How do I order Cologuard (Multitarget Stool DNA test) through Sonora Quest Laboratories?

Ordering Cologuard Through Sonora Quest Laboratories

To order Cologuard (multitarget stool DNA test) through Sonora Quest Laboratories, you need to complete a test requisition form specifically for Cologuard and submit it through their electronic ordering system.

Ordering Process

1. Access the Sonora Quest ordering system:

   • Log into your Sonora Quest provider portal
   • Navigate to the test ordering section
   • Search for "Cologuard" or "Multitarget Stool DNA Test"

2. Complete the requisition form with required information:

   • Patient demographics (name, DOB, contact information)
   • Insurance information
   • Clinical indication for screening
   • Verify patient meets eligibility criteria:
     • Average-risk adult aged 45-75 years 1
     • No prior diagnosis of colorectal cancer or adenomatous polyps
     • No inflammatory bowel disease
     • No family history of genetic disorders predisposing to high CRC risk

3. Submit the order electronically:

   • The order will be transmitted to Exact Sciences (manufacturer of Cologuard)
   • Exact Sciences will ship the collection kit directly to the patient

Patient Instructions

When ordering Cologuard, inform your patient about:

• They will receive the kit directly from Exact Sciences
• Simple collection instructions will be included
• No dietary restrictions or medication limitations are required
• The sample needs to be returned promptly using the pre-paid shipping container
• Results will be sent to the ordering provider

Clinical Context for Ordering

Cologuard is an FDA-approved multitarget stool DNA test that combines:

• Molecular assays for KRAS mutations
• Tests for aberrant NDRG4 and BMP3 methylation
• β-actin assay
• Hemoglobin immunoassay 2

Advantages of Cologuard:

• Higher sensitivity for colorectal cancer (92.3%) compared to FIT (73.8%) 2
• Better detection of advanced precancerous lesions (42.4% vs 23.8% with FIT) 2
• Superior detection of sessile serrated polyps ≥1cm (42.4% vs 5.1% with FIT) 2
• No bowel preparation required
• Non-invasive home-based collection

Important Considerations:

• Recommended screening interval is every 3 years 1
• Lower specificity (86.6%) compared to FIT (94.9%), resulting in more false positives 2
• Positive results require follow-up diagnostic colonoscopy
• Medicare covers Cologuard once every 3 years for eligible beneficiaries

Follow-up Management

• A positive Cologuard result requires follow-up with colonoscopy
• Document the recommendation for colonoscopy in your order notes
• Ensure patients understand that declining follow-up colonoscopy after a positive result negates the benefit of screening

Common Pitfalls to Avoid

1. Ordering for inappropriate patients:

   • High-risk patients need direct colonoscopy screening
   • Patients with symptoms should undergo diagnostic evaluation, not screening

2. Failing to specify the correct screening interval:

   • Cologuard should be ordered every 3 years, not annually 1

3. Not having a follow-up plan for positive results:

   • Ensure systems are in place to track results and schedule colonoscopies

4. Ordering for patients over 75 without careful consideration:

   • Benefits may not outweigh risks in older adults 1

By following these steps, you can effectively order Cologuard through Sonora Quest Laboratories and provide appropriate colorectal cancer screening for your average-risk patients.