].
• Absence of Symptoms: Patients often report a significant reduction in fatigue and other symptoms, contributing to an improved quality of life[10].

Diagnostic Considerations

Laboratory Tests

Diagnosis and monitoring of CLL, especially in remission, typically involve:

• Complete Blood Count (CBC): To assess white blood cell counts and hemoglobin levels[11].
• Flow Cytometry: Used to identify the characteristic B-cell markers (CD5, CD23, and weak expression of surface immunoglobulin) that confirm the diagnosis of CLL[12].
• Bone Marrow Biopsy: May be performed to evaluate the extent of disease involvement, although it is less common in remission[13].

Imaging Studies

While imaging is not routinely required for diagnosis, it may be used to assess lymphadenopathy or splenomegaly if clinically indicated[14].

Conclusion

Chronic lymphocytic leukemia of B-cell type in remission is characterized by a reduction or absence of symptoms and signs associated with the disease. Understanding the clinical presentation, including patient demographics and common symptoms, is essential for healthcare providers in managing and monitoring patients effectively. Regular follow-up and laboratory assessments are crucial to ensure that the disease remains in remission and to address any potential complications that may arise.

Chronic lymphocytic leukemia (CLL) of B-cell type in remission, designated by the ICD-10 code C91.11, is a specific classification within the broader category of lymphoid leukemias. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with this condition.

Alternative Names

1. B-cell Chronic Lymphocytic Leukemia (CLL): This is a more general term that refers to the same condition, emphasizing the B-cell origin of the leukemia.
2. Chronic Lymphocytic Leukemia in Remission: This phrase highlights the remission status of the disease, indicating that the symptoms and signs of CLL are not currently present.
3. B-cell Leukemia in Remission: A simplified term that focuses on the B-cell lineage of the leukemia while noting the remission status.
4. CLL in Remission: An abbreviation that is commonly used in clinical settings to refer to chronic lymphocytic leukemia when it is in a state of remission.

Related Terms

1. ICD-10 Code C91.10: This code refers to chronic lymphocytic leukemia of B-cell type that has not achieved remission, providing a direct contrast to C91.11.
2. Minimal Residual Disease (MRD): This term is often used in the context of CLL to describe the small number of cancer cells that may remain after treatment, which can be a critical factor in determining remission status.
3. Lymphoid Leukemia: A broader category that includes various types of leukemia originating from lymphoid cells, including CLL.
4. Chronic Lymphoproliferative Disorders: This term encompasses a range of conditions characterized by the proliferation of lymphocytes, including CLL.
5. B-cell Neoplasms: A general term that includes various malignancies arising from B-cells, including CLL.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C91.11 is essential for accurate medical coding, documentation, and communication among healthcare professionals. These terms not only facilitate clarity in clinical discussions but also enhance the understanding of the condition's status, particularly in relation to treatment and remission. If you need further information or specific details about CLL or its management, feel free to ask!

Chronic lymphocytic leukemia (CLL) of B-cell type in remission is classified under the ICD-10 code C91.11. The diagnosis of CLL, particularly in the context of remission, involves a combination of clinical evaluation, laboratory tests, and specific diagnostic criteria. Below is a detailed overview of the criteria used for diagnosing CLL and determining remission status.

Diagnostic Criteria for Chronic Lymphocytic Leukemia (CLL)

1. Clinical Presentation

• Symptoms: Patients may present with symptoms such as fatigue, weight loss, night sweats, and lymphadenopathy (swollen lymph nodes). However, many patients are asymptomatic at the time of diagnosis.
• Physical Examination: A thorough physical examination may reveal enlarged lymph nodes, splenomegaly (enlarged spleen), or hepatomegaly (enlarged liver).

2. Blood Tests

• Complete Blood Count (CBC): A CBC typically shows lymphocytosis, which is an elevated number of lymphocytes. In CLL, the lymphocyte count is often greater than 5,000 cells per microliter of blood.
• Peripheral Blood Smear: A blood smear may reveal characteristic small, mature lymphocytes and the presence of smudge cells, which are fragile lymphocytes that break during the preparation of the slide.

3. Bone Marrow Examination

• Bone Marrow Biopsy: A bone marrow biopsy may be performed to assess the infiltration of leukemic cells. In CLL, the bone marrow is often hypercellular with a predominance of small, mature lymphocytes.

4. Immunophenotyping

• Flow Cytometry: This test is crucial for confirming the diagnosis of CLL. It identifies the specific markers on the surface of the leukemic cells. CLL cells typically express CD5, CD23, and weakly express surface immunoglobulin (sIg), distinguishing them from other types of leukemias.

5. Cytogenetic and Molecular Studies

• FISH Analysis: Fluorescence in situ hybridization (FISH) can identify chromosomal abnormalities associated with CLL, such as deletions of 13q, 11q, and 17p. These abnormalities can provide prognostic information.
• Molecular Testing: Testing for mutations in the IGHV gene can also help assess prognosis, with unmutated IGHV being associated with a poorer outcome.

