What do the MRI findings of multilevel lumbar degenerative changes with disc bulging, facet and ligamentum flavum hypertrophy, Modic type I changes at L1‑L2 and L2‑L3, Modic type II changes at L4‑L5, and a 3 mm anterolisthesis of L3 on L4 indicate, and which ICD‑10‑CM codes should be assigned?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 27, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

MRI Interpretation and ICD-10 Coding

This MRI demonstrates multilevel lumbar degenerative disc disease with spinal stenosis, most significantly at L3-L4 (moderate central canal stenosis with 3 mm anterolisthesis) and L2-L3 (mild to moderate central canal stenosis), along with varying degrees of neuroforaminal narrowing, particularly severe at right L4-L5.

Clinical Significance of Key Findings

The MRI reveals several pathologic features that warrant specific attention:

Most Clinically Relevant Findings

  • L3-L4 level: The combination of 3 mm anterolisthesis with moderate central canal stenosis and moderate left neuroforaminal narrowing represents the most significant structural abnormality. This level is the primary pain generator candidate if the patient has failed conservative management 1.

  • L4-L5 level: Moderate to severe right neuroforaminal narrowing with Modic type II changes indicates chronic degenerative changes with potential nerve root compression.

  • L2-L3 level: Mild to moderate central canal stenosis with Modic type I changes is particularly noteworthy. Modic type I changes represent active inflammatory endplate changes and may predict rapid progressive disc degeneration 2. These changes are associated with accelerated degenerative processes including endplate deformation and decreasing disc height 2.

Modic Changes Interpretation

Modic type I changes at L1-L2 and L2-L3 indicate active inflammatory endplate changes with vascularized fibrous tissue replacement of normal marrow 3. These changes may predict rapid progressive, deforming disc degeneration and are associated with more severe radiographic representation of lumbar degeneration 2, 4.

Modic type II changes at L4-L5 represent chronic fatty marrow replacement, indicating a more stable but advanced degenerative state 4.

Appropriate ICD-10-CM Codes

Primary Diagnosis Codes:

  • M47.26 - Other spondylosis with radiculopathy, lumbar region (if radicular symptoms present)
  • M47.816 - Spondylosis without myelopathy or radiculopathy, lumbar region (if no radicular symptoms)
  • M48.06 - Spinal stenosis, lumbar region
  • M51.36 - Other intervertebral disc degeneration, lumbar region
  • M43.16 - Spondylolisthesis, lumbar region (for the L3-L4 anterolisthesis)

Additional Codes Based on Specific Findings:

  • M51.26 - Other intervertebral disc displacement, lumbar region (for disc bulges)
  • M47.897 - Other spondylosis, lumbosacral region
  • M99.03 - Segmental and somatic dysfunction of lumbar region (if documenting facet hypertrophy/dysfunction)

Laterality and Specificity:

If documenting specific nerve root involvement based on clinical correlation:

  • M54.16 - Radiculopathy, lumbar region
  • M54.5 - Low back pain (if primary complaint)

Clinical Correlation Required

Critical caveat: MRI abnormalities are frequently seen in asymptomatic individuals, and imaging findings do not necessarily correlate with clinical symptoms 1. The ACR Appropriateness Criteria emphasize that many MRI abnormalities can be present in asymptomatic patients and imaging is often not beneficial unless the patient has failed 6 weeks of conservative therapy and is a surgical or interventional candidate 1.

When These Findings Matter:

The imaging findings become clinically actionable when:

  • Patient has persistent or progressive symptoms after 6 weeks of optimal medical management
  • Physical examination demonstrates objective neurologic deficits correlating with imaging findings
  • Patient is being considered for surgical or interventional treatment 1

Red Flags to Exclude:

Ensure clinical evaluation has ruled out:

  • Cauda equina syndrome (bladder/bowel dysfunction, saddle anesthesia)
  • Progressive neurologic deficit
  • Infection or malignancy
  • Fracture (already excluded on this MRI)

Coding Strategy

For billing and documentation purposes, select the ICD-10 code that best reflects the patient's primary clinical presentation and the anatomic level most responsible for symptoms. If the patient has radicular symptoms correlating with the L3-L4 or L4-L5 findings, use M47.26. If presenting primarily with neurogenic claudication from stenosis, M48.06 is appropriate. The anterolisthesis at L3-L4 warrants M43.16 as an additional diagnosis.

Document the specific levels involved (L1-L2 through L5-S1) in your clinical note to justify the complexity of the degenerative changes and support medical decision-making, particularly if considering interventional procedures or surgical consultation.

References

1
Guideline

acr appropriateness criteria® low back pain: 2021 update.

Journal of the American College of Radiology, 2021

2
Research

Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2012

3
Research

Degenerative disease of the spine: How to relate clinical symptoms to radiological findings.

Advances in clinical and experimental medicine : official organ Wroclaw Medical University, 2024

Related Questions

For a 64‑year‑old patient with multilevel degenerative changes of the spine but no significant central canal narrowing or critical neuroforaminal narrowing, how should the imaging findings be interpreted?
What do the lumbar MRI findings of multilevel disc bulging, Modic type I and II degenerative end‑plate changes, moderate spinal canal stenosis from L3 to S1, and severe left L5 foraminal narrowing indicate, and what conservative management is recommended?
Can you interpret the spinal imaging findings showing moderate multilevel disc height loss and facet hypertrophy without compression deformities, fracture, or subluxation?
In a patient with a 7 mm retrolisthesis at L2‑L3, multilevel degenerative disc disease, low back and hip pain, no weakness, numbness, or tingling, a history of bladder prolapse, and recent episodes of bowel incontinence, what is the next appropriate step in management?
What is the general term for degenerative spinal changes such as disc disease, facet joint arthritis, and spinal stenosis?
When should blood tests be ordered for a patient presenting with a rash?
Can tacrolimus and mycophenolate cause pancytopenia, neutropenia (low absolute neutrophil count), and thrombocytopenia?
Is azithromycin a bacteriostatic antibiotic?
Can amiodarone cause a rash?
Can dexamethasone be used to treat migraine in a pregnant woman, and what are the appropriate dose, timing, and safety considerations?
What is the likely cause of a toddler’s intermittent fever, swollen cheek, and occasional facial bumps, and what evaluation and treatment are recommended?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.