When you have multiple codes of the same number then you need to append the 59 modifier to the second and subsequent of the same number to show that three separte injections were performed at three distinct and separate sites. What makes it distinct and separate is that each injection is a diferent location even though it may be close to the same site as the first it is still a different site. Without the 59 modifer the payer will reject the 2nd and subsequent codes as dulicate entires. And you still need the 25 modifier on the E&M to support that the assessment is significant and separately identifiable from the procedures. My reference is the definition of the modifiers.
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