Explainable ICD Coding via Entity Linking

Clinical coding is a critical task in healthcare, although traditional methods for automating clinical coding may not provide sufficient explicit evidence for coders in production environments. This evidence is crucial, as medical coders have to make sure there exists at least one explicit passage in the input health record that justifies the attribution of a code. We therefore propose to reframe the task as an entity linking problem, in which each document is annotated with its set of codes and respective textual evidence, enabling better human-machine collaboration. By leveraging parameter-efficient fine-tuning of Large Language Models (LLMs), together with constrained decoding, we introduce three approaches to solve this problem that prove effective at disambiguating clinical mentions and that perform well in few-shot scenarios.

Accurate and Well-Calibrated ICD Code Assignment Through Attention Over Diverse Label Embeddings

Although the International Classification of Diseases (ICD) has been adopted worldwide, manually assigning ICD codes to clinical text is time-consuming, error-prone, and expensive, motivating the development of automated approaches. This paper describes a novel approach for automated ICD coding, combining several ideas from previous related work. We specifically employ a strong Transformer-based model as a text encoder and, to handle lengthy clinical narratives, we explored either (a) adapting the base encoder model into a Longformer, or (b) dividing the text into chunks and processing each chunk independently. The representations produced by the encoder are combined with a label embedding mechanism that explores diverse ICD code synonyms. Experiments with different splits of the MIMIC-III dataset show that the proposed approach outperforms the current state-of-the-art models in ICD coding, with the label embeddings significantly contributing to the good performance. Our approach also leads to properly calibrated classification results, which can effectively inform downstream tasks such as quantification.