NHA CBCS Final Exam Prep Document | 2026/2027 Edition |
250 Verified Questions
NHA CBCS Final Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document contains 250 verified questions and answers for the
National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS) final exam.
Designed for medical billing and coding students, this resource covers all key content areas including
ICD-10-CM coding, CPT/HCPCS Level II coding, revenue cycle management, and compliance. Each
question includes detailed rationales and distractor explanations to reinforce understanding. Updated
for the 2026/2027 academic year, this document ensures alignment with the latest industry standards
and exam blueprints.
Key Features:
ICD-10-CM coding guidelines and conventions
CPT and HCPCS Level II coding procedures
Revenue cycle management and claims processing
Compliance, ethics, and HIPAA regulations
Medical terminology and anatomy for coders
Reimbursement methodologies and payer policies
Updates for 2026:
- Incorporated 2026 ICD-10-CM updates and new codes
- Revised CPT coding guidelines per 2026 AMA changes
- Updated compliance content to reflect latest HIPAA and OIG guidance
- Added questions on value-based care and alternative payment models
- Enhanced rationales with step-by-step coding logic
Abstract:
This document provides a rigorous preparation tool for the NHA CBCS final exam, featuring 250 meticulously
verified questions that mirror the exam's content distribution. The questions are organized by core domains:
diagnostic coding (ICD-10-CM), procedural coding (CPT/HCPCS), and billing/reimbursement. Each question is
accompanied by a comprehensive rationale explaining the correct answer and common pitfalls, with distractor
analysis to deepen conceptual understanding. The material reflects the 2026/2027 coding updates, including new
ICD-10-CM codes and CPT guideline revisions. Emphasis is placed on real-world application, such as accurate
code selection, modifier usage, and claims compliance. This resource is ideal for students seeking to achieve a high
score on the CBCS certification exam and transition into professional medical coding roles.
Keywords:
NHA CBCS, medical billing and coding, ICD-10-CM, CPT coding, HCPCS Level II, revenue cycle management,
certification exam prep, 2026/2027 edition
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is indicated, followed
by a detailed rationale explaining the coding guideline or billing rule applied. Distractor explanations clarify why
each incorrect option is wrong, reinforcing key concepts and common errors.
Compliance Checklist:
Aligned with 2026 NHA CBCS exam blueprint
Updated for 2026 ICD-10-CM and CPT code changes
Page 1
, Includes HIPAA and OIG compliance scenarios
Covers all exam domains with proportional weighting
Verified by subject matter experts for accuracy
Suitable for self-study and group review
Content Area Overview:
Content Area Questions Key Topics Weight
ICD-10-CM Coding 1-80 Guidelines, conventions, diagnosis coding, 32%
chapter-specific coding, Z codes, external
cause codes
CPT/HCPCS Level II Coding 81-150 Evaluation and management, surgery, 28%
radiology, pathology, medicine, HCPCS
modifiers
Revenue Cycle Management 151-200 Claims submission, payment posting, denial 20%
management, patient billing, charge capture
Compliance and Ethics 201-230 HIPAA privacy and security, fraud and 12%
abuse, OIG compliance, documentation
requirements
Reimbursement Methodologies 231-250 Medicare/Medicaid, private payers, 8%
value-based care, capitation, fee-for-service
Page 2
,Q1. A patient with chronic kidney disease stage 4 undergoes an arteriovenous fistula creation for
hemodialysis. The surgeon documents creation of a direct arteriovenous fistula using autogenous
graft. Which CPT code is assigned?
A. 36820 - Arteriovenous anastomosis, open; by upper arm cephalic vein transposition
B. 36825 - Creation of arteriovenous fistula; autogenous (eg, direct) (separate procedure)
C. 36830 - Creation of arteriovenous fistula; nonautogenous (eg, prosthetic) (separate procedure)
D. 36838 - Distal revascularization and interval ligation (DRIL), upper extremity
Correct Answer: B. 36825 - Creation of arteriovenous fistula; autogenous (eg, direct) (separate
procedure)
Rationale: CPT 36825 is used for creation of a direct arteriovenous fistula using autogenous tissue (e.g.,
vein). Option A (36820) is for a transposition procedure, not a fistula creation. Option C (36830) is for
nonautogenous (prosthetic) grafts. Option D (36838) is a different procedure for steal syndrome.
Why Wrong:
A - This code describes transposition of the cephalic vein, not creation of a fistula using autogenous
graft.
C - This code is for nonautogenous (prosthetic) graft, not autogenous.
D - This code is for distal revascularization and interval ligation, not fistula creation.
Reference: CPT Professional 2026, Surgery: Cardiovascular System, Arteriovenous Fistula codes.
Q2. A patient with acute respiratory failure due to COVID-19 requires mechanical ventilation for
96 hours. The physician documents severe sepsis with acute organ dysfunction. Which ICD-10-CM
codes are assigned?
