{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:02:06Z","timestamp":1785250926882,"version":"3.55.0"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intradetrusor abotulinum toxin A (BoNT\u2010A) injections effectively manage urinary urgency, frequency, and urinary incontinence in patients with both overactive bladder (OAB) and neurogenic lower urinary tract dysfunction (NLUTD). However, NLUTD patients often require increased staffing support and extended procedure times compared to OAB patients. This study aims to quantify resource utilization differences between the two populations undergoing cystoscopic BoNT\u2010A treatment where only one Current Procedural Terminology Code (CPT 52287) exists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively collected data at a tertiary urology clinic over 6 months on patients undergoing cystoscopic intradetrusor BoNT\u2010A injection. Nursing\/medical assistant (RN\/MA) time, physician time, room occupancy duration, and staffing numbers were documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010five patients (NLUTD\u2009=\u200944 and OAB\u2009=\u200921) were included. NLUTD patients when compared to OAB patients required significantly greater RN\/MA time (72\u2009min vs. 48\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), extended room occupancy (51\u2009min vs. 43\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), and RN\/MA staff per procedure (2.4 vs. 1.9 RN\/MA's,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Physician times, while statistically different, were clinically similar (9\u2009min vs 7\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>When comparing a NLUTD to an OAB population undergoing intradetrusor BoNT\u2010A injections, current procedural billing codes do not reflect the substantial differences in auxiliary staff requirements or room occupancy times. The absence of nuanced reimbursement mechanisms may foster avoidance of resource\u2010intensive patient populations and their medical access. Our findings underscore the potential need to consider implementing novel reimbursement strategies to ensure equitable access to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70392","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:39:16Z","timestamp":1785249556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Resource Use in Patients Undergoing Intradetrusor Abotulinum Toxin A Injections for Neurogenic Compared to Non\u2010Neurogenic Indications\u2014The Potential for Compensation Inequities for Urologic and Urogynecologic Practices"],"prefix":"10.1002","author":[{"given":"Manu","family":"Saravanan","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University School of Medicine Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1852-0018","authenticated-orcid":false,"given":"Christopher S","family":"Elliott","sequence":"additional","affiliation":[{"name":"Santa Clara Valley Medical Center, Division of Urology San Jose California USA"},{"name":"Department of Urology Stanford University Medical Center San Jose California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"3","key":"e_1_2_11_2_1","first-page":"S6","article-title":"Chapter 2: Pathophysiology of Neurogenic Detrusor Overactivity and the Symptom Complex of \u2018Overactive Bladder\u2019","volume":"33","author":"Chapple C.","year":"2014","journal-title":"Neurourology and Urodynamics"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1007\/s11934-014-0448-8","article-title":"Neurogenic Bladder: From Diagnosis to Management","volume":"15","author":"Goldmark E.","year":"2014","journal-title":"Current Urology Reports"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.5489\/cuaj.11210","article-title":"Overactive Bladder: Symptom Complex or Separate Entity?","volume":"5","author":"Herschorn S.","year":"2011","journal-title":"Canadian Urological Association Journal"},{"issue":"6","key":"e_1_2_11_5_1","first-page":"1045","article-title":"Onabotulinumtoxina 100 U Significantly Improves All Idiopathic Overactive Bladder Symptoms and Quality of Life in Patients With Overactive Bladder and Urinary Incontinence: A Randomized, Double\u2010Blind, Placebo\u2010Controlled Trial","volume":"66","author":"Chapple C.","year":"2014","journal-title":"European Urology"},{"issue":"6","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1016\/j.juro.2012.01.125","article-title":"Phase 3 Efficacy and Tolerability Study of OnabotulinumtoxinA for Urinary Incontinence From Neurogenic Detrusor Overactivity","volume":"187","author":"Ginsberg D.","year":"2012","journal-title":"Journal of Urology"},{"key":"e_1_2_11_7_1","unstructured":"Centers for Medicare and Medicaid Services. Billing and Coding: Botulinum Toxin Injections [cited 2025 Jun 10]. Available from: Draft Article\u2014Billing and Coding: Botulinum Toxin Injections (DA57186)."},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","DOI":"10.1177\/26335565221081288","article-title":"Definition of Patient Complexity in Adults: A Narrative Review","volume":"12","author":"Nicolaus S.","year":"2022","journal-title":"Journal of Multimorbidity and Comorbidity"},{"issue":"2","key":"e_1_2_11_9_1","first-page":"121","article-title":"Physician Financial Incentives and Care for the Underserved in the United States","volume":"20","author":"Chien A. T.","year":"2014","journal-title":"American Journal of Managed Care"},{"issue":"6","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1001\/jamasurg.2024.0048","article-title":"Modifier 22 Use in Fee\u2010for\u2010Service Medicare","volume":"159","author":"Childers C. P.","year":"2024","journal-title":"JAMA Surgery"},{"key":"e_1_2_11_11_1","unstructured":"American College of Obstetricians and Gynecologists. Payment for Obstetricians and Gynecologists [Internet].2024[cited 2025 Jun 10]. Available from:https:\/\/www.acog.org\/clinical-information\/policy-and-position-statements\/statements-of-policy\/2024\/payment-for-obstetricians-and-gynecologists."},{"issue":"6","key":"e_1_2_11_12_1","first-page":"S44","article-title":"A Retrospective Review of Reimbursement in Revision Total Hip Arthroplasty: A Disparity Between Case Complexity and RVU Compensation","volume":"37","author":"Nayar S. K.","year":"2022","journal-title":"Journal of Artroplasty"},{"issue":"1","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/TA.0b013e3182ab1ae3","article-title":"Does Relative Value Unit\u2010Based Compensation Shortchange the Acute Care Surgeon?","volume":"76","author":"Schwartz D. A.","year":"2014","journal-title":"Journal of Trauma and Acute Care Surgery"},{"issue":"7","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"e632","DOI":"10.1200\/JOP.2016.015834","article-title":"Design Challenges of an Episode\u2010Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model","volume":"13","author":"Kline R. M.","year":"2017","journal-title":"Journal of Oncology Practice"},{"issue":"10","key":"e_1_2_11_15_1","first-page":"50","article-title":"The Strategy That Will Fix Health Care","volume":"91","author":"Porter M. E.","year":"2013","journal-title":"Harvard Business Review"}],"container-title":["Neurourology and Urodynamics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70392","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/nau.70392","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70392","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:39:18Z","timestamp":1785249558000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nau.70392"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":14,"alternative-id":["10.1002\/nau.70392"],"URL":"https:\/\/doi.org\/10.1002\/nau.70392","archive":["Portico"],"relation":{},"ISSN":["0733-2467","1520-6777"],"issn-type":[{"value":"0733-2467","type":"print"},{"value":"1520-6777","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"2026-05-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"nau.70392"}}