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Arterial Blood Gas (ABG) Interpretation for Medical Auditors & Health Insurance Claim Processors

February 2025

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THE INSURANCE TIMES

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.

- Vinay Verma, Dr Vaishali Pradhan

Arterial Blood Gas (ABG) Interpretation for Medical Auditors & Health Insurance Claim Processors

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 transforms the food one eats into energy), especially in emergency situations.

Understanding ABG reports help medical auditors and health claim processors to determine the medical necessity of the treatment. This report is important clinical tool as well as it is very important document for health insurance professionals who process claims or medical auditors who investigate a case to determine its medical necessity.

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.

When blood is taken from an artery the report is known as ABG. Peripheral Venus blood gas (VBG) is a valuable alternate as it is less painful and easy to collect.

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