Understanding the Limits of Agentic ICD Coding
ICD-10-CM codes are alphanumeric codes used in the US to classify diagnoses and injuries for medical billing and epidemiological reporting. Standard ICD-10-CM benchmarks report aggregate metrics that obscure performance on complex coding scenarios. We evaluate neural, workflow, and agentic systems on a rarity-stratified set of MIMIC-IV discharge summaries and identify two orthogonal failure modes. Neural classifiers exhibit a 0.43 micro-F1 gap between rare and common codes. Workflow systems handle rare codes well but score near zero on injury and external cause codes that require multi-step guideline following. A tool-augmented agentic configuration with structured access to official ICD-...
| Authors | Chong Yock Eng, Yushi Cao, Yiming Chen et al. |
|---|---|
| Primary category | cs.CL |
| Published | 12 September 2026 |
| Last updated at source | 12 September 2026 |
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