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Letter to the Editor Update on Magnetic Resonance Angiography of the Circle of Willis in Patients with Symptomatic Intracranial Neuropathology John Gilbert, MD, Greg Wheeler, MD, Gregory Mick, DO, Stephanie Herder, MD, Gay Richardson, MD, Charles Kenney III, MD From the Spine & Brain Neurosurgical Center, Lexington, Kentucky. We recently described numerous difficulties caused by the July 2009 revision to Medicare’s Kentucky local coverage determi- nation for magnetic resonance angiography (MRA), in which unspecified transient ischemic attack (TIA) was deleted as a covered International Classification of Diseases (ICD)-9 diag- nosis. We discussed the barriers this coverage change created to the timely testing and treatment of this high-risk patient pop- ulation. 1,2 We are pleased to report that Kentucky’s Medicare Carrier has reconsidered its position, and as of August 1, 2010 the clin- ical diagnosis of unspecified TIA is again a covered diagnosis for MRA of the circle of Willis. 3 This change significantly im- proves access to high-quality patient care. Information from MRA of the circle of Willis helps neurologists, neurosurgeons, and neuroimaging specialists in working up and treating pa- tients in a timely and appropriate manner. Neuroscience physi- cians should continue to advocate for access to this potentially life-saving procedure on behalf of the patients who exhibit uni- versal, nonspecific symptoms, such as nausea, dizziness, vertigo, chronic headache, visual disturbances, numbness, and seizures, that are consistent with intracranial neuropathy (eg, atheroscle- rotic stenosis, unruptured intracranial aneurysms). 1 References 1. Gilbert JW, Wheeler GR, Mick GE, et al. Magnetic resonance angiography of the circle of Willis in patients with symptomatic Keywords: Circle of Willis, ischemic attack, transient, magnetic resonance angiography, aneurysm, intracranial, arterial Diseases Intracranial. Acceptance: Received August 20, 2010. Accepted for publication September 19, 2010. Correspondence: Address correspon- dence to John Gilbert, MD, Spine & Brain Neurosurgical Center, PO Box 22430, Lexington, Kentucky 40522. E-mail: [email protected]. J Neuroimaging 2012;22:213-213. DOI: 10.1111/j.1552-6569.2010.00541.x intracranial neuropathology: Medicare LCD L25367(R4). J Neu- roimaging In press. 2. Centers for Medicare & Medicaid Services. LCD for magnetic resonance angiography (MRA)(T10)(116534). 2009 Available from: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=16534&lcd_ version=24&show=all. Accessed on September 2, 2009 3. Centers for Medicare & Medicaid Services. Magnetic resonance angiography. July 7, 2010. Available from: http://www4.cms.gov/ transmittals/downloads/R123NCD.pdf. Accessed on August 18, 2010 Copyright ◦ C 2010 by the American Society of Neuroimaging 213
