Ordering Practices and Utilization of a Next-Generation Sequencing Panel for Myeloproliferative Neoplasms

Area of Science:

• Hematology
• Molecular Diagnostics
• Oncology

Background:

• Myeloproliferative neoplasms (MPNs) are diagnosed using molecular testing for JAK2, CALR, and MPL mutations.
• High reimbursement denial rates prompted a review of MPN panel ordering practices and test utilization.
• The goal was to identify optimization, education, or triage strategies to enhance laboratory stewardship.

Purpose of the Study:

• To evaluate the appropriateness of MPN panel test orders.
• To assess the utility of clinical decision support tools, such as CBC values and ICD10 codes, in optimizing test utilization.
• To understand factors contributing to reimbursement denials.

Main Methods:

• Analysis of MPN panel orders from January 1, 2023, to December 31, 2023.
• Data included ordering provider, complete blood count (CBC) values, demographics, test results, and ICD10 codes.
• Manual review of orders by laboratory staff defined clinical appropriateness based on unexplained cytosis or thrombosis.

Main Results:

• 257 unique patient orders were analyzed; 79.0% were from hematology/oncology providers.
• 72.8% of orders had cytosis-related ICD10 codes; 11.7% had thrombosis-related codes.
• MPN panel results were negative in 76.3% of patients; 13.2% were positive for JAK2/CALR/MPL mutations. No significant association between ICD10 codes and positive results was found.

Conclusions:

• MPN panel orders at the institution are generally appropriate and correctly placed.
• Additional interventions using CBC values or ICD10 codes are unlikely to significantly benefit test utilization.
• Addressing reimbursement challenges requires continued stakeholder engagement to ensure continued access to diagnostic testing.