Page 32 - The Insurance Times February 2025

etry and end-tidal carbon di oxide monitoring respectively The following six-step process helps ensure a complete in-
but where ABG being a standard is prescribed as manda- terpretation of every ABG component.
tory investigation it must remain available to consider a pre- 1. Is pH normal? It is measured acid-base balance of the
authorization of any specific treatment or to consider the blood.
final settlement of such treatment. If not mandatory the
2. Is CO normal? Partial pressure of carbon di oxide in
2
pulse oximetry readings and end-tidal carbon dioxide moni- arterial blood.
toring report are generally considered with evaluation of
3. Is HCO normal? Calculated concentration of bicarbon-
other medical documents. 3
ate in arterial blood
For a reliable ABG report an ABG specimen should be col- 4. Match CO & HCO with pH.
2 3
lected in a heparinised blood gas syringe anaerobically and 5. Does CO or HCO go the opposite direction of pH?
analysed within 30 minutes otherwise they should be placed 2 3
6. Are pO & O2 saturation normal?
on ice. Prior to an arterial puncture the Allen test should be 2
performed to check for the ability of radial and ulnar arter-
ies to return blood to the hand. Medical Auditors who find Normal Arterial Value Range:
ABG report not that supportive of other medical documents An acceptable normal range of ABG values of ABG compo-
do analyse this process during their medical audit to have nents is the following. However the medical auditors and
fair idea of treatment. health claim processors may know that the range of nor-
mal values may vary among laboratories and in different age
For Health Insurance Claim Processors and Medical Auditors groups from neonates to geriatrics.
interpreting this report is equally important to understand
the necessity of treatment provided. In Government Health Parameter Reference Range
Insurance Schemes the Standard Treatment Guidelines pH 7.35-7.45
(STGs) prescribe the necessity of this report in specific pro- PaCO 35-45 mmHg
cedures before pre-authorization of that procedure and 2
PaO 80-100 mmHg (millimetres of
necessity of serial ABG reports, as mandatory investigation, 2
mercury)
at the time of settlement of claim. For example, in case of
SaO (saturation) 95-100%
neo-natal care packages for mild encephalopathy, care re- 2
quiring mechanical ventilation or non-invasive respiratory HCO 3 22-26 mEq/L (mill equivalents
support (CPAP, HFFNC) ABG is a mandatory medical investi- per litre)
gation to consider the necessity of the treatment. Base excess/deficit 4 to +2

Similarly, at the time of pre-authorization to consider ad-
Interpretation of ABG systematically leads to understand
missibility of a claim for congestive cardiac failure, pneumo-
the degree of severity of abnormalities and to assess
nia, lower respiratory tract infection, bronchiolitis, asthma,
whether the abnormalities are acute or chronic and whether
COPD ( chronic lung condition), ARDS, severe sepsis, septic
the primary disorder is metabolic or respiratory in origin.
shock &poisoning etc ABG is prescribed as mandatory inves-
This along with other medical documents helps to determine
tigation report for emergency medicine, anaesthesiology,
whether line of treatment claimed is in order or needs fur-
pulmonology, diabetes related ketoacidosis, renal tubular
ther investigation or assessment to ensure it is a genuinely
acidosis etc. Thus this medical test is very common in many
claimed procedure.
of the disorders requiring in-patient treatment and care.
This makes this medical document very important in its In addition, you will find tables that list commonly encoun-
nature and professionals handling health insurance claims tered acid-base disorders.
should know the basics of this medical test. It is expected
from pre-authorization claim processor or final claim settling Many methods exist to guide the interpretation of the ABG.
doctor/officer to diligently review the mandatory docu- This discussion does not include some methods, such as analy-
ments. Understanding ABG is very important to such pro- sis of base excess or Stewart's strong ion difference. A sum-
fessionals. mary of these techniques can be found in some of the sug-

The Insurance Times February 2025 29