Auditory Brainstem Response

Clinical Indicators
Auditory Brainstem Response
(ABR), (BAER), (BAEP)

Procedure	CPT	FUD
Auditory Brainstem Response	92585	XXX

Indications

1. History...one or more required

a)	Asymmetric hearing loss
b)	Unilateral tinnitus
c)	Sudden hearing loss
d)	Suspected cerebellopontine angle tumor
e)	Suspected demyelinating disorder
f)	Suspected functional hearing loss
g)	Newborn or infant hearing screening
h)	Inability to obtain behavioral hearing level
i)	Chemotherapy
j)	Suspected auditory neuropathy
k)	Preoperative baseline: •Posterior fossa surgery •Cochlear implant
l)	Intraoperative monitoring: •Acoustic neuroma •Vestibular nerve section •Vascular loop decompression •Glomus tumor •Other neurosurgical procedures as indicated
m)	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

a)	Speech audiometry
b)	Otoacoustic emissions
c)	Tympanogram

Associated ICD-9 Diagnostic Codes (included but not limited to):

225.1	Acoustic neuroma
300.11	Functional deafness
306.7	Psychogenic deafness
349.89	Degenerative disease central nervous system
386.02	Active Meniere's disease, cochlear
386.2	Vertigo of central origin
386.5	Labyrinthine dysfunction
388.02	Transient ischemic deafness
388.2	Sudden sensorineural hearing loss
388.31	Subjective tinnitus
388.41	Diplacusis
388.42	Hypercusis
388.43	Impairment of auditory discrimination
388.44	Recruitment
388.5	Disorders of acoustic nerve
389.10	Sensorineural hearing loss, unspecified
389.11	Sensory hearing loss
389.12	Neural hearing loss
389.14	Central hearing loss
389.18	Sensorineural hearing loss of combined types
389.2	Mixed conductive and sensorineural hearing loss
389.7	Deaf mutism, not elsewhere classified
780.4	Disequilibrium
V65.2	Malingering

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 Notice

The Clinical Indicators for Otolaryngology--Head and Neck Surgery are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The American Academy of Otolaryngology-Head and Neck Surgery, Inc. 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.