Page 31 - The Insurance Times February 2025

Health Insurance

Arterial Blood Gas (ABG)
Interpretation for

Medical Auditors &

Health Insurance

Vinay Verma Dr Vaishali Pradhan
Claim Processors M.com, F.I.I.I, ACS, Team Leader of Desk Medical

PGDMM,PGDIM: Former Dy
Jaipur Project Office
General Manager in Oriental Audit in GHPL TPA Limited in
Insurance Company Limited.

A blood gas analysis may be performed on blood obtained from anywhere in the circulatory system
say artery, vein or capillary. A medical auditor and claim processor should know that differences
in measured blood gas values between arterial and venous blood are most pronounced for PO2
as PO2 is the only clinical reason for obtaining arterial collections.

Abstract

Arterial Blood Gas Analysis (ABG) is commonly used diagnostic tool to evaluate the partial pressures of gas in blood
and acid base content. It is integral to assessing emergency department patients with acute respiratory or metabolic
disease. This medical test is done to measure the levels of oxygen and carbon dioxide in the blood of patient. It equally
checks the balance of acids and bases known as the pH balance, in the blood. Understanding and using ABG analysis
guides medical professionals to interpret respiratory, circulatory and metabolic disorders in any patient. It helps in
interpreting conditions that affect respiratory system, circulatory system and metabolic processes (how body trans-
forms the food one eats into energy), especially in emergency situations.

Understanding ABG reports help medical auditors and health When blood is taken from an artery the report is known as
claim processors to determine the medical necessity of the ABG. Peripheral Venus blood gas (VBG) is a valuable alter-
treatment. This report is important clinical tool as well as it nate as it is less painful and easy to collect.
is very important document for health insurance profession-
als who process claims or medical auditors who investigate Interpreting an arterial blood gas (ABG) is a crucial skill for
a case to determine its medical necessity. physicians, nurses, respiratory therapists, and other health
care personnel. ABG interpretation is especially important
A blood gas analysis may be performed on blood obtained in critically ill patients. ABG analysis assesses the patient's
from anywhere in the circulatory system say artery, vein or partial pressures of oxygen (PaO2) and carbon dioxide
capillary. A medical auditor and claim processor should know (PaCO2) PaCO2 provides information on the oxygenation
that differences in measured blood gas values between ar- status & PaCO2 provides information on ventilation status
terial and venous blood are most pronounced for PO2 as PO2 i.e. chronic or acute respiratory failure. Though oxygenation
is the only clinical reason for obtaining arterial collections. and ventilation can be assessed non-invasively via pulse oxim-

28 February 2025 The Insurance Times