1. you dont need to add 25 to an e/m service when you perform an ekg during same session neither a 59 to an EKG. this is the right code and it does require ordering/ref physician on block 17a in the cms form from the primary who is the ordering physician
2. yes Q codes are the right codes for flu vaccines, the administration 90741 if you bill medicare the G0008. yes use modifier 59 for the third vaccine you administer, there is 90742 code for the sec vaccine
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