Clinical Indicators: Auditory Brainstem Response

1. History (One or more required)
   1. Asymmetric hearing loss
   2. Unilateral tinnitus
   3. Sudden hearing loss
   4. Suspected cerebellopontine angle tumor
   5. Suspected demyelinating disorder
   6. Suspected functional hearing loss
   7. Newborn or infant hearing screening
   8. Inability to obtain behavioral hearing level
   9. Chemotherapy
   10. Suspected auditory neuropathy
   11. Preoperative baseline:
       • Posterior fossa surgery
       • Cochlear implant
   12. Intraoperative monitoring:
       • Acoustic neuroma
       • Vestibular nerve section
       • Vascular loop decompression
       • Glomus tumor
       • Other neurosurgical procedures as indicated
   13. Postoperative testing:
       • Cochlear implant
       • Auditory brainstem implant
2. Otologic Exam (required)
   • Description of both ear canals and tympanic membranes
   • Gross hearing assessment
3. Tests (required)
   • Air and bone pure tone audiogram (unless not
     possible/reliable)
4. Tests (optional)
   1. Speech audiometry
   2. Otoacoustic emissions
   3. Tympanogram

Associated ICD-10-CM diagnosis codes (Representative, but not all-inclusive codes)

• D33.3 Benign neoplasm of cranial nerves
• F44.6 Conversion disorder with sensory symptom or deficit
• F45.8 Other somatoform disorders
• G96.8 Other specified disorders of central nervous system
• H81.09 Ménière’s disease, unspecified ear
• H81.01 Ménière’s disease, right ear
• H81.02 Ménière’s disease, left ear
• H81.03 Ménière’s disease, bilateral
• H81.49 Vertigo of central origin, unspecified ear
• H81.41 Vertigo of central origin, right ear
• H81.42 Vertigo of central origin, left ear
• H81.43 Vertigo of central origin, bilateral
• H83.2X9 Labyrinthine dysfunction, unspecified ear
• H83.2X1 Labyrinthine dysfunction, right ear
• H83.2X2 Labyrinthine dysfunction, left ear
• H83.2X3 Labyrinthine dysfunction, bilateral
• H93.019 Transient ischemic deafness, unspecified ear
• H93.011 Transient ischemic deafness, right ear
• H93.012 Transient ischemic deafness, left ear
• H93.013 Transient ischemic deafness, bilateral
• H91.23 Sudden idiopathic hearing loss, bilateral
• H91.20 Sudden idiopathic hearing loss, unspecified ear
• H91.21 Sudden idiopathic hearing loss, right ear
• H91.22 Sudden idiopathic hearing loss, left ear
• H93.19 Tinnitus, unspecified ear
• H93.11 Tinnitus, right ear
• H93.12 Tinnitus, left ear
• H93.13 Tinnitus, bilateral
• H93.229 Diplacusis, unspecified ear
• H93.221 Diplacusis, right ear
• H93.222 Diplacusis, left ear
• H93.223 Diplacusis, bilateral
• H93.239 Hyperacusis, unspecified ear
• H93.231 Hyperacusis, right ear
• H93.232 Hyperacusis, left ear
• H93.233 Hyperacusis, bilateral
• H93.241 Temporary auditory threshold shift, right ear
• H93.242 Temporary auditory threshold shift, left ear
• H93.291 Other abnormal auditory perceptions, right ear
• H93.243 Temporary auditory threshold shift, bilateral
• H93.292 Other abnormal auditory perceptions, left ear
• H93.293 Other abnormal auditory perceptions, bilateral
• H93.219 Auditory recruitment, unspecified ear
• H93.211 Auditory recruitment, right ear
• H93.212 Auditory recruitment, left ear
• H93.213 Auditory recruitment, bilateral
• H93.3X9 Disorders of unspecified acoustic nerve
• H93.3X1 Disorders of right acoustic nerve
• H93.3X2 Disorders of left acoustic nerve
• H93.3X3 Disorders of bilateral acoustic nerves
• H94.00 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, unspecified ear
• H94.01 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, right ear
• H94.02 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, left ear
• H94.03 Acoustic neuritis in infectious and parasitic diseases classified elsewhere, bilateral
• H90.5 Unspecified sensorineural hearing loss
• H90.3 Sensorineural hearing loss, bilateral
• H90.3 Sensorineural hearing loss, bilateral
• H90.5 Unspecified sensorineural hearing loss
• H90.3 Sensorineural hearing loss, bilateral
• H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
• H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
• H90.3 Sensorineural hearing loss, bilateral
• H90.8 Mixed conductive and sensorineural hearing loss, unspecified
• H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
• H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
• H90.6 Mixed conductive and sensorineural hearing loss, bilateral
• H91.3 Deaf nonspeaking, not elsewhere classified
• R42 Dizziness and giddiness
• Z76.5 Malingerer [conscious simulation]

Patient Information

The Auditory Brainstem Response (ABR) measures the electrical activity of the hearing nerve pathway from the inner ear to the brain. In this test, a clicking sound is presented to one ear at a time. The electrical activity of this signal is recorded by electrodes. The average response is displayed as a waveform that contains peaks and troughs, which correspond to various points along the hearing nerve. The time between these peaks is measured and compared to normal data. A delay in a response might indicate an abnormality on or near the hearing or balance nerve. The ABR is also helpful in the diagnosis of multiple sclerosis (demyelinating diseases of the brain), tumors (acoustic neuroma) of the eighth cranial nerve (hearing and balance nerve) and strokes (vascular lesions) of the brainstem. ABR testing can serve as both a screening tool for hearing and a diagnostic assessment of the severity of loss in infants or in individuals unable to perform a conventional hearing test. Infants may require sedation for this test. ABR is also used in the operating room to monitor auditory function during surgery.

Important Disclaimer Notice (Updated 8/7/14)

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care.

The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient.

Adherence to these clinical indicators will not ensure successful treatment in every situation.

The AAO-HNS/F emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or business advice.

CPT five-digit codes, nomenclature and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.