100+ Free CGSC Practice Questions

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An intermediate (layered) repair of a 5 cm laceration of the trunk that required cleansing of contaminated tissue is reported with:

13101

12034

12032

12002

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2026 Statistics

Key Facts: CGSC Exam

150

Total Items

AAPC

5h 40m

Exam Time

AAPC

$299

AAPC Member Fee

AAPC

90 days

Major Surgery Global

CMS

The AAPC CGSC consists of 150 MCQ items over 5h40m with 70% passing. Fee $299 AAPC member. Master 2023 ventral hernia revision, lap vs open cholecystectomy/appendectomy, breast surgery (incl. SLN biopsy), wound debridement by depth and area, and the 90-day global period with surgical modifiers.

Sample CGSC Practice Questions

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

1Which layer of the abdominal wall lies immediately deep to Scarpa's fascia?

A.External oblique aponeurosis

B.Camper's fascia

C.Transversalis fascia

D.Peritoneum

Explanation: Moving from superficial to deep, the anterolateral abdominal wall layers are skin, Camper's fascia (fatty), Scarpa's fascia (membranous), then the external oblique aponeurosis/muscle. Knowing layer order is essential for accurate operative-note interpretation in hernia and laparotomy coding.

2The peritoneal reflection that suspends the small intestine from the posterior abdominal wall is the:

A.Greater omentum

B.Mesentery proper

C.Falciform ligament

D.Gastrohepatic ligament

Explanation: The mesentery proper is the broad, fan-shaped peritoneal fold that anchors the jejunum and ileum to the posterior abdominal wall, carrying the superior mesenteric vessels and lymphatics. Coders see it referenced in bowel resection and trauma operative reports.

3Which structure forms the floor of Hesselbach's triangle, an important landmark for direct inguinal hernias?

A.Inguinal ligament

B.Inferior epigastric vessels

C.Rectus abdominis

D.Transversalis fascia

Explanation: Hesselbach's triangle is bounded by the inguinal ligament inferiorly, the inferior epigastric vessels laterally, and the rectus abdominis medially; its floor is the transversalis fascia. Direct inguinal hernias protrude through this weakened floor, distinguishing them from indirect hernias that pass through the deep inguinal ring.

4The terminal ileum joins the colon at which structure?

A.Ileocecal valve

B.Pylorus

C.Ligament of Treitz

D.Hepatic flexure

Explanation: The ileocecal valve marks the junction of the terminal ileum with the cecum and helps prevent reflux of colonic contents. Knowing GI landmarks helps coders confirm anatomic site for partial colectomy, ileocecectomy, and right hemicolectomy CPT selection.

5The functional unit of the breast that produces milk is the:

A.Lactiferous sinus

B.Terminal duct lobular unit (TDLU)

C.Cooper's ligament

D.Areolar gland

Explanation: The terminal duct lobular unit (TDLU) is the milk-producing functional structure of the breast and is the most common origin site for both ductal and lobular carcinomas. Pathology reports for breast lesion excisions frequently reference TDLU involvement.

6Which gland sits posterior to the thyroid and is responsible for calcium homeostasis?

A.Adrenal

B.Pituitary

C.Parathyroid

D.Thymus

Explanation: The four parathyroid glands lie on the posterior surface of the thyroid lobes and secrete parathyroid hormone (PTH), the principal regulator of serum calcium. Inadvertent parathyroid removal during thyroidectomy is a documented complication coders see linked to hypocalcemia diagnoses.

7Which lymph node level corresponds to nodes lateral to the lateral border of the pectoralis minor?

A.Level I

B.Level II

C.Level III

D.Rotter's nodes

Explanation: Axillary node levels are defined by the pectoralis minor: Level I lies lateral to it, Level II is posterior to it, and Level III is medial. This terminology drives axillary lymphadenectomy CPT and ICD-10-CM coding for breast cancer staging.

8Acute appendicitis most commonly results from which initial pathophysiologic event?

A.Mesenteric ischemia

B.Luminal obstruction (often by a fecalith)

C.Viral lymphoid hyperplasia only

D.Carcinoid invasion

Explanation: Most cases of acute appendicitis begin with luminal obstruction, classically by a fecalith, leading to distension, bacterial overgrowth, ischemia, and possible perforation. Coders use this progression to differentiate K35.30 (acute without perforation) from K35.2/K35.3 ruptured forms.

9Which classification system is most commonly used surgically to grade the severity of acute cholecystitis?

