Validation of the American Society for Gastrointestinal Endoscopy's Complexity Grading System for Endoscopic Procedures

INTRODUCTION: We sought to perform the first validation of the American Society for Gastrointestinal Endoscopy complexity grades for esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS). METHODS: We used Pearson correlation coefficients to measure the correlation between complexity grades and both work relative value units and malpractice relative value units (RVUs) obtained from the Centers for Medicare and Medicaid Services. RESULTS: There was moderate to strong positive correlation between complexity grades and both work relative value unit and malpractice RVU for a range of EGD, colonoscopy, and EUS procedures. This was not observed for ERCP procedures, with many RVU values remaining low for even the most complex ERCP cases. DISCUSSION: The American Society for Gastrointestinal Endoscopy's endoscopic complexity grading system for EGD, colonoscopy, and EUS seems to correlate reasonably well with other recognized metrics of complexity and risk. The complexity levels for ERCP may be valid, but there is poor correlation with how these procedures are valued by Medicare.