HEALTHCARE CERTIFICATION
NHA CBCS Exam Study Guide 200+ Questions
and Revised Correct Answers (2026/2027) 100%
Guarantee Pass 2026/2027
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
1. Medical Coding Systems (ICD-10-CM, CPT, HCPCS)
2. Claims Processing and Revenue Cycle Management
3. Insurance Payers, Coverage, and Reimbursement
4. Compliance, Ethics, and Regulatory Requirements
5. Patient Accounts, Billing Procedures, and Documentation
STUVIAACTUALEXAM
, 1. Medical Coding Systems (ICD-10-CM, CPT, HCPCS)
Q1
A billing specialist reviews a claim for a patient who received an office visit and a minor surgical procedure on the same
day. The physician documented a significant, separately identifiable E/M service. Which modifier is required on the E/M
code to indicate this?
A. Modifier -25
B. Modifier -59
C. Modifier -51
D. Modifier -76
Correct Answer: A
Rationale: Modifier -25 indicates a significant, separately identifiable evaluation and management service by the same physician on the same day
of a procedure. Modifier -59 is for distinct procedural services, -51 for multiple procedures, and -76 for repeat procedures by the same physician.
Q2
A coder is assigning an ICD-10-CM code for a patient diagnosed with type 2 diabetes mellitus with diabetic nephropathy.
Which code category correctly reflects the combination of conditions?
A. E11.21
B. E10.21
C. E13.9
D. E11.9
Correct Answer: A
Rationale: ICD-10-CM code E11.21 is Type 2 diabetes mellitus with diabetic nephropathy. E10 codes are for type 1 diabetes. E11.9 is type 2
diabetes without complications. Accurate combination coding is required when a manifestation is present.
Q3
A patient undergoes a colonoscopy with biopsy of a polyp and removal of another polyp by snare technique during the
same session. Which CPT coding approach is correct?
A. Report only the snare polypectomy code
B. Report both biopsy and snare codes with appropriate modifiers if required by payer
C. Report the colonoscopy without intervention only
D. Report two separate colonoscopy codes without modifiers
Correct Answer: B
Rationale: When multiple interventions occur during colonoscopy, report each distinct procedure. Biopsy and snare polypectomy are different
techniques; modifiers such as -59 or -XS may be needed depending on payer rules to indicate distinct services.
Q4
A claim is denied because the diagnosis code does not support medical necessity for the procedure performed. Which
action should the billing specialist take first?
A. Immediately write off the charge as uncollectible
B. Review the documentation and query the provider for a more specific diagnosis if supported
C. Change the diagnosis code to any covered code without documentation review
D. Resubmit the claim with the same codes and no changes
Correct Answer: B
Rationale: Medical necessity denials require verification that the diagnosis supports the service. If documentation supports a more specific or
appropriate code, a query and corrected claim are appropriate. Changing codes without support is noncompliant.
NHA CBCS Exam Study Guide 2026/2027 Page 2
, Q5
A patient presents for a well-child visit and also receives a vaccine. The coder needs to report the vaccine administration
and product. Which coding system is used for the vaccine product itself?
A. ICD-10-CM only
B. CPT or HCPCS Level II depending on the vaccine
C. Only revenue codes
D. Only place of service codes
Correct Answer: B
Rationale: Vaccine products are reported with CPT codes (for many vaccines) or HCPCS Level II codes (for some). Administration codes are
separate CPT codes. ICD-10-CM is used for diagnosis, not the product.
Q6
A physician performs a closed treatment of a radial shaft fracture with manipulation. Which CPT category does this
service fall under?
A. Evaluation and Management
B. Surgery / Musculoskeletal System
C. Radiology
D. Medicine
Correct Answer: B
Rationale: Fracture treatment codes are located in the Surgery section under the Musculoskeletal System. Closed treatment with manipulation is
a specific procedure code in that section.
Q7
A coder is selecting a principal diagnosis for an inpatient claim. The patient was admitted for acute exacerbation of
COPD and also has hypertension and osteoarthritis. Which guideline determines the principal diagnosis?
A. The condition that was treated first alphabetically
B. The condition chiefly responsible for the admission after study
C. The condition with the highest reimbursement
D. Any secondary condition listed by the physician
Correct Answer: B
Rationale: UHDDS and Official Coding Guidelines define principal diagnosis as the condition established after study to be chiefly responsible for
occasioning the admission. Secondary conditions are coded as additional diagnoses when they meet criteria.
Q8
A claim includes CPT code 99213 for an established patient office visit. The documentation supports a problem-focused
history, expanded problem-focused examination, and straightforward medical decision making. Which level is most
consistent with the documentation?
