Wiki Atypical lymphoid infiltrate, code needed

[mjl903]

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]

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]

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.

 

[DeeCPC]

I agree with 238.2 - this a an appropriate example of uncertain behavior.

 

[m.edwards]

I always bill this as 709.8 for our Derm as it is not technically a neoplasm.