10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The NCICS exam has 125 questions and runs 3 hours.
These 10 free NCICS questions are organized by exam domain, so you can see how each part of the National Certified Insurance and Coding Specialist blueprint is tested. Reveal the answer and explanation under each question.
For a covered in-network procedure, the practice charges $640 and the contracted allowed amount is $400. The patient has $150 of deductible remaining and owes 20% coinsurance after the deductible. A $60 prepayment is already credited to this procedure. There is no copayment or secondary coverage, and the out-of-pocket maximum will not affect this claim. How much additional patient payment should the practice estimate?
Correct answer: A - $140
Two employer-sponsored plans cover an 11-year-old as a dependent. The parents are married and live with the child, and both plans use the standard birthday rule. The mother was born October 8, 1978, and has held her coverage since 2017. The father was born March 16, 1986, and has held his coverage since 2022. Which plan should receive the child's claim first?
Correct answer: C - The father's plan, because March precedes October.
After a 24-hour hospital observation stay, a patient is discharged without ever being admitted as an inpatient. The final signed assessment states, "Right upper quadrant pain; probable acute cholecystitis." No definitive diagnosis is established, and the record is complete. Which diagnosis reporting is appropriate for this outpatient claim?
Correct answer: C - R10.11 alone - right upper quadrant pain.
The physician evaluates an established patient's hypertension, hypothyroidism, and gastroesophageal reflux disease during an office visit. All three conditions are at treatment goals. After assessing response and tolerability, the physician decides to continue the prescription regimens. No tests, outside records, or other data are ordered or reviewed. The service level is selected by medical decision making, not time. Which level is supported?
Correct answer: D - 99214 - moderate medical decision making.
The medication administration record documents 0.6 mL of dexamethasone sodium phosphate given from a 1 mL single-dose vial labeled 10 mg/mL. The remaining 0.4 mL is discarded and documented. The drug is separately payable under Medicare Part B, and the discard qualifies for reimbursement. J1100 represents 1 mg per billing unit. Considering only the J1100 drug lines, which reporting matches the record?
Correct answer: A - 6 administered units without JW or JZ, plus 4 discarded units with JW.
Item 21 of a commercial CMS-1500 claim lists the diagnosis codes in this order: A, essential hypertension; B, left knee pain; C, type 2 diabetes. The knee radiographs on one service line were performed solely to evaluate the knee pain. The payer follows NUCC instructions. What belongs in Item 24E for that line?
Correct answer: D - The letter B.
A pre-submission Medicare NCCI procedure-to-procedure edit links two wound procedures and shows modifier indicator 1. The operative report documents the Column One procedure on the left forearm and the Column Two procedure on a separate right lower-leg wound. The services do not overlap, and no more specific anatomical modifier applies. Which claim change is supported by these facts?
Correct answer: B - Append XS to the Column Two service for the separate anatomical structure.
A Medicare remittance for a covered office service shows a $300 charge, a $200 allowance, a $160 payment, a $100 CO-45 adjustment, and $40 assigned to PR-2. Eligibility confirms that the patient was a Qualified Medicare Beneficiary on the service date. Medicaid has processed the cost-sharing claim and paid $0. Before the automated $40 patient statement is released, how should the account be handled?
Correct answer: A - Do not bill the $40; QMB protection overrides the PR-2 amount.
An outside cardiologist who is now treating a patient requests the recent ECG report and medication list from the primary care practice. Staff have verified the requester and the treatment purpose. The patient is unavailable to sign a release, and no special confidentiality restriction applies to these records. Under HIPAA, which response is appropriate?
Correct answer: B - Send the requested records through an approved secure channel.
At a Medicare-participating hospital's emergency department, a patient with chest pressure has completed triage but has not received a medical screening examination. The registrar cannot confirm insurance coverage and is told, "Get the insurer's approval before the patient is evaluated." What should the registrar do?
Correct answer: D - Alert the clinical team so screening is not delayed by coverage verification.
The full bank has 1,020 more NCICS questions with explanations.
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