Dear Colleagues

As many of you are aware I sit on The Uniform System of Coding and List of Services (USC&LS) Committee at the CDA representing the Canadian Dental Specialists Association (CDSA). This list of services is an evolving document that the committee continues to attempt to improve.

It is important to note: The uniform system of coding and list of services is a terminological standard that provides descriptions and codes to represent oral health services. Its two main purposes are: 1) To support the production of fee guides and 2) To support the processing of dental claims.

It is intended to be used by dentists in Canada. The service descriptors should be clear and unambiguous for this audience.

To maximize its value the standard USC&LS should be implemented in provincial fee guides in its entirety.

While the general scope of the USC&LS is ‘services offered in dental offices in Canada’, the only conditions for the inclusion of a service in the USC&LS are:

1) It has been determined to constitute a distinctive service that can be provided on its own without being a component of a broader service.

2) It is offered in dental offices in Canada.

3) Its inclusion in the USC&LS is needed to support either the production of fee guides or the processing of dental claims.

For 2021, the USC&LS has included disclaimers:

1) Considering the therapeutic value of a service before including it in the USC&LS is incompatible with the scope stated above as it could result in the exclusion of services offered in dental offices in Canada. This being the case users are cautioned that the therapeutic value of a service is not a factor in the decision to include a description of a service in the USC&LS. Further the description of a service in the USC&LS is not an endorsement or a certification of therapeutic value of that service by the Canadian Dental Association.

2) Because the USC&LS is national in scope, its descriptors must be generic enough to be usable in every province and cannot include information that might vary from province to province. Therefore, its users are notified that the description of a service in the USC&LS does not mean it can legally be provided by dentists in a specific jurisdiction. The descriptor of a service provided in the USC&LS is not intended to determine the standard at which the service should be delivered. Descriptors of the service provided in the USC&LS are not detailed enough to meet the record keeping requirements of provincial dental regulators. The use of USC&LS codes for record keeping purposes is not recommended.

As many of you know, work done in relation to CDAnet and ITRANS has provided CDA with an enhanced ability to look at de-identified claims data. As a result, we have become aware that some offices are using codes ending in 0 on claims. This indicates there is a need to remind all users of the USC&LS that codes that end in 0 are header codes used only for classification purposes. They do not provide complete descriptions of services and as such should not be used in claims and will not be adjudicated by the insurance companies. Only codes that end in a numeral other than 0 can be used in submitting claims.

In addition, there is a new service title 93340 Predetermination of available benefit, NO FEE under which one new service code 93341 Orthodontic Treatment is placed. These new codes have been introduced to better align the functionalities of the USC&LS with those of CDAnet in relation to the predetermination of orthodontic treatments. It is important to note that the service described by this code is the predetermination of the coverage available and the fee indicated in the CDAnet predetermination message is the total fee for the complete orthodontic treatment that is being predetermined, not a fee being charged for the predetermination.

As always if you have any questions please do not hesitate to contact me at your convenience.

Dr. Paul Andrews