NHA - CERTIFIED BILLING AND CODING
SPECIALIST (CBCS) STUDY GUIDE
150+ (Latest 2026 Edition) 100% Verified Q&A + Answer Key Solutions
100% Guarantee Pass
📋 DOCUMENT OVERVIEW 153 Qs
This document, "NHA - Certified Billing and Coding Specialist (CBCS) Study Guide," covers various topics in
medical billing and coding, including CPT coding, anesthesia, surgical procedures, claim forms (CMS-1500),
and billing procedures. Each of the 153 questions includes the correct answer with detailed explanations,
offering a comprehensive review of key concepts for exam preparation . Students can use this
document to study, review, and understand the concepts, ultimately enhancing their knowledge and
preparation for the CBCS exam.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 1
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
CORRECT ANSWER
Reinstated or recycled code
RATIONALE: The symbol "O" in the Current Procedural Terminology reference is used to indicate "Reinstated or recycled
code" because it signifies that a previously deleted code has been reinstated or reused, often due to its relevance or
necessity in updated medical procedures. This notation helps healthcare professionals and coders easily identify and adapt
to changes in the classification system, ensuring accurate and consistent coding practices.
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, QUESTION 2
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
CORRECT ANSWER
Add-on codes
RATIONALE: The correct answer is "Add-on codes" because qualifying circumstances in the anesthesia section of the CPT
manual refer to additional procedures or services provided during a primary anesthesia service that require separate
reporting and payment, which is facilitated by the use of add-on codes. These add-on codes allow for the accurate and
efficient reporting of these additional services, ensuring that providers receive the necessary compensation for their work.
QUESTION 3
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-1500
claim form before a further claim is required?
CORRECT ANSWER
12
RATIONALE: The CMS-1500 claim form has a specific layout with multiple boxes for reporting diagnoses, and each box is
designated for a specific number of diagnosis codes. Since there are five boxes on the form labeled as "1-5" for reporting
up to 5 diagnoses, the maximum number of diagnoses that can be reported on this form is the total of the capacities of
these individual boxes, which is 1 + 2 + 3 + 4 + 5 = 15, but the actual limit for 12 diagnosis codes can be reported when
using a modifier in box 19 to report additional codes, the key to the answer is understanding the modifier's effect.
QUESTION 4
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures?
CORRECT ANSWER
Operative report
RATIONALE: An operative report is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures because it provides a detailed and contemporaneous record of the surgical procedure, including the
specific CPT code used and any relevant ICD codes. This documentation serves as tangible evidence of the procedure
performed, allowing for accurate billing and coding, and helps healthcare providers demonstrate compliance with regulatory
requirements.
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, QUESTION 5
What action should be taken first when reviewing a delinquent claim?
CORRECT ANSWER
Verify the age of the account
RATIONALE: When reviewing a delinquent claim, verifying the age of the account is the correct initial action because it
helps determine whether the claim is still valid or has exceeded the statute of limitations, which could significantly impact
the outcome of the review. This verification process ensures that the reviewer is addressing a claim that is eligible for
consideration, reducing the risk of unnecessary further investigation or incorrect conclusions.
QUESTION 6
A claim can be denied or rejected for which of the following reasons?
CORRECT ANSWER
Block 24D contains the diagnosis code
RATIONALE: The correct answer is "Block 24D contains the diagnosis code" because the presence of a diagnosis code in
this section is crucial for processing a claim, and its absence can trigger a denial or rejection due to incomplete or
inaccurate information. This is because diagnosis codes are essential for identifying the services provided, determining the
correct payment amount, and ensuring compliance with billing regulations.
QUESTION 7
A coroner's autopsy is comprised of what examinations?
CORRECT ANSWER
Gross Examination
RATIONALE: A coroner's autopsy is typically divided into two main examinations: the external examination and the internal
examination, with "Gross Examination" being the term commonly used to describe the external examination. This is
because "Gross Examination" refers to the external examination of the body, where the coroner assesses the body's
external appearance, including any visible injuries or abnormalities, before proceeding with the internal examination.
QUESTION 8
Medigap coverage is offered to Medicare beneficiaries by whom?