A. 99211
B. 99212
C. 99213
D. 99214
Correct Answer: C
Rationale: Under the 1995/1997 guidelines or MDM-focused 2021 guidelines (depending on year of service), 99213 typically requires expanded
problem-focused history/exam and low complexity MDM or the equivalent time/MDM thresholds. Matching documentation to level is essential.
NHA CBCS Exam Study Guide 2026/2027 Page 3
, Q9
A patient has a history of breast cancer that is no longer present and is being seen for routine surveillance. Which
ICD-10-CM coding concept applies?
A. Code the active cancer code
B. Use a personal history of malignant neoplasm code (Z85.-)
C. Code only the screening encounter without history
D. Use an unspecified neoplasm code
Correct Answer: B
Rationale: When cancer is no longer present and the encounter is for surveillance or history, the personal history code Z85.- is appropriate rather
than an active cancer code. Active codes are used only when the disease is under treatment or present.
Q10
A billing specialist needs to report a durable medical equipment item. Which coding system is primarily used for DME?
A. ICD-10-CM
B. HCPCS Level II
C. CPT Category III only
D. Revenue codes exclusively
Correct Answer: B
Rationale: HCPCS Level II codes (A, E, K, L, etc.) are used for durable medical equipment, supplies, and certain other services not covered by
CPT. ICD-10-CM provides the diagnosis supporting medical necessity.
Q11
A claim is submitted with an unlisted CPT procedure code. What documentation is typically required to support the
claim?
A. No additional documentation is needed
B. A detailed description of the service and comparison to a similar listed procedure
C. Only the diagnosis code
D. A letter from the patient
Correct Answer: B
Rationale: Unlisted procedure codes require a special report or detailed operative note describing the service performed and often a comparison
to a similar listed code for pricing. Payers review these carefully.
Q12
A patient undergoes bilateral carpal tunnel release. Which modifier is used to indicate bilateral procedures when
required?
A. Modifier -50
B. Modifier -51
C. Modifier -59
D. Modifier -76
Correct Answer: A
Rationale: Modifier -50 indicates a bilateral procedure. Some payers require reporting the code once with -50; others require two line items with
RT/LT. Modifier -51 is for multiple procedures, -59 for distinct services.
NHA CBCS Exam Study Guide 2026/2027 Page 4
NHA CBCS Exam Study Guide 200+ Questions
and Revised Correct Answers (2026/2027) 100%
Guarantee Pass 2026/2027
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
1. Medical Coding Systems (ICD-10-CM, CPT, HCPCS)
2. Claims Processing and Revenue Cycle Management
3. Insurance Payers, Coverage, and Reimbursement
4. Compliance, Ethics, and Regulatory Requirements
5. Patient Accounts, Billing Procedures, and Documentation
STUVIAACTUALEXAM
, 1. Medical Coding Systems (ICD-10-CM, CPT, HCPCS)
Q1
A billing specialist reviews a claim for a patient who received an office visit and a minor surgical procedure on the same
day. The physician documented a significant, separately identifiable E/M service. Which modifier is required on the E/M
code to indicate this?
A. Modifier -25
B. Modifier -59
C. Modifier -51
D. Modifier -76
Correct Answer: A
Rationale: Modifier -25 indicates a significant, separately identifiable evaluation and management service by the same physician on the same day
of a procedure. Modifier -59 is for distinct procedural services, -51 for multiple procedures, and -76 for repeat procedures by the same physician.
Q2
A coder is assigning an ICD-10-CM code for a patient diagnosed with type 2 diabetes mellitus with diabetic nephropathy.
Which code category correctly reflects the combination of conditions?
A. E11.21
B. E10.21
C. E13.9
D. E11.9
Correct Answer: A
Rationale: ICD-10-CM code E11.21 is Type 2 diabetes mellitus with diabetic nephropathy. E10 codes are for type 1 diabetes. E11.9 is type 2
diabetes without complications. Accurate combination coding is required when a manifestation is present.
Q3
A patient undergoes a colonoscopy with biopsy of a polyp and removal of another polyp by snare technique during the
same session. Which CPT coding approach is correct?
A. Report only the snare polypectomy code
B. Report both biopsy and snare codes with appropriate modifiers if required by payer
C. Report the colonoscopy without intervention only
D. Report two separate colonoscopy codes without modifiers
Correct Answer: B
Rationale: When multiple interventions occur during colonoscopy, report each distinct procedure. Biopsy and snare polypectomy are different
techniques; modifiers such as -59 or -XS may be needed depending on payer rules to indicate distinct services.
