The paper releases the first public, rule-complete benchmark for LLM reasoning over NordDRG hospital payment logic, with top models scoring 13/13 on logic tasks and 7/13 on full grouper emulation.
Large language models are good medical coders, if provided with tools
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abstