CPT CODE FOR LAPAROSCOPIC SIGMOID COLON RESECTION WITH END COLOSTOMY

CCANTER

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So my question is where I am not sure do I use 44206 with modifier 52? or 44204 and 44188?

Operative note: abdomen is then prepped and draped in the standard sterile fashion.  The site of the end colostomy had been marked preoperatively.  The abdomen was insufflated using various technique.  3 trochars were inserted in the right lateral and epigastric region through Optiview technique.  The site of insufflation was inspected and no bowel injury was identified.  The patient was placed in Trendelenburg position and the sigmoid colon was thoroughly inspected.  He had a fairly long redundant though otherwise normal-appearing sigmoid colon.  Point of transection below the sacral promontory was chosen and the mesentery entered through that level.  A blue load stapler was used to transect the colon.  The proximal portion was dissected using an energy device along the mesentery in order to mobilize it.  The white line of Toldt was also taken down.  This ultimately was about 12 inches worth of mobilization until an appropriate amount of colon located at the preoperatively marked colostomy site was reached.  12 mm trocar was placed in that area the colon was grasped and the area developed for colostomy.  Colostomy was brought up through the skin.  Demarcation and devascularized colon was identified and appeared to be well beyond our chosen portion for the colostomy site.  This portion of colon was sharply transected and the colostomy matured in the left lateral abdomen through the rectus muscle using 3-0 Vicryl suture.  The abdomen was reinsufflated and the colostomy inspected internally.  There was no evidence of bleeding in the colon appeared to maintain proper orientation heading up to the level of the skin.  With the operation complete the abdomen was closed.  A 12 mm trocar site in the right lower quadrant was closed using 0 Vicryl for fascia.  All trocar sites were closed using 4-0 Monocryl and skin glue.  
 
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