# Toward Reliable Clinical Coding with Language Models: Verification and Lightweight Adaptation

arXiv: https://arxiv.org/abs/2510.07629 · HTML: https://mlsanity.com/paper/2510.07629/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 9 of its 20 references that are in the map.
- First posted on arXiv 8 Oct 2025.

## Builds on (most cited first, 9 of 9)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission](https://mlsanity.com/paper/1904.05342/) (2019)
- [Deep EHR: A Survey of Recent Advances in Deep Learning Techniques for Electronic Health Record (EHR) Analysis](https://mlsanity.com/paper/1706.03446/) (2017)
- [ACI-BENCH: a Novel Ambient Clinical Intelligence Dataset for Benchmarking Automatic Visit Note Generation](https://mlsanity.com/paper/2306.02022/) (2023)
- [PLM-ICD: Automatic ICD Coding with Pretrained Language Models](https://mlsanity.com/paper/2207.05289/) (2022)
- [Learning to Revise References for Faithful Summarization](https://mlsanity.com/paper/2204.10290/) (2022)
- [Towards Clinical Encounter Summarization: Learning to Compose Discharge Summaries from Prior Notes](https://mlsanity.com/paper/2104.13498/) (2021)
- [Zero-Shot Fact-Checking with Semantic Triples and Knowledge Graphs](https://mlsanity.com/paper/2312.11785/) (2023)

## Built on by (most cited first, 5 of 5)

- [Symphony for Medical Coding: A Next-Generation Agentic System for Scalable and Explainable Medical Coding](https://mlsanity.com/paper/2603.29709/) (2026)
- [From Documents to Spans: Span-Centric Learning for LLM-based Explainable Medical Coding](https://mlsanity.com/paper/2603.15270/) (2026)
- [A decision-basis contract for auditable LLM-assisted medical billing verification: deterministic rules, verbatim evidence, and fail-closed abstention](https://mlsanity.com/paper/2609.12156/) (2026)
- [Decomposing Error and Style in Automated Clinical Coding](https://mlsanity.com/paper/2609.24877/) (2026)
- [Beyond ICD Codes: Semantic IDs for Generative Medical Coding](https://mlsanity.com/paper/2610.19301/) (2026)

## Abstract (arXiv)

Accurate clinical coding is essential for healthcare documentation, billing, and decision-making. While prior work shows that off-the-shelf LLMs struggle with this task, evaluations based on exact match metrics often overlook errors where predicted codes are hierarchically close but incorrect. Our analysis reveals that such hierarchical misalignments account for a substantial portion of LLM failures. We show that lightweight interventions, including prompt engineering and small-scale fine-tuning, can improve accuracy without the computational overhead of search-based methods. To address hierarchically near-miss errors, we introduce clinical code verification as both a standalone task and a pipeline component. To mitigate the limitations in existing datasets, such as incomplete evidence and inpatient bias in MIMIC, we release an expert double-annotated benchmark of outpatient clinical notes with ICD-10 codes. Our results highlight verification as an effective and reliable step toward improving LLM-based medical coding.