Q4
A claim is denied because the diagnosis code does not support medical necessity for the procedure performed. Which
action should the billing specialist take first?
A. Immediately write off the charge as uncollectible
B. Review the documentation and query the provider for a more specific diagnosis if supported
C. Change the diagnosis code to any covered code without documentation review
D. Resubmit the claim with the same codes and no changes
Correct Answer: B
Rationale: Medical necessity denials require verification that the diagnosis supports the service. If documentation supports a more specific or
appropriate code, a query and corrected claim are appropriate. Changing codes without support is noncompliant.
NHA CBCS Exam Study Guide 2026/2027 Page 2
, Q5
A patient presents for a well-child visit and also receives a vaccine. The coder needs to report the vaccine administration
and product. Which coding system is used for the vaccine product itself?
A. ICD-10-CM only
B. CPT or HCPCS Level II depending on the vaccine
C. Only revenue codes
D. Only place of service codes
Correct Answer: B
Rationale: Vaccine products are reported with CPT codes (for many vaccines) or HCPCS Level II codes (for some). Administration codes are
separate CPT codes. ICD-10-CM is used for diagnosis, not the product.
Q6
A physician performs a closed treatment of a radial shaft fracture with manipulation. Which CPT category does this
service fall under?
A. Evaluation and Management
B. Surgery / Musculoskeletal System
C. Radiology
D. Medicine
Correct Answer: B
Rationale: Fracture treatment codes are located in the Surgery section under the Musculoskeletal System. Closed treatment with manipulation is
a specific procedure code in that section.
Q7
A coder is selecting a principal diagnosis for an inpatient claim. The patient was admitted for acute exacerbation of
COPD and also has hypertension and osteoarthritis. Which guideline determines the principal diagnosis?
A. The condition that was treated first alphabetically
B. The condition chiefly responsible for the admission after study
C. The condition with the highest reimbursement
D. Any secondary condition listed by the physician
Correct Answer: B
Rationale: UHDDS and Official Coding Guidelines define principal diagnosis as the condition established after study to be chiefly responsible for
occasioning the admission. Secondary conditions are coded as additional diagnoses when they meet criteria.
Q8
A claim includes CPT code 99213 for an established patient office visit. The documentation supports a problem-focused
history, expanded problem-focused examination, and straightforward medical decision making. Which level is most
consistent with the documentation?
A. 99211
B. 99212
C. 99213
D. 99214
Correct Answer: C
Rationale: Under the 1995/1997 guidelines or MDM-focused 2021 guidelines (depending on year of service), 99213 typically requires expanded
problem-focused history/exam and low complexity MDM or the equivalent time/MDM thresholds. Matching documentation to level is essential.
NHA CBCS Exam Study Guide 2026/2027 Page 3
, Q9
A patient has a history of breast cancer that is no longer present and is being seen for routine surveillance. Which
ICD-10-CM coding concept applies?
A. Code the active cancer code
B. Use a personal history of malignant neoplasm code (Z85.-)
C. Code only the screening encounter without history
D. Use an unspecified neoplasm code
Correct Answer: B
Rationale: When cancer is no longer present and the encounter is for surveillance or history, the personal history code Z85.- is appropriate rather
than an active cancer code. Active codes are used only when the disease is under treatment or present.
Q10
A billing specialist needs to report a durable medical equipment item. Which coding system is primarily used for DME?
A. ICD-10-CM
B. HCPCS Level II
C. CPT Category III only
D. Revenue codes exclusively
Correct Answer: B
Rationale: HCPCS Level II codes (A, E, K, L, etc.) are used for durable medical equipment, supplies, and certain other services not covered by
CPT. ICD-10-CM provides the diagnosis supporting medical necessity.
Q11
A claim is submitted with an unlisted CPT procedure code. What documentation is typically required to support the
claim?
A. No additional documentation is needed
B. A detailed description of the service and comparison to a similar listed procedure
C. Only the diagnosis code
D. A letter from the patient
Correct Answer: B
Rationale: Unlisted procedure codes require a special report or detailed operative note describing the service performed and often a comparison
to a similar listed code for pricing. Payers review these carefully.
Q12
A patient undergoes bilateral carpal tunnel release. Which modifier is used to indicate bilateral procedures when
required?
A. Modifier -50
B. Modifier -51
C. Modifier -59
D. Modifier -76
Correct Answer: A
Rationale: Modifier -50 indicates a bilateral procedure. Some payers require reporting the code once with -50; others require two line items with
RT/LT. Modifier -51 is for multiple procedures, -59 for distinct services.
NHA CBCS Exam Study Guide 2026/2027 Page 4
