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Atypical lymphoid infiltrate, code needed

  1. #1
    Exclamation Atypical lymphoid infiltrate, code needed
    Medical Coding Books
    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!

  2. Default Atypical lymphoid infiltrate, code needed
    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.

  3. #3
    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.

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

  5. #5
    I always bill this as 709.8 for our Derm as it is not technically a neoplasm.

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