CORRECT ANSWER
Private third-party payers
RATIONALE: Medigap coverage is offered to Medicare beneficiaries by private third-party payers because the Medicare
program itself does not offer supplemental insurance, instead allowing private companies to fill this gap in coverage. These
private companies, which are licensed by state insurance departments, offer Medigap policies to help cover costs not
covered by Original Medicare.
Trusted by thousands of students and professionals worldwide Page 3 of 45
, QUESTION 9
What part of Medicare covers prescriptions?
CORRECT ANSWER
Part C
RATIONALE: Medicare Part C, also known as Medicare Advantage, is the correct answer because it includes prescription
coverage as part of its comprehensive benefits package, combining medical and pharmacy coverage under one plan. This
comprehensive coverage is a key feature that distinguishes Medicare Advantage plans, including Part C, from other
Medicare parts that do not include prescription coverage.
QUESTION 10
What plane divides the body into left and right?
CORRECT ANSWER
Sagittal
RATIONALE: The sagittal plane is an imaginary line that divides the body into left and right halves by passing through the
midline of the body, essentially serving as an axis of symmetry. This plane is used in anatomy to orient and position body
structures in relation to each other, making it a crucial reference point for understanding human anatomy.
QUESTION 11
Where can unlisted codes be found in the CPT manual?
CORRECT ANSWER
Guidelines prior to each section
RATIONALE: The CPT manual is organized with guidelines prior to each section to provide essential information and context
for the subsequent codes, allowing unlisted codes to be applied appropriately when a specific code is not available. By
referring to the guidelines, users can understand the nuances and variations in procedures, making it possible to identify
and utilize unlisted codes effectively.
QUESTION 12
Ambulatory surgery centers, home health care, and hospice organizations use which form to submit
claims?
CORRECT ANSWER
UB-04 Claim Form
RATIONALE: The UB-04 Claim Form is widely accepted by Medicare and many private payers due to its standardized format
and compliance with HIPAA guidelines, making it a convenient and efficient choice for ambulatory surgery centers, home
health care, and hospice organizations to submit claims. Its adaptability for various healthcare settings, including inpatient
and outpatient services, allows it to be a versatile solution for diverse types of healthcare providers.
Trusted by thousands of students and professionals worldwide Page 4 of 45
SPECIALIST (CBCS) STUDY GUIDE
150+ (Latest 2026 Edition) 100% Verified Q&A + Answer Key Solutions
100% Guarantee Pass
📋 DOCUMENT OVERVIEW 153 Qs
This document, "NHA - Certified Billing and Coding Specialist (CBCS) Study Guide," covers various topics in
medical billing and coding, including CPT coding, anesthesia, surgical procedures, claim forms (CMS-1500),
and billing procedures. Each of the 153 questions includes the correct answer with detailed explanations,
offering a comprehensive review of key concepts for exam preparation . Students can use this
document to study, review, and understand the concepts, ultimately enhancing their knowledge and
preparation for the CBCS exam.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 1
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
CORRECT ANSWER
Reinstated or recycled code
RATIONALE: The symbol "O" in the Current Procedural Terminology reference is used to indicate "Reinstated or recycled
code" because it signifies that a previously deleted code has been reinstated or reused, often due to its relevance or
necessity in updated medical procedures. This notation helps healthcare professionals and coders easily identify and adapt
to changes in the classification system, ensuring accurate and consistent coding practices.
Trusted by thousands of students and professionals worldwide Page 1 of 45
, QUESTION 2
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
CORRECT ANSWER
Add-on codes
RATIONALE: The correct answer is "Add-on codes" because qualifying circumstances in the anesthesia section of the CPT
manual refer to additional procedures or services provided during a primary anesthesia service that require separate
reporting and payment, which is facilitated by the use of add-on codes. These add-on codes allow for the accurate and
efficient reporting of these additional services, ensuring that providers receive the necessary compensation for their work.
QUESTION 3
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-1500
claim form before a further claim is required?
CORRECT ANSWER
12
RATIONALE: The CMS-1500 claim form has a specific layout with multiple boxes for reporting diagnoses, and each box is
designated for a specific number of diagnosis codes. Since there are five boxes on the form labeled as "1-5" for reporting
up to 5 diagnoses, the maximum number of diagnoses that can be reported on this form is the total of the capacities of
these individual boxes, which is 1 + 2 + 3 + 4 + 5 = 15, but the actual limit for 12 diagnosis codes can be reported when
using a modifier in box 19 to report additional codes, the key to the answer is understanding the modifier's effect.
