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A screening colonoscopy is performed on a Medicare patient who is at average risk. During the procedure, a polyp is removed by snare. Which modifier is appended to the polypectomy code?

A
B
C
D
to track
2026 Statistics

Key Facts: CGIC Exam

150

Total Items

AAPC

5h 40m

Exam Time

AAPC

$299

AAPC Member Fee

AAPC

Age 45

USPSTF Screening Start

USPSTF 2021 update

The AAPC CGIC consists of 150 MCQ items over 5h40m with 70% passing. Fee $299 AAPC member. Master endoscopy CPT (45378 diagnostic colonoscopy, 45380 with biopsy, 45385 polypectomy snare; 43235 EGD, 43239 with biopsy), screening codes G0105/G0121 + modifier PT, and ASA polyp surveillance intervals.

Sample CGIC Practice Questions

Try these sample questions to test your CGIC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which segment of the colon is located between the cecum and the transverse colon?
A.Sigmoid colon
B.Descending colon
C.Ascending colon
D.Rectum
Explanation: The ascending colon travels upward from the cecum (in the right lower quadrant) to the hepatic flexure, where it turns to become the transverse colon. Knowing the order — cecum, ascending, transverse, descending, sigmoid, rectum — is essential for selecting the correct CPT endoscopy code based on how far the scope was advanced.
2Which structure connects the gallbladder to the common bile duct?
A.Cystic duct
B.Hepatic duct
C.Pancreatic duct
D.Duct of Santorini
Explanation: The cystic duct connects the gallbladder to the common bile duct. The common hepatic duct (from the liver) joins the cystic duct to form the common bile duct, which empties into the duodenum. This anatomy is foundational for ERCP coding (43260-43278) and for cholecystectomy procedures.
3The lower esophageal sphincter (LES) is primarily responsible for preventing which condition?
A.Dysphagia
B.Gastroesophageal reflux
C.Pyloric stenosis
D.Achalasia
Explanation: The LES is a ring of smooth muscle at the junction of the esophagus and stomach that relaxes to allow food into the stomach and contracts to prevent stomach contents from refluxing back into the esophagus. LES dysfunction is the primary mechanism of GERD (K21.x).
4Which layer of the GI tract wall contains the muscularis mucosae and is the deepest layer reached by an EMR (endoscopic mucosal resection)?
A.Serosa
B.Muscularis propria
C.Submucosa
D.Mucosa
Explanation: EMR (endoscopic mucosal resection, e.g., 43254 esophageal, 45390 colonic) removes lesions confined to the mucosal layer, which includes the epithelium, lamina propria, and muscularis mucosae. The submucosa is injected to lift the lesion but the resection plane stays within the mucosa. ESD goes deeper into the submucosa.
5Which condition is characterized by transmural inflammation that can affect any part of the GI tract from mouth to anus, often with skip lesions?
A.Ulcerative colitis
B.Crohn disease
C.Diverticulitis
D.Celiac disease
Explanation: Crohn disease (K50.x) is characterized by transmural (full-thickness) inflammation, skip lesions (areas of normal bowel between diseased segments), and can involve any part of the GI tract. Ulcerative colitis (K51.x), in contrast, is limited to the colon, involves only the mucosa, and is continuous starting from the rectum.
6The ampulla of Vater is the anatomical site where which two structures empty into the duodenum?
A.Cystic duct and hepatic duct
B.Common bile duct and pancreatic duct
C.Pancreatic duct and duct of Santorini
D.Common bile duct and cystic duct
Explanation: The ampulla of Vater (hepatopancreatic ampulla) is where the common bile duct and the main pancreatic duct (duct of Wirsung) join and empty into the second portion of the duodenum, controlled by the sphincter of Oddi. This is the target site for ERCP cannulation.
7Helicobacter pylori is most strongly associated with which GI condition?
A.Gastroesophageal reflux disease
B.Peptic ulcer disease
C.Irritable bowel syndrome
D.Diverticulosis
Explanation: H. pylori is the most common cause of peptic ulcer disease (K25-K28), responsible for the majority of gastric and duodenal ulcers not caused by NSAIDs. It also increases the risk of gastric cancer and MALT lymphoma. Testing and eradication are standard care for ulcer patients.
8Which liver condition was formerly called NAFLD (non-alcoholic fatty liver disease) and is now coded under K76.0 with updated terminology MASLD?
A.Hepatocellular carcinoma
B.Metabolic dysfunction-associated steatotic liver disease
C.Primary biliary cholangitis
D.Wilson disease
Explanation: MASLD (metabolic dysfunction-associated steatotic liver disease) replaced the term NAFLD in 2023. It is coded as K76.0 (fatty [change of] liver, not elsewhere classified). Coders should be aware of the terminology shift even though the ICD-10-CM code did not change.
9The peritoneal fold that suspends the small intestine from the posterior abdominal wall and contains its blood supply is called the:
A.Greater omentum
B.Lesser omentum
C.Mesentery
D.Falciform ligament
Explanation: The mesentery (mesentery proper) is the peritoneal fold that anchors the jejunum and ileum to the posterior abdominal wall, carrying the superior mesenteric artery and vein, lymphatics, and nerves to the small intestine. Mesenteric ischemia (K55.x) results from compromised mesenteric blood flow.
10Esophageal varices most commonly develop as a complication of which underlying condition?
A.GERD
B.Peptic ulcer disease
C.Portal hypertension from cirrhosis
D.Achalasia
Explanation: Esophageal varices (I85.x) are dilated submucosal veins in the distal esophagus caused by portal hypertension, most often from cirrhosis. Bleeding varices are treated with endoscopic banding (43244) or sclerosis (43243). Coding the underlying liver disease is required to support medical necessity.

