CAPD/ACDP Membership Value Series
Every day you are running your Paediatric Dental practice always acutely aware that the quality patient care services you provide also pay your office overhead and put food on the table for your family. Once a year you are asked to renew your membership and perhaps you wonder why you should renew and what are you getting out of CAPD/ACDP membership, in addition to a great Annual Conference.
As the voice of children’s dentistry in Canada your membership dues go so much further than just a yearly meeting. In this series of articles, we will identify how your membership dues specifically contribute to CAPD/ACDP’s strategic plan of accomplishment. It is only through your membership participation that we are able to not only host the Annual Conference but also the many actions that CAPD/ACDP undertakes behind the scenes for all Paediatric Dentists in Canada.
2020 - 1 USC&LS CODING
You have just provided a service for a patient with ECC. Your staff is doing the billing for the procedures you have completed so that the parent can be reimbursed by their insurance company or you can be reimbursed directly from the company. Do you every wonder about the intricacies of those multiple billing codes and how you as an individual practitioner benefit from them?
One of our Past Presidents, Dr. Paul Andrews acts in the capacity of the USC&LS expert for the Canadian Dental Specialties Association (CDSA). CAPD/ACDP is one of the nine charter members of this association and as such your dues contribute towards CDSA’s input into the development, adjudication and maintenance of USC&LS codes with the dental insurance industry of Canada.
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
November 4, 2020
The Canadian Pediatric Society (CPS) announced today that the 2020 edition of the Rourke Baby Record is now available.
On January 19, 2018, the CAPD/ACDP was contacted by Dr. James Taylor, Canada’s Chief Dental Officer. He invited us, along with the CPS and CAPDH, to participate in a working group regarding a review of a “Caries Risk Assessment Tool”. Drs. Paul Andrews and Raymond Lee represented the CAPD/ACDP in Ottawa. Dr. Taylor informed us last week that the finished Tool is now included in the updated Rourke Baby Record (RBR). The previous revision was in 2017.
CAPD/ACDP takes great pride in contributing to the updated RBR, with the hopes of providing meaningful and relevant information on oral health. And this is only possible with your membership in CAPD/ACDP!
The RBR (2020) is available for download at: < https://www.rourkebabyrecord.ca/rbr2020/default >
Please review and notice the increased attention to oral health. Rest assured that a CAPD/ACDP, with a strong and solid membership, remains at the forefront of paediatric health in Canada.
From the CPS:
The Rourke Baby Record (RBR)—an evidence-based health supervision guide for physicians and other health care providers caring for children in the first five years of life—has just been updated. Many of the new recommendations reflect recent CPS guidance, including:
• Diagnosis and management of Autism Spectrum Disorder
• A new Canadian Caries Risk Assessment Tool
• Counsel on removal or safe storage of firearms and of cannabis edibles
• Early introduction of allergenic foods to high-risk infants
• Physical examination recommendations to detect early signs of cerebral palsy
The latest 2020 RBR revision was developed by CPS members Drs. Denis Leduc, Patricia Li, Anne Rowan-Legg, Leslie Rourke, and by family physicians Drs. Bruce Kwok, Imaan Bayoumi, and James Rourke, with help from the McMaster Evidence Review and Synthesis Team. The Rourke Baby Record website includes all supporting evidence for the recommendations. The RBR is endorsed by the CPS, College of Family Physicians of Canada and Dietitians of Canada, and is supported by the Government of Ontario.
Dr. James Taylor addressed the 2018 Executive Council Committee at the Annual Conference in Ottawa.
L to R: Dr. Paul Andrews, Dr. Raymond Lee, Dr. Taylor and Dr. Jennifer MacLellan
See the Canadian Pediatric Society (CPS) News, Fall/Winter 2020