modifier 59 vs 91

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I work for a genetics lab and we are having difficulties with Medicare and which modifier to use when multiple genes are being billed under 81479.

Here are 3 scenarios

• Scenario 1—if we do bill with a Z code for an unlisted code (81479) multiple times for a different gene do we use 59 or 91?
• Scenario 2—If we bill with a Z code for an unlisted code (81479) multiple times for a different gene and want to show different units for that gene on the same claim and date of service, should we bill individual genes with 59 or 91?
• Scenario 3--Can we bill 59 and 91 on the same claim?

Any help would be very appreciated
 
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