Criteria for Remission

The determination of remission in CLL is based on specific criteria, which include:

1. Clinical Criteria

• Absence of Symptoms: Patients should be free of symptoms related to CLL, such as fatigue, weight loss, and night sweats.
• Normal Physical Examination: No evidence of lymphadenopathy, splenomegaly, or hepatomegaly should be present.

2. Laboratory Criteria

• Blood Counts: A complete blood count should show a lymphocyte count within the normal range (typically less than 4,000 cells per microliter).
• Bone Marrow Assessment: Bone marrow biopsy may show less than 30% lymphocyte infiltration, indicating a significant reduction in leukemic cells.

3. Duration of Remission

• Sustained Remission: Remission is often defined as the absence of disease symptoms and laboratory evidence for a specified duration, typically at least 12 months after treatment.

Conclusion

The diagnosis of chronic lymphocytic leukemia of B-cell type in remission (ICD-10 code C91.11) involves a comprehensive evaluation that includes clinical assessment, laboratory tests, and specific diagnostic criteria. Understanding these criteria is essential for healthcare providers to accurately diagnose and monitor patients with CLL, ensuring appropriate management and treatment strategies are employed. Regular follow-up and monitoring are crucial to detect any signs of disease progression or relapse.

Chronic Lymphocytic Leukemia (CLL) of B-cell type, particularly when classified under ICD-10 code C91.11, refers to a form of leukemia characterized by the accumulation of functionally incompetent B lymphocytes. When patients are in remission, the treatment approaches focus on maintaining this state and preventing relapse. Here’s a detailed overview of standard treatment strategies for CLL in remission.

Overview of Chronic Lymphocytic Leukemia (CLL)

CLL is a type of cancer that primarily affects older adults and is characterized by the slow accumulation of abnormal B lymphocytes in the blood, bone marrow, and lymphatic tissues. The disease can be asymptomatic for years, and treatment is often initiated based on disease progression, symptoms, or laboratory findings.

Treatment Approaches for CLL in Remission

1. Monitoring and Observation

For patients in remission, especially those who are asymptomatic, a common approach is watchful waiting or active surveillance. This involves regular monitoring of blood counts and clinical status without immediate treatment. This strategy is particularly relevant for patients with early-stage CLL who do not exhibit significant symptoms or disease progression.

2. Maintenance Therapy

In some cases, maintenance therapy may be considered to prolong remission. This can include:

• Rituximab: A monoclonal antibody that targets CD20 on B cells. It is often used in combination with chemotherapy during initial treatment but can also be administered as a maintenance therapy to help sustain remission[1][2].
• Acalabrutinib or Ibrutinib: These are Bruton's tyrosine kinase (BTK) inhibitors that may be used in certain cases to maintain remission, particularly in patients with high-risk features or those who have previously received treatment[3].

3. Chemotherapy

While chemotherapy is typically used during active disease, some patients may receive low-intensity chemotherapy regimens as a precautionary measure to prevent relapse. Common regimens include:

• Fludarabine, Cyclophosphamide, and Rituximab (FCR): This combination is often used in younger patients or those with a good performance status.
• Chlorambucil: This may be used in older patients or those with comorbidities, especially if they are not candidates for more intensive therapy[4].

4. Targeted Therapies

Targeted therapies have revolutionized the treatment landscape for CLL. In remission, these therapies may be used to prevent relapse:

• Venetoclax: This BCL-2 inhibitor is effective in reducing the number of malignant B cells and may be used in combination with other agents for patients at high risk of relapse[5].
• Idelalisib: A PI3K inhibitor that can be used in combination with rituximab for patients who have relapsed or are refractory to other treatments[6].

5. Clinical Trials

Participation in clinical trials can be an option for patients in remission. These trials may offer access to novel therapies or combinations that are not yet widely available. Patients should discuss with their healthcare providers about ongoing studies that may be appropriate for their condition.

Conclusion

The management of Chronic Lymphocytic Leukemia of B-cell type in remission primarily focuses on monitoring and maintaining the remission state while minimizing treatment-related side effects. The choice of therapy, if needed, depends on individual patient factors, including age, overall health, and specific disease characteristics. Regular follow-up with healthcare providers is essential to ensure timely intervention should the disease progress. As research continues, new therapies and strategies are likely to emerge, offering hope for improved outcomes in CLL management.

References

1. Billing and Coding: Off-label Use of Rituximab.
2. Draft PMB definition guideline: Chronic Lymphocytic Leukemia.
3. A clinical practice comparison of patients with chronic lymphocytic leukemia.
4. Full article: Time to Next Treatment in Patients with Chronic Lymphocytic Leukemia.
5. Medical policy for chronic lymphocytic leukemia and treatment options.
6. ICD-10-CM Diagnosis Code C91.11 - Chronic lymphocytic leukemia of B-cell type.