NHA CBCS 2026/2027 COMPREHENSIVE EXAM: 100
QUESTIONS WITH DETAILED RATIONALES
1. During pre-registration, a patient presents an insurance card
indicating a plan with a $30 copay for primary care visits and a $2,000
annual deductible that has not yet been met. The patient is scheduled
for a problem-focused E/M visit. What amount should the billing and
coding specialist collect at the time of service?
A) $30
B) $2,000
C) $0
D) $30 plus 20% of the billed charge
Correct Answer: A
Rationale: A copayment is a fixed dollar amount the patient pays at the
time of service for a specific type of visit. The deductible applies to
certain services but does not replace the copay requirement for an
office visit. Collecting the copay at the time of service is standard front-
end revenue cycle practice.
2. A coder is reviewing an operative report for a laparoscopic
cholecystectomy. The surgeon documents that during the same
operative session, a lysis of adhesions was also performed in a
separate anatomical area to access the gallbladder. How should these
services be reported?
,A) Report only the cholecystectomy code
B) Report the cholecystectomy with modifier -51 and the lysis of
adhesions separately
C) Report the cholecystectomy with modifier -22
D) Report only the lysis of adhesions code
Correct Answer: B
Rationale: When a distinct procedural service is performed during the
same operative session, modifier -51 (multiple procedures) is appended
to the secondary procedure to indicate that multiple procedures were
performed. The lysis of adhesions in a separate anatomical area is
separately reportable.
3. Which of the following best describes the purpose of the National
Correct Coding Initiative (NCCI) edits?
A) To determine patient eligibility for Medicaid
B) To prevent improper coding and unbundling of services that should
be reported together
C) To establish the fee schedule for Medicare reimbursement
D) To verify physician credentials
Correct Answer: B
Rationale: NCCI edits are used to promote national correct coding
methodologies and control improper coding that leads to inappropriate
payment. These edits identify code pairs that should not be reported
together because they are considered integral to one another.
,4. A patient presents to the emergency department with chest pain.
The physician documents a detailed history, comprehensive
examination, and medical decision-making of high complexity. The
patient is admitted to the hospitalist service. Which E/M code
category should be reported by the emergency physician?
A) Office or other outpatient visit
B) Emergency department services
C) Initial hospital care
D) Subsequent hospital care
Correct Answer: B
Rationale: Emergency department E/M codes (99281-99285) are used
to report services provided in the emergency department. These codes
are based on the three key components: history, examination, and
medical decision-making. The emergency physician reports the ED visit,
while the hospitalist would report the initial hospital care code.
5. A billing specialist is reviewing a claim that was denied with reason
code CO-97. What does this denial indicate?
A) The benefit for this service is included in another service already
adjudicated
B) The claim was denied because the patient is not covered
C) The service was not medically necessary
D) The provider is not participating with the plan
Correct Answer: A
, Rationale: CO-97 is a Claim Adjustment Reason Code indicating that the
benefit for the service is included in the payment or allowance for
another procedure or service already adjudicated. This often occurs
when services are considered bundled and should be reported with the
appropriate modifier.
6. Which of the following actions by a billing and coding specialist
would be considered fraud rather than abuse?
A) Submitting a claim for a service that was not documented in the
medical record
B) Using an outdated code that was inadvertently selected
C) Failing to verify patient eligibility before submitting a claim
D) Assigning a lower-level E/M code than documented
Correct Answer: A
Rationale: Fraud requires intentional misrepresentation for payment.
Billing for services not rendered is a classic example of fraud. Abuse, by
contrast, involves practices that are inconsistent with sound business or
medical practice but do not necessarily involve intentional deception.
7. Under HIPAA, which of the following is considered a breach of
protected health information (PHI)?
A) Faxing a patient's record to another provider after obtaining written
authorization
B) Discussing a patient's condition in a private hospital room with the
patient present
QUESTIONS WITH DETAILED RATIONALES
1. During pre-registration, a patient presents an insurance card
indicating a plan with a $30 copay for primary care visits and a $2,000
annual deductible that has not yet been met. The patient is scheduled
for a problem-focused E/M visit. What amount should the billing and
coding specialist collect at the time of service?
A) $30
B) $2,000
C) $0
D) $30 plus 20% of the billed charge
Correct Answer: A
Rationale: A copayment is a fixed dollar amount the patient pays at the
time of service for a specific type of visit. The deductible applies to
certain services but does not replace the copay requirement for an
office visit. Collecting the copay at the time of service is standard front-
end revenue cycle practice.
2. A coder is reviewing an operative report for a laparoscopic
cholecystectomy. The surgeon documents that during the same
operative session, a lysis of adhesions was also performed in a
separate anatomical area to access the gallbladder. How should these
services be reported?
,A) Report only the cholecystectomy code
B) Report the cholecystectomy with modifier -51 and the lysis of
adhesions separately
C) Report the cholecystectomy with modifier -22
D) Report only the lysis of adhesions code
Correct Answer: B
Rationale: When a distinct procedural service is performed during the
same operative session, modifier -51 (multiple procedures) is appended
to the secondary procedure to indicate that multiple procedures were
performed. The lysis of adhesions in a separate anatomical area is
separately reportable.
3. Which of the following best describes the purpose of the National
Correct Coding Initiative (NCCI) edits?
A) To determine patient eligibility for Medicaid
B) To prevent improper coding and unbundling of services that should
be reported together
C) To establish the fee schedule for Medicare reimbursement
D) To verify physician credentials
Correct Answer: B
Rationale: NCCI edits are used to promote national correct coding
methodologies and control improper coding that leads to inappropriate
payment. These edits identify code pairs that should not be reported
together because they are considered integral to one another.
,4. A patient presents to the emergency department with chest pain.
The physician documents a detailed history, comprehensive
examination, and medical decision-making of high complexity. The
patient is admitted to the hospitalist service. Which E/M code
category should be reported by the emergency physician?
A) Office or other outpatient visit
B) Emergency department services
C) Initial hospital care
D) Subsequent hospital care
Correct Answer: B
Rationale: Emergency department E/M codes (99281-99285) are used
to report services provided in the emergency department. These codes
are based on the three key components: history, examination, and
medical decision-making. The emergency physician reports the ED visit,
while the hospitalist would report the initial hospital care code.
5. A billing specialist is reviewing a claim that was denied with reason
code CO-97. What does this denial indicate?
A) The benefit for this service is included in another service already
adjudicated
B) The claim was denied because the patient is not covered
C) The service was not medically necessary
D) The provider is not participating with the plan
Correct Answer: A
, Rationale: CO-97 is a Claim Adjustment Reason Code indicating that the
benefit for the service is included in the payment or allowance for
another procedure or service already adjudicated. This often occurs
when services are considered bundled and should be reported with the
appropriate modifier.
6. Which of the following actions by a billing and coding specialist
would be considered fraud rather than abuse?
A) Submitting a claim for a service that was not documented in the
medical record
B) Using an outdated code that was inadvertently selected
C) Failing to verify patient eligibility before submitting a claim
D) Assigning a lower-level E/M code than documented
Correct Answer: A
Rationale: Fraud requires intentional misrepresentation for payment.
Billing for services not rendered is a classic example of fraud. Abuse, by
contrast, involves practices that are inconsistent with sound business or
medical practice but do not necessarily involve intentional deception.
7. Under HIPAA, which of the following is considered a breach of
protected health information (PHI)?
A) Faxing a patient's record to another provider after obtaining written
authorization
B) Discussing a patient's condition in a private hospital room with the
patient present