A.TNM staging

B.Tokyo Guidelines

C.Ranson criteria

D.Forrest classification

Explanation: The Tokyo Guidelines (TG18) grade acute cholecystitis as Grade I (mild), II (moderate), or III (severe with organ dysfunction) and inform surgical urgency. Coders may see these grades referenced in op reports when justifying urgent vs elective cholecystectomy.

10An incarcerated hernia is BEST defined as a hernia that:

A.Can be returned to the abdominal cavity manually

B.Cannot be reduced but has no compromise of blood supply

C.Has compromised blood supply requiring emergent surgery

D.Contains only preperitoneal fat

Explanation: Strictly, incarceration means the hernia is irreducible. However, in CPT coding (and in most clinical use of the term differentiating reducible from non-reducible repair codes), 'incarcerated' is grouped with 'strangulated' to indicate compromise requiring more complex repair. CPT pairs the terms incarcerated/strangulated for code selection.

About the CGSC Exam

AAPC specialty credential for general surgery coders. Validates expertise in abdominal/hernia surgery (2023 ventral hernia code revision 49591-49622), cholecystectomy (47562-47600), appendectomy, bowel resection, breast/endocrine/skin surgery, wound debridement, vascular access, trauma, and the global surgical package with associated modifiers (24, 25, 57, 58, 78, 79).

Questions

150 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$299 AAPC member (AAPC)

CGSC Exam Content Outline

15%

Surgical Anatomy and Pathophysiology

Abdominal wall, peritoneum, GI tract, breast, thyroid/parathyroid/adrenal

20%

CPT Abdominal and Hernia Surgery

2023 ventral hernia revision (49591-49622), inguinal/femoral/umbilical, with/without mesh

15%

CPT Breast, Endocrine and Skin Surgery

Mastectomy, partial mastectomy, SLN biopsy, thyroidectomy, parathyroidectomy

15%

CPT Wound Care, Vascular Access, Trauma

Debridement 11042-11047, central line 36556, exploratory lap, splenectomy

10%

ICD-10-CM Surgical Diagnoses

K35-K38 appendicitis, K40-K46 hernia, C50.x breast neoplasms, K80 cholelithiasis

15%

Global Period, Modifiers and Compliance

90-day global, modifier 24/25/57/58/78/79 use cases

10%

E/M for Surgical Patients

Pre-op consults, decision for surgery (mod 57), post-op global follow-up

How to Pass the CGSC 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

CGSC Study Tips from Top Performers

1Master 2023 ventral hernia codes: by SIZE (small ≤3cm, medium 3.1-10cm, large >10cm) AND initial vs recurrent AND reducible vs incarcerated/strangulated; mesh inherent in newer codes

2Know cholecystectomy codes: 47562 lap, 47563 lap with cholangiography, 47564 lap with CBD exploration, 47600 open

3Memorize global period modifiers: 24 unrelated E/M during global; 57 decision for major surgery during E/M; 78 unplanned return to OR for RELATED; 79 UNRELATED procedure during global

4Understand wound debridement coding: 11042-11047 by depth (subQ/muscle/bone) and SQ CM area (first 20 sq cm + each addt'l 20 sq cm)

Frequently Asked Questions

What changed with hernia repair codes in 2023?

CPT 2023 rewrote ventral hernia repair codes (49591-49622) by SIZE (≤3 cm, 3.1-10 cm, >10 cm) AND initial vs recurrent AND reducible vs incarcerated/strangulated. Old codes 49560-49566 were deleted for ventral; new codes incorporate mesh implant inherently. Inguinal/femoral/umbilical hernia codes (49505-49587) were not affected by this revision.

What is the 90-day global period?

Major surgical procedures (most CPT 10000-69990 with global indicator 090) carry a 90-day global period: pre-op (1 day), intra-op, and 90 days post-op are bundled into the surgery payment. Modifier 24 = unrelated E/M during global; 25 = significant E/M same day with procedure; 57 = decision for major surgery during E/M (24-48h before); 58 = staged or related procedure during global; 78 = unplanned return to OR for related complication; 79 = unrelated procedure during global.

How do I code a partial mastectomy with SLN biopsy?

Partial mastectomy 19301; with axillary lymphadenectomy 19302. Sentinel lymph node biopsy: 38525 (deep axillary/cervical, open) or 38500 (superficial); for the radioactive tracer mapping use 38792 (intraoperative) + 78195 (lymphoscintigraphy). Apply modifier 51 (multiple procedures) for multiple separate procedure codes if not bundled.