Atypical lymphoid infiltrate, code needed

mjl903

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Local Chapter Officer
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The Derm billing mgr and I are trying to figure out how to code the following pathology from an excision:

"Upper dermal dense atypical lympohid infiltrate. TCR negative. Although a cutaneous T-cell lymphoma is not confirmed, other entities that show atypical lympohid infiltrate such as drug and bite reactions cannot be ruled out. Clinical correlation is recommended."

The patient has a history of BCC.

I think the code should be: 238.2
The billing mgr feels the code should be 709.8

Can anyone suggest a reasoning of why one code should be used vs the other?
Thank you!
 

Cbaldon

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I also struggle with this particular code. I would agree with the billing manager. I would go with 709.8. I would not go with 238.2 bc as it states in ICD-9 that it is to be used for Keratocanthoma only.
 

bbooks

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I would code this 238.2 Neoplasm of uncertain behavior of the skin.

The pathologist has not given a definite diagnosis but has raised at least the possibility of a lymphoma. I think the atypia supports the uncertain behavior.
 
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