A. J96.00, U07.1, R65.20
B. U07.1, J96.00, R65.21
C. J96.01, U07.1, R65.21
D. U07.1, J96.01, R65.20
Correct Answer: D. U07.1, J96.01, R65.20
Rationale: U07.1 (COVID-19) is sequenced first when it is the reason for encounter. J96.01 (acute
respiratory failure with hypoxia) is assigned for acute respiratory failure. R65.20 (severe sepsis without
septic shock) is used because sepsis is present but no shock. R65.21 would be incorrect as there is no
shock documented.
Why Wrong:
A - J96.00 is unspecified severity; R65.20 is correct but sequencing is wrong (COVID-19 should be
first).
B - R65.21 indicates septic shock, which is not documented.
C - R65.21 indicates septic shock, which is not documented.
Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY 2026, Section I.C.1.g.1 and
I.C.15.
Page 3
, Q3. Which of the following best describes the primary purpose of the National Correct Coding
Initiative (NCCI) edits?
A. To establish fee schedules for Medicare Part B services
B. To prevent improper coding that could lead to duplicate payments
C. To standardize the use of modifiers across all payers
D. To define medical necessity criteria for outpatient services
Correct Answer: B. To prevent improper coding that could lead to duplicate payments
Rationale: NCCI edits are pairs of codes that should not be billed together due to overlapping services,
preventing duplicate payments. Option A describes the Medicare Physician Fee Schedule. Option C is not
the primary purpose; modifiers are used to bypass edits. Option D relates to LCDs/NCDs, not NCCI.
Why Wrong:
A - Fee schedules are established by CMS, not NCCI edits.
C - Modifier usage is governed by CPT guidelines, not NCCI primarily.
D - Medical necessity criteria are defined by Local Coverage Determinations (LCDs) and National
Coverage Determinations (NCDs).
Reference: CMS, National Correct Coding Initiative Policy Manual, Chapter 1, Introduction.
Q4. A provider performs an initial comprehensive preventive medicine evaluation and management
(E/M) service on a new patient aged 20. Which CPT code is reported?
A. 99384
B. 99385
C. 99386
D. 99387
Correct Answer: B. 99385
Rationale: CPT 99385 is for initial comprehensive preventive medicine E/M service for new patients aged
12-17 or 18-39? Actually, 99385 is for ages 18-39. The patient is 20, so 99385 is correct. 99384 is for
ages 12-17. 99386 is for ages 40-64. 99387 is for ages 65 and over.
Why Wrong:
A - This code is for ages 12-17, not for a 20-year-old patient.
C - This code is for ages 40-64, not for a 20-year-old patient.
D - This code is for ages 65 and over, not for a 20-year-old patient.
Reference: CPT Professional 2026, Preventive Medicine Services, code range 99384-99387.
Page 4
250 Verified Questions
NHA CBCS Final Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document contains 250 verified questions and answers for the
National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS) final exam.
Designed for medical billing and coding students, this resource covers all key content areas including
ICD-10-CM coding, CPT/HCPCS Level II coding, revenue cycle management, and compliance. Each
question includes detailed rationales and distractor explanations to reinforce understanding. Updated
for the 2026/2027 academic year, this document ensures alignment with the latest industry standards
and exam blueprints.
Key Features:
ICD-10-CM coding guidelines and conventions
CPT and HCPCS Level II coding procedures
Revenue cycle management and claims processing
Compliance, ethics, and HIPAA regulations
Medical terminology and anatomy for coders
Reimbursement methodologies and payer policies
Updates for 2026:
- Incorporated 2026 ICD-10-CM updates and new codes
- Revised CPT coding guidelines per 2026 AMA changes
- Updated compliance content to reflect latest HIPAA and OIG guidance
- Added questions on value-based care and alternative payment models
- Enhanced rationales with step-by-step coding logic
Abstract:
This document provides a rigorous preparation tool for the NHA CBCS final exam, featuring 250 meticulously
verified questions that mirror the exam's content distribution. The questions are organized by core domains:
diagnostic coding (ICD-10-CM), procedural coding (CPT/HCPCS), and billing/reimbursement. Each question is
accompanied by a comprehensive rationale explaining the correct answer and common pitfalls, with distractor
analysis to deepen conceptual understanding. The material reflects the 2026/2027 coding updates, including new
ICD-10-CM codes and CPT guideline revisions. Emphasis is placed on real-world application, such as accurate
code selection, modifier usage, and claims compliance. This resource is ideal for students seeking to achieve a high
score on the CBCS certification exam and transition into professional medical coding roles.
Keywords:
NHA CBCS, medical billing and coding, ICD-10-CM, CPT coding, HCPCS Level II, revenue cycle management,
certification exam prep, 2026/2027 edition
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is indicated, followed
by a detailed rationale explaining the coding guideline or billing rule applied. Distractor explanations clarify why
each incorrect option is wrong, reinforcing key concepts and common errors.
