Understanding the Limits of Agentic ICD Coding

• URL: http://arxiv.org/abs/2609.13806v1
• Date: Sat, 12 Sep 2026 08:33:38 GMT
• Title: Understanding the Limits of Agentic ICD Coding
• Abstract summary: ICD-10-CM codes are alphanumeric codes used in the US to classify diagnoses and injuries for medical billing and epidemiological reporting.<n>Standard ICD-10-CM benchmarks report aggregate metrics that obscure performance on complex coding scenarios.<n>We evaluate neural, workflow, and agentic systems on a rarity-stratified set of MIMIC-IV discharge summaries.
• Score: 18.80812324281645
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: 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-10-CM reference materials recovers up to 0.34 micro-F1 on this subset. No single system dominates across all conditions.

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