Depending on your carrier rules, I would use a 25 modifier on the office visit when an injection is done at the same visit as an E/M.
I don't think you'd need to use a 59 modifier because "modifier 59 is used to identify procedures or cervices other than E/M services, that are not normally reported together..." (CPT professional edition)
Labs and EKGs are often times done with an E/M, so there isn't a need for a 59 modifier.
This is just my two cents
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