NHA CBCS Exam Study Guide 2025: 200+
Questions & Revised Answers | 100%
Guaranteed Pass
Question 1: Which of the following is the primary purpose of the ICD-10-CM coding system?
A. To standardize billing for medical procedures B. To classify diagnoses and reasons for visits
C. To document medical necessity for laboratory tests D. To track pharmaceutical prescriptions
Correct Answer: B Rationale: The ICD-10-CM coding system is used to classify diagnoses
and reasons for patient visits in all healthcare settings. CPT codes (A) are used for
procedures, not diagnoses. Medical necessity (C) and pharmaceutical tracking (D) are not the
primary purposes of ICD-10-CM.
Question 2: Which code set is used to report medical procedures and services performed by
healthcare providers?
A. ICD-10-CM B. CPT C. HCPCS Level II D. NDC
Correct Answer: B Rationale: CPT (Current Procedural Terminology) codes are used to
report medical procedures and services performed by healthcare providers. ICD-10-CM (A) is
for diagnoses, HCPCS Level II (C) is for supplies and non-physician services, and NDC (D) is
for pharmaceuticals.
Question 3: A patient presents with type 2 diabetes mellitus with diabetic retinopathy. Which
ICD-10-CM code should be assigned?
A. E11.9 B. E11.319 C. E10.319 D. E13.319
Correct Answer: B Rationale: The correct code for type 2 diabetes mellitus with diabetic
retinopathy is E11.319. E11.9 (A) is for type 2 diabetes without complications. E10.319 (C) is
for type 1 diabetes, and E13.319 (D) is for other specified diabetes.
Question 4: Which modifier indicates that a procedure was performed bilaterally?
,A. -25 B. -50 C. -59 D. -76
Correct Answer: B Rationale: The modifier -50 is used to indicate that a procedure was
performed bilaterally. Modifier -25 (A) is for significant, separately identifiable evaluation and
management service. Modifier -59 (C) is for distinct procedural service, and -76 (D) is for a
repeat procedure by the same physician.
Question 5: What is the purpose of the HCPCS Level II coding system?
A. To report physician services B. To report non-physician services, supplies, and equipment C.
To classify patient diagnoses D. To document surgical procedures
Correct Answer: B Rationale: The HCPCS Level II coding system is used to report
non-physician services, supplies, and equipment not covered by CPT codes. Physician
services (A) are reported with CPT codes, diagnoses (C) are reported with ICD-10-CM, and
surgical procedures (D) are reported with CPT codes.
Question 6: Which of the following is an example of a bundled service in medical billing?
A. Office visit and EKG performed on the same day B. Surgical procedure and postoperative
care C. Laboratory tests ordered by different physicians D. Radiology services and physical
therapy
Correct Answer: B Rationale: A bundled service includes multiple services that are typically
reported together under a single code , such as a surgical procedure and its
postoperative care . Office visits and EKGs (A), laboratory tests (C), and radiology/physical
therapy (D) are not typically bundled.
Question 7: What is the primary purpose of the National Correct Coding Initiative (NCCI) edits?
A. To ensure accurate diagnosis coding B. To prevent improper payment for services that should
not be billed together C. To standardize electronic health record documentation D. To streamline
insurance claim appeals
Correct Answer: B Rationale: The National Correct Coding Initiative (NCCI) edits are
designed to prevent improper payment for services that should not be billed together. They do
not focus on diagnosis coding (A), EHR documentation (C), or claim appeals (D).
,Question 8: Which of the following is required for a claim to be considered "clean" under HIPAA
standards?
A. Patient demographic information only B. Complete and accurate coding and billing information
C. Physician signature only D. Insurance verification only
Correct Answer: B Rationale: A "clean claim" under HIPAA standards requires complete and
accurate coding and billing information to avoid rejections or denials. Patient demographics
(A), physician signature (C), and insurance verification (D) alone are insufficient.
Question 9: Which type of insurance typically covers individuals aged 65 and older?
A. Medicaid B. Medicare C. TRICARE D. Workers' Compensation
Correct Answer: B Rationale: Medicare is the federal health insurance program that covers
individuals aged 65 and older, as well as some younger individuals with disabilities. Medicaid
(A) covers low-income individuals, TRICARE (C) covers military personnel, and Workers'
Compensation (D) covers work-related injuries.
Question 10: What is the purpose of the Advance Beneficiary Notice (ABN)?
A. To inform patients of their rights under HIPAA B. To notify patients when Medicare may not
cover a service C. To document patient consent for surgery D. To verify insurance eligibility
Correct Answer: B Rationale: The Advance Beneficiary Notice (ABN) is used to notify
patients when Medicare may not cover a service , allowing them to decide whether to
proceed and assume financial responsibility. It is not related to HIPAA rights (A), surgical consent
(C), or insurance verification (D).