QUESTION 4
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures?
CORRECT ANSWER
Operative report
RATIONALE: An operative report is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures because it provides a detailed and contemporaneous record of the surgical procedure, including the
specific CPT code used and any relevant ICD codes. This documentation serves as tangible evidence of the procedure
performed, allowing for accurate billing and coding, and helps healthcare providers demonstrate compliance with regulatory
requirements.
Trusted by thousands of students and professionals worldwide Page 2 of 45
, QUESTION 5
What action should be taken first when reviewing a delinquent claim?
CORRECT ANSWER
Verify the age of the account
RATIONALE: When reviewing a delinquent claim, verifying the age of the account is the correct initial action because it
helps determine whether the claim is still valid or has exceeded the statute of limitations, which could significantly impact
the outcome of the review. This verification process ensures that the reviewer is addressing a claim that is eligible for
consideration, reducing the risk of unnecessary further investigation or incorrect conclusions.
QUESTION 6
A claim can be denied or rejected for which of the following reasons?
CORRECT ANSWER
Block 24D contains the diagnosis code
RATIONALE: The correct answer is "Block 24D contains the diagnosis code" because the presence of a diagnosis code in
this section is crucial for processing a claim, and its absence can trigger a denial or rejection due to incomplete or
inaccurate information. This is because diagnosis codes are essential for identifying the services provided, determining the
correct payment amount, and ensuring compliance with billing regulations.
QUESTION 7
A coroner's autopsy is comprised of what examinations?
CORRECT ANSWER
Gross Examination
RATIONALE: A coroner's autopsy is typically divided into two main examinations: the external examination and the internal
examination, with "Gross Examination" being the term commonly used to describe the external examination. This is
because "Gross Examination" refers to the external examination of the body, where the coroner assesses the body's
external appearance, including any visible injuries or abnormalities, before proceeding with the internal examination.
QUESTION 8
Medigap coverage is offered to Medicare beneficiaries by whom?
CORRECT ANSWER
Private third-party payers
RATIONALE: Medigap coverage is offered to Medicare beneficiaries by private third-party payers because the Medicare
program itself does not offer supplemental insurance, instead allowing private companies to fill this gap in coverage. These
private companies, which are licensed by state insurance departments, offer Medigap policies to help cover costs not
covered by Original Medicare.
Trusted by thousands of students and professionals worldwide Page 3 of 45
, QUESTION 9
What part of Medicare covers prescriptions?
CORRECT ANSWER
Part C
RATIONALE: Medicare Part C, also known as Medicare Advantage, is the correct answer because it includes prescription
coverage as part of its comprehensive benefits package, combining medical and pharmacy coverage under one plan. This
comprehensive coverage is a key feature that distinguishes Medicare Advantage plans, including Part C, from other
Medicare parts that do not include prescription coverage.
QUESTION 10
What plane divides the body into left and right?
CORRECT ANSWER
Sagittal
RATIONALE: The sagittal plane is an imaginary line that divides the body into left and right halves by passing through the
midline of the body, essentially serving as an axis of symmetry. This plane is used in anatomy to orient and position body
structures in relation to each other, making it a crucial reference point for understanding human anatomy.
QUESTION 11
Where can unlisted codes be found in the CPT manual?
CORRECT ANSWER
Guidelines prior to each section
RATIONALE: The CPT manual is organized with guidelines prior to each section to provide essential information and context
for the subsequent codes, allowing unlisted codes to be applied appropriately when a specific code is not available. By
referring to the guidelines, users can understand the nuances and variations in procedures, making it possible to identify
and utilize unlisted codes effectively.
QUESTION 12
Ambulatory surgery centers, home health care, and hospice organizations use which form to submit
claims?
CORRECT ANSWER
UB-04 Claim Form
RATIONALE: The UB-04 Claim Form is widely accepted by Medicare and many private payers due to its standardized format
and compliance with HIPAA guidelines, making it a convenient and efficient choice for ambulatory surgery centers, home
health care, and hospice organizations to submit claims. Its adaptability for various healthcare settings, including inpatient
and outpatient services, allows it to be a versatile solution for diverse types of healthcare providers.
Trusted by thousands of students and professionals worldwide Page 4 of 45
