Need help!!! 94640, 94664

When billing these together should 59 be appended to 94640 along with 25 on the E/M? I have a physician that wants to bill 94010, 94640 & 94664 all on the same visit. Each one is done at a different time. A spirometry will be done and based on that result he decides to do a treatment and then does the education with the patient and/or parents on use of mdi/nebulizer.
Can these be billed together & if so, where do you append modifier?
If just E/M & 94640 is done, should 59 be added?

Thanks for the help!