You do not need a 59 modifier when you have an injection and an xray since the codes are definitely distinct by descriptor they need no further separation. Same thing for an ultrasound and an injection. Basically you need a 59 when you have 2 procedures where one is considered a component of the other or the 2 procedures are considered mutually exclusive, so you need to check both of these files in the CCI edits to be sure. Now as far as the 25 modifier, in the facility you need the 25 modifier on the E&M only when combined with a significant procedure that would be any status S or status T procedure, Chest xrays and EKGs are status X and are not considered significant. Hopefully this will help
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