# Hybrid-Code v2: Zero-Hallucination Clinical ICD-10 Coding via Neuro-Symbolic Verification and Automated Knowledge Base Expansion

arXiv: https://arxiv.org/abs/2512.23743 · HTML: https://mlsanity.com/paper/2512.23743/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 11 of its 30 references that are in the map.
- First posted on arXiv 26 Dec 2025.

## Builds on (most cited first, 11 of 11)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [BioMistral: A Collection of Open-Source Pretrained Large Language Models for Medical Domains](https://mlsanity.com/paper/2402.10373/) (2024)
- [Matching the Blanks: Distributional Similarity for Relation Learning](https://mlsanity.com/paper/1906.03158/) (2019)
- [BEHRT: Transformer for Electronic Health Records](https://mlsanity.com/paper/1907.09538/) (2019)
- [Neurosymbolic AI: The 3rd Wave](https://mlsanity.com/paper/2012.05876/) (2020)
- [Explainable Prediction of Medical Codes from Clinical Text](https://mlsanity.com/paper/1802.05695/) (2018)
- [Few-shot Relation Extraction via Bayesian Meta-learning on Relation Graphs](https://mlsanity.com/paper/2007.02387/) (2020)
- [An Empirical Evaluation of Deep Learning for ICD-9 Code Assignment using MIMIC-III Clinical Notes](https://mlsanity.com/paper/1802.02311/) (2018)

## Abstract (arXiv)

Automated clinical ICD-10 coding is a high-impact healthcare task requiring a balance between coverage, precision, and safety. While neural approaches achieve strong performance, they suffer from hallucination-generating invalid or unsupported codes-posing unacceptable risks in safety-critical clinical settings. Rule-based systems eliminate hallucination but lack scalability and coverage due to manual knowledge base (KB) curation. We present Hybrid-Code v2, a neuro-symbolic framework that achieves zero Type-I hallucination by construction while maintaining competitive coverage and precision. The system integrates neural candidate generation with a symbolic KB verification layer that enforces validity constraints through multi-layer verification, including format, evidence grounding, negation detection, temporal consistency, and exclusion rules. In addition, we introduce an automated KB expansion mechanism that extracts and validates coding patterns from unlabeled clinical text, addressing the scalability limitations of rule-based systems. Evaluated on the MIMIC-III dataset against ClinicalBERT, BioBERT, rule-based systems, and GPT-4, Hybrid-Code v2 achieves 85% coverage, 92% precision, and 0% Type-I hallucination, outperforming rule-based systems by +40% coverage while eliminating hallucination observed in neural baselines (6-18%). The proposed architecture provides a formal safety guarantee for syntactic validity while preserving strong empirical performance. These results demonstrate that neuro-symbolic verification can enforce safety constraints in neural medical AI systems without sacrificing effectiveness, offering a generalizable design pattern for deploying trustworthy AI in safety-critical domains.