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In fact, some even experience a little extra shedding at the beginning

Here's when each modifier applies: No modifier needed: the injection is the only service provided at the visit Modifier 25 needed: a separately identifiable E/M service is performed the same day Modifier 59 needed: multiple distinct injections are given at the same visit involving different drugs at different sites Modifier 76 needed: the same injection is repeated by the same provider on the same date of service Modifier 77 needed: a different provider repeats the same injection on the same date One warning that trips up a lot of billers: appending Modifier 59 to an E/M service code is incorrect

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[1] Niacinamide in high doses can sometimes cause nausea, heartburn, or a sensation of warmth