Question 11: Which of the following is an example of a primary payer in medical billing?
A. Medicaid B. Secondary commercial insurance C. Patient responsibility D. Tertiary insurance
Correct Answer: A Rationale: A primary payer is the first insurance plan responsible for
paying a claim. Medicaid (A) can be a primary payer. Secondary insurance (B), patient
responsibility (C), and tertiary insurance (D) are not primary payers.
Question 12: What is the first step in the medical billing revenue cycle?
, A. Claim submission B. Patient registration and insurance verification C. Payment posting D.
Claim adjudication
Correct Answer: B Rationale: The first step in the medical billing revenue cycle is patient
registration and insurance verification to ensure accurate patient and insurance information.
Claim submission (A), payment posting (C), and adjudication (D) occur later in the process.
Question 13: Which of the following is a key component of HIPAA's Privacy Rule?
A. Ensuring timely claim submission B. Protecting patients' personal health information (PHI) C.
Standardizing billing codes D. Reducing claim denials
Correct Answer: B Rationale: The HIPAA Privacy Rule is designed to protect patients'
personal health information (PHI) and regulate its use and disclosure. It does not address
claim submission (A), billing codes (C), or claim denials (D).
Question 14: Which modifier is used to indicate that a service was provided at a higher level
than usual?
A. -22 B. -25 C. -52 D. -59
Correct Answer: A Rationale: Modifier -22 is used to indicate that a service was provided at
a higher level than usual, often due to increased complexity. Modifier -25 (B) is for significant,
separately identifiable E/M services, -52 (C) is for reduced services, and -59 (D) is for distinct
procedural services.
Question 15: Which of the following is an example of a secondary diagnosis code?
A. The main reason for the patient's visit B. A condition that affects the patient's treatment C. The
physician's specialty code D. The facility's NPI number
Correct Answer: B Rationale: A secondary diagnosis code represents a condition that
affects the patient's treatment but is not the primary reason for the visit. The main reason for
the visit (A) is the primary diagnosis. Physician specialty (C) and facility NPI (D) are not
diagnosis codes.
Question 16: What is the purpose of the UB-04 claim form?
Questions & Revised Answers | 100%
Guaranteed Pass
Question 1: Which of the following is the primary purpose of the ICD-10-CM coding system?
A. To standardize billing for medical procedures B. To classify diagnoses and reasons for visits
C. To document medical necessity for laboratory tests D. To track pharmaceutical prescriptions
Correct Answer: B Rationale: The ICD-10-CM coding system is used to classify diagnoses
and reasons for patient visits in all healthcare settings. CPT codes (A) are used for
procedures, not diagnoses. Medical necessity (C) and pharmaceutical tracking (D) are not the
primary purposes of ICD-10-CM.
Question 2: Which code set is used to report medical procedures and services performed by
healthcare providers?
A. ICD-10-CM B. CPT C. HCPCS Level II D. NDC
Correct Answer: B Rationale: CPT (Current Procedural Terminology) codes are used to
report medical procedures and services performed by healthcare providers. ICD-10-CM (A) is
for diagnoses, HCPCS Level II (C) is for supplies and non-physician services, and NDC (D) is
for pharmaceuticals.
Question 3: A patient presents with type 2 diabetes mellitus with diabetic retinopathy. Which
ICD-10-CM code should be assigned?
A. E11.9 B. E11.319 C. E10.319 D. E13.319
Correct Answer: B Rationale: The correct code for type 2 diabetes mellitus with diabetic
retinopathy is E11.319. E11.9 (A) is for type 2 diabetes without complications. E10.319 (C) is
for type 1 diabetes, and E13.319 (D) is for other specified diabetes.
Question 4: Which modifier indicates that a procedure was performed bilaterally?
,A. -25 B. -50 C. -59 D. -76
Correct Answer: B Rationale: The modifier -50 is used to indicate that a procedure was
performed bilaterally. Modifier -25 (A) is for significant, separately identifiable evaluation and
management service. Modifier -59 (C) is for distinct procedural service, and -76 (D) is for a
repeat procedure by the same physician.
Question 5: What is the purpose of the HCPCS Level II coding system?
A. To report physician services B. To report non-physician services, supplies, and equipment C.
To classify patient diagnoses D. To document surgical procedures
Correct Answer: B Rationale: The HCPCS Level II coding system is used to report
non-physician services, supplies, and equipment not covered by CPT codes. Physician
services (A) are reported with CPT codes, diagnoses (C) are reported with ICD-10-CM, and
surgical procedures (D) are reported with CPT codes.
