Yidong Gan

Yidong Gan, David D. Nguyen, Yang Lin et al.

We present RAG-Coding, an agentic method for automated ICD-10-CM coding. RAG-Coding orchestrates four large language model (LLM) agents and grounds their coding decisions in external knowledge sources (e.g. the official coding tabular list and guidelines). By retrieving and cross-referencing relevant knowledge in these sources, the agents enhance coding accuracy and ensure clinical compliance. On the MDACE dataset, RAG-Coding outperforms the best LLM-based baseline by 8-13\% in micro-F1 and 2-8\% in macro-F1 across multiple LLM backbones. Compared to the state-of-the-art pretrained language model method, PLM-ICD, RAG-Coding exhibits higher micro recall (+11\%), while PLM-ICD exhibits higher micro precision (+6\%), yielding comparable micro- and macro-F1. Ablations show stepwise gains, highlighting the importance of incorporating external knowledge. We also release MDACE-2025, updating the original dataset with expert re-annotations with the latest 2025 ICD-10-CM guidelines. This update features more fine-grained code labels and enables evaluation against current clinical standards.

Yidong Gan, Maciej Rybinski, Ben Hachey et al.

Clinical coding is crucial for healthcare billing and data analysis. Manual clinical coding is labour-intensive and error-prone, which has motivated research towards full automation of the process. However, our analysis, based on US English electronic health records and automated coding research using these records, shows that widely used evaluation methods are not aligned with real clinical contexts. For example, evaluations that focus on the top 50 most common codes are an oversimplification, as there are thousands of codes used in practice. This position paper aims to align AI coding research more closely with practical challenges of clinical coding. Based on our analysis, we offer eight specific recommendations, suggesting ways to improve current evaluation methods. Additionally, we propose new AI-based methods beyond automated coding, suggesting alternative approaches to assist clinical coders in their workflows.