Unless he converted to an open procedure you would use 44204 and possibly 44213 if he took down the slpenic flexure. 49000 is for Exploratory laparotomy (open) and you are describing 2 different types of entry. Once it's converted from a laparscopic repair to an open repair, you would use the open procedure code (44140) w/ V64.41 as the dx.
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