Question 6: Which of the following is an example of a bundled service in medical billing?
A. Office visit and EKG performed on the same day B. Surgical procedure and postoperative
care C. Laboratory tests ordered by different physicians D. Radiology services and physical
therapy
Correct Answer: B Rationale: A bundled service includes multiple services that are typically
reported together under a single code , such as a surgical procedure and its
postoperative care . Office visits and EKGs (A), laboratory tests (C), and radiology/physical
therapy (D) are not typically bundled.
Question 7: What is the primary purpose of the National Correct Coding Initiative (NCCI) edits?
A. To ensure accurate diagnosis coding B. To prevent improper payment for services that should
not be billed together C. To standardize electronic health record documentation D. To streamline
insurance claim appeals
Correct Answer: B Rationale: The National Correct Coding Initiative (NCCI) edits are
designed to prevent improper payment for services that should not be billed together. They do
not focus on diagnosis coding (A), EHR documentation (C), or claim appeals (D).
,Question 8: Which of the following is required for a claim to be considered "clean" under HIPAA
standards?
A. Patient demographic information only B. Complete and accurate coding and billing information
C. Physician signature only D. Insurance verification only
Correct Answer: B Rationale: A "clean claim" under HIPAA standards requires complete and
accurate coding and billing information to avoid rejections or denials. Patient demographics
(A), physician signature (C), and insurance verification (D) alone are insufficient.
Question 9: Which type of insurance typically covers individuals aged 65 and older?
A. Medicaid B. Medicare C. TRICARE D. Workers' Compensation
Correct Answer: B Rationale: Medicare is the federal health insurance program that covers
individuals aged 65 and older, as well as some younger individuals with disabilities. Medicaid
(A) covers low-income individuals, TRICARE (C) covers military personnel, and Workers'
Compensation (D) covers work-related injuries.
Question 10: What is the purpose of the Advance Beneficiary Notice (ABN)?
A. To inform patients of their rights under HIPAA B. To notify patients when Medicare may not
cover a service C. To document patient consent for surgery D. To verify insurance eligibility
Correct Answer: B Rationale: The Advance Beneficiary Notice (ABN) is used to notify
patients when Medicare may not cover a service , allowing them to decide whether to
proceed and assume financial responsibility. It is not related to HIPAA rights (A), surgical consent
(C), or insurance verification (D).
Question 11: Which of the following is an example of a primary payer in medical billing?
A. Medicaid B. Secondary commercial insurance C. Patient responsibility D. Tertiary insurance
Correct Answer: A Rationale: A primary payer is the first insurance plan responsible for
paying a claim. Medicaid (A) can be a primary payer. Secondary insurance (B), patient
responsibility (C), and tertiary insurance (D) are not primary payers.
Question 12: What is the first step in the medical billing revenue cycle?
, A. Claim submission B. Patient registration and insurance verification C. Payment posting D.
Claim adjudication
Correct Answer: B Rationale: The first step in the medical billing revenue cycle is patient
registration and insurance verification to ensure accurate patient and insurance information.
Claim submission (A), payment posting (C), and adjudication (D) occur later in the process.
Question 13: Which of the following is a key component of HIPAA's Privacy Rule?
A. Ensuring timely claim submission B. Protecting patients' personal health information (PHI) C.
Standardizing billing codes D. Reducing claim denials
Correct Answer: B Rationale: The HIPAA Privacy Rule is designed to protect patients'
personal health information (PHI) and regulate its use and disclosure. It does not address
claim submission (A), billing codes (C), or claim denials (D).
Question 14: Which modifier is used to indicate that a service was provided at a higher level
than usual?
A. -22 B. -25 C. -52 D. -59
Correct Answer: A Rationale: Modifier -22 is used to indicate that a service was provided at
a higher level than usual, often due to increased complexity. Modifier -25 (B) is for significant,
separately identifiable E/M services, -52 (C) is for reduced services, and -59 (D) is for distinct
procedural services.
Question 15: Which of the following is an example of a secondary diagnosis code?
A. The main reason for the patient's visit B. A condition that affects the patient's treatment C. The
physician's specialty code D. The facility's NPI number
Correct Answer: B Rationale: A secondary diagnosis code represents a condition that
affects the patient's treatment but is not the primary reason for the visit. The main reason for
the visit (A) is the primary diagnosis. Physician specialty (C) and facility NPI (D) are not
diagnosis codes.
Question 16: What is the purpose of the UB-04 claim form?
