238.x dx codes are not to be used when you are unsure of what the path will reveal, they are path codes for when the pathologist sees microscopically uncertain behavior in the cells. You are not to code an excision until after the path report so you code from that result. You did not know it was a 238.x at the time of the excision. If you get back a seborrehic Keratosis, then you can use V71.1 as your first listed which shows the medical necessity for the excision.
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