Compliance Checklist:
Aligned with 2026 NHA CBCS exam blueprint
Updated for 2026 ICD-10-CM and CPT code changes
Page 1
, Includes HIPAA and OIG compliance scenarios
Covers all exam domains with proportional weighting
Verified by subject matter experts for accuracy
Suitable for self-study and group review
Content Area Overview:
Content Area Questions Key Topics Weight
ICD-10-CM Coding 1-80 Guidelines, conventions, diagnosis coding, 32%
chapter-specific coding, Z codes, external
cause codes
CPT/HCPCS Level II Coding 81-150 Evaluation and management, surgery, 28%
radiology, pathology, medicine, HCPCS
modifiers
Revenue Cycle Management 151-200 Claims submission, payment posting, denial 20%
management, patient billing, charge capture
Compliance and Ethics 201-230 HIPAA privacy and security, fraud and 12%
abuse, OIG compliance, documentation
requirements
Reimbursement Methodologies 231-250 Medicare/Medicaid, private payers, 8%
value-based care, capitation, fee-for-service
Page 2
,Q1. A patient with chronic kidney disease stage 4 undergoes an arteriovenous fistula creation for
hemodialysis. The surgeon documents creation of a direct arteriovenous fistula using autogenous
graft. Which CPT code is assigned?
A. 36820 - Arteriovenous anastomosis, open; by upper arm cephalic vein transposition
B. 36825 - Creation of arteriovenous fistula; autogenous (eg, direct) (separate procedure)
C. 36830 - Creation of arteriovenous fistula; nonautogenous (eg, prosthetic) (separate procedure)
D. 36838 - Distal revascularization and interval ligation (DRIL), upper extremity
Correct Answer: B. 36825 - Creation of arteriovenous fistula; autogenous (eg, direct) (separate
procedure)
Rationale: CPT 36825 is used for creation of a direct arteriovenous fistula using autogenous tissue (e.g.,
vein). Option A (36820) is for a transposition procedure, not a fistula creation. Option C (36830) is for
nonautogenous (prosthetic) grafts. Option D (36838) is a different procedure for steal syndrome.
Why Wrong:
A - This code describes transposition of the cephalic vein, not creation of a fistula using autogenous
graft.
C - This code is for nonautogenous (prosthetic) graft, not autogenous.
D - This code is for distal revascularization and interval ligation, not fistula creation.
Reference: CPT Professional 2026, Surgery: Cardiovascular System, Arteriovenous Fistula codes.
Q2. A patient with acute respiratory failure due to COVID-19 requires mechanical ventilation for
96 hours. The physician documents severe sepsis with acute organ dysfunction. Which ICD-10-CM
codes are assigned?
A. J96.00, U07.1, R65.20
B. U07.1, J96.00, R65.21
C. J96.01, U07.1, R65.21
D. U07.1, J96.01, R65.20
Correct Answer: D. U07.1, J96.01, R65.20
Rationale: U07.1 (COVID-19) is sequenced first when it is the reason for encounter. J96.01 (acute
respiratory failure with hypoxia) is assigned for acute respiratory failure. R65.20 (severe sepsis without
septic shock) is used because sepsis is present but no shock. R65.21 would be incorrect as there is no
shock documented.
Why Wrong:
A - J96.00 is unspecified severity; R65.20 is correct but sequencing is wrong (COVID-19 should be
first).
B - R65.21 indicates septic shock, which is not documented.
C - R65.21 indicates septic shock, which is not documented.
Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY 2026, Section I.C.1.g.1 and
I.C.15.
Page 3
, Q3. Which of the following best describes the primary purpose of the National Correct Coding
Initiative (NCCI) edits?
A. To establish fee schedules for Medicare Part B services
B. To prevent improper coding that could lead to duplicate payments
C. To standardize the use of modifiers across all payers
D. To define medical necessity criteria for outpatient services
Correct Answer: B. To prevent improper coding that could lead to duplicate payments
Rationale: NCCI edits are pairs of codes that should not be billed together due to overlapping services,
preventing duplicate payments. Option A describes the Medicare Physician Fee Schedule. Option C is not
the primary purpose; modifiers are used to bypass edits. Option D relates to LCDs/NCDs, not NCCI.
Why Wrong:
A - Fee schedules are established by CMS, not NCCI edits.
C - Modifier usage is governed by CPT guidelines, not NCCI primarily.
D - Medical necessity criteria are defined by Local Coverage Determinations (LCDs) and National
Coverage Determinations (NCDs).
Reference: CMS, National Correct Coding Initiative Policy Manual, Chapter 1, Introduction.
Q4. A provider performs an initial comprehensive preventive medicine evaluation and management
(E/M) service on a new patient aged 20. Which CPT code is reported?
A. 99384
B. 99385
C. 99386
D. 99387
Correct Answer: B. 99385
Rationale: CPT 99385 is for initial comprehensive preventive medicine E/M service for new patients aged
12-17 or 18-39? Actually, 99385 is for ages 18-39. The patient is 20, so 99385 is correct. 99384 is for
ages 12-17. 99386 is for ages 40-64. 99387 is for ages 65 and over.
Why Wrong:
A - This code is for ages 12-17, not for a 20-year-old patient.
C - This code is for ages 40-64, not for a 20-year-old patient.
D - This code is for ages 65 and over, not for a 20-year-old patient.
Reference: CPT Professional 2026, Preventive Medicine Services, code range 99384-99387.
Page 4
