CCA NCCI, Medical Necessity & Claims Practice Questions
NCCI, Medical Necessity & Claims makes up 6 of every 50 questions on a Tigertest CCA practice test. Here are 10 of the 24 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Weighted to the AHIMA CCA Exam Content Outline. Original questions on coding guidelines and concepts; not affiliated with AHIMA.
1. In an NCCI procedure-to-procedure edit pair, which code is normally denied when both are billed?
- A.The lower-paid code
- B.The column 2 code
- C.The column 1 code
- D.Both of the codes
Answer: B. In a PTP edit, the column 1 code is paid and the column 2 code is denied unless a modifier is allowed and supported.
2. An NCCI PTP edit with modifier indicator 0 means:
- A.Only modifier 25 bypasses it
- B.The edit has been deleted
- C.Any modifier can bypass it
- D.No modifier can bypass it
Answer: D. Indicator 0 means the code pair can never be reported together on the same date, whatever modifier is used.
3. An NCCI PTP edit with modifier indicator 1 means an NCCI-associated modifier:
- A.May bypass it if supported
- B.Is not relevant to it
- C.Can never bypass it
- D.Must always be added
Answer: A. Indicator 1 lets an NCCI-associated modifier bypass the edit, but only when the documentation shows the services were distinct.
4. An NCCI PTP edit with modifier indicator 9 means:
- A.A modifier may bypass it
- B.The edit applies daily
- C.The edit does not apply
- D.No modifier can bypass it
Answer: C. Indicator 9 means not applicable. CMS uses it for edits deleted back to their effective date, so the pair is not edited.
5. A medically unlikely edit (MUE) sets the:
- A.Codes that cannot pair
- B.Diagnoses each code requires
- C.Maximum units for a code
- D.Minimum units per claim
Answer: C. An MUE is the most units of service a provider would report for one patient on one date of service under most circumstances.
6. A coder may append an NCCI-associated modifier such as 59 or XS only when:
- A.Records show a distinct service
- B.The physician asks verbally
- C.The payer accepts any modifier
- D.The claim was denied before
Answer: A. Modifiers that bypass NCCI edits are allowed only when documentation supports a separate site, session or encounter. Adding one just to get paid is abuse.
7. NCCI treats services that are integral to a procedure, such as access and closure, as:
- A.Add-on services
- B.Separately payable
- C.Billable with a 59 modifier
- D.Included in the procedure
Answer: D. Services needed to perform a procedure are part of it and are not reported separately. Billing them on their own is unbundling.
8. A Medicare local coverage determination (LCD) is issued by:
- A.The AMA CPT Editorial Panel
- B.A Medicare contractor (MAC)
- C.CMS for the whole country
- D.The Office of Inspector General
Answer: B. MACs write LCDs for their own jurisdictions. National coverage determinations come from CMS and apply everywhere.
9. A national coverage determination (NCD) is issued by:
- A.AHIMA
- B.CMS
- C.Each MAC
- D.The OIG
Answer: B. CMS issues NCDs, which bind every Medicare contractor. Where no NCD exists, a MAC may issue an LCD.
10. On a Medicare claim, medical necessity for a service is shown mainly by:
- A.The place of service
- B.The patient's age
- C.The service's RVUs
- D.Its linked diagnosis codes
Answer: D. Payers judge medical necessity by the diagnosis codes linked to each service, checked against coverage policies such as LCDs and NCDs.
Practice all 24 ncci, medical necessity & claims questions, and the rest of the 200-question bank, in the free CCA training sets. Questions you miss come back until you have mastered them.
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