Although you have not stated exactly what sort of exam you're taking, I can think of only one instance in which you would fail to observe or use the Patholgists's final dx.
In some instances of facility-fee, inpatient, you cannot choose a diagnosis based on "abnormal findings of a diagnostic test," without the Attending's explicit agreeance or record of such a dx on a discharge summary. Therefore, to some extent I could understand that 709.9 could be fitting, but only under those specific conditions.
It would be hard to believe that any exam (other than perhaps the CCS) or any study guide (outside those for the CCS) would query coders in a such a confusing and exceptional way. I might be mistaken, but doubt it.
If you're coding for the professional charges/services or outpatient scheme, it is correct coding to assign dx according to the certainty of them. A Pathology report would be considered certainty in this setting and a malignancy code, specific to that site/body system would be appropriate.
I hope this makes sense to you. If not, private message me and I'll try again.
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