This is a Medicare patient who had bilateral tympanostomy tubes placed due to otitis media with effusion on 08/07/08 in office. Patient returned 08/11/08 with obstructed tubes. Both ears were suctioned and the RT tube removed and replaced with another brand. On 8/13/8 patient returned again with thick mucoid fluid covering tubes and both ears were suctioned. All this was done in the office. My question is what is billable considering Medicare's rule about complications requiring a return trip to the OR. The OR never happend because all was done in office. Would the suctioning of the ears be considered all part of the post operative care? Also physician didn't document that he used an otoscope to remove mucous/cerumen but wants to bill 69210 on both 08/11 and 08/13. Any advice is greatly appreciated.