About the CGIC Exam

AAPC specialty credential for gastroenterology coders. Validates expertise in GI endoscopy CPT (EGD 43235-43259, colonoscopy 45378-45398, ERCP 43260-43278, sigmoidoscopy 45330-45350), GI/hepatobiliary surgery, ICD-10-CM K-codes, screening colonoscopy rules (G0105/G0121 Medicare; modifier PT for screening that becomes diagnostic), and GI bundling.

Questions

150 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$299 AAPC member (AAPC)

CGIC Exam Content Outline

15%

GI Anatomy and Pathophysiology

GI tract from oral cavity through anus; accessory organs; colon segments

30%

CPT Endoscopy

EGD 43235-43259, colonoscopy 45378-45398, ERCP 43260-43278, sigmoidoscopy, capsule

15%

CPT GI Surgery and Hepatobiliary

Cholecystectomy, appendectomy, bowel resection, liver biopsy

15%

ICD-10-CM GI Diagnoses

K20-K31 esophageal/gastric, K50-K52 IBD, K70-K77 liver, K80-K87 gallbladder/pancreas

10%

Modifiers, E/M and Bundling

33 preventive (ACA mandated), 53 discontinued, PT screening to diagnostic, 51, 59

15%

Compliance, Screening Rules and Payer Policies

USPSTF colon screening 45-75, Medicare every 24 mo high-risk / 120 mo avg risk

How to Pass the CGIC Exam

What You Need to Know

  • Passing score: 70%
  • Exam length: 150 questions
  • Time limit: 5 hours 40 minutes
  • Exam fee: $299 AAPC member

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

CGIC Study Tips from Top Performers

1Master endoscopy code hierarchy: diagnostic → with biopsy → with intervention. Code most extensive procedure when multiple done at same session same site
2Know modifier PT for screening to diagnostic conversion (Medicare): added to therapeutic colonoscopy code when started as screening, then polyp removed
3Memorize Medicare colon screening intervals: every 24 months high-risk, every 120 months (10 years) average-risk; minimum age 45 per USPSTF 2021
4Understand ASA polyp surveillance: 1-2 small adenomas = 7-10 yr; 3+ adenomas or large = 3-5 yr; sessile serrated = 3-5 yr

Frequently Asked Questions

What's the difference between G0105, G0121, and 45378 for colonoscopy?

G0105 = Medicare screening colonoscopy for HIGH-RISK patient (personal/family history of colorectal cancer, IBD, etc.). G0121 = Medicare screening for AVERAGE-RISK (no high-risk factors). 45378 = diagnostic colonoscopy (commercial payers also use this for screening; check payer rules). If a screening colonoscopy becomes therapeutic (e.g., polyp removed), Medicare requires modifier PT (Colorectal Cancer Screening Test; converted to diagnostic) on the therapeutic code.

What is the screening colonoscopy interval?

Per USPSTF 2021, average-risk screening starts at age 45 (changed from 50). Medicare covers screening every 24 months for HIGH-risk patients and every 120 months (10 years) for average-risk patients. ASA polyp surveillance: 1-2 small adenomas → 7-10 yr; 3-10 adenomas or 1+ large adenoma (≥10 mm) → 3-5 yr; sessile serrated polyp → 3-5 yr; family history of CRC affects intervals.

When do I use modifier 33?

Modifier 33 (Preventive Services) is appended when the primary purpose is delivery of an evidence-based ACA-mandated preventive service that should be covered without copay. Example: screening colonoscopy 45378 on commercial payer. Helps the payer correctly waive cost-sharing. Do NOT use 33 with Medicare screening codes G0105/G0121 (those are inherently preventive).