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

JAK2, CALR, and MPL mutations are defining features of myeloproliferative neoplasms (MPNs). Molecular testing for variants in these genes is standard of care in the diagnosis of MPNs. A high reimbursement denial rate led to review of ordering practices and test utilization to identify potential areas for optimization, education, or triage to improve laboratory stewardship.

MPN panel orders placed between January 1, 2023 and December 31, 2023 were analyzed by ordering provider, complete blood count (CBC) values, demographics, test results, and International Classification of Diseases, 10th revision (ICD10) code. Laboratory staff manually review orders prior to testing. Clinical appropriateness was defined as unexplained cytosis or atypical thrombosis.

Orders for 257 unique patients were included for analysis. Most orders were placed by hematology/oncology providers (79.0%). Of orders, 72.8% had a cytosis-related ICD10 code, and 11.7% a thrombosis-related ICD10 code. MPN panel results were negative in 76.3% of patients and positive (pathogenic mutations in JAK2/CALR/MPL) in 13.2%. A χ2 test did not show a statistically significant association between ICD10 category and positive results. Of patients with positive results, 79.4% had thrombocytosis on CBC, but 70.6% had normal or low hemoglobin.

Orders for our institution's MPN panel are generally appropriate and placed correctly. Our findings do not support additional interventions or clinical decision support, utilizing features such as the patient's CBC values or ICD10 codes, as likely to be of significant benefit. The limited reimbursement remains challenging, but we will continue to engage stakeholders to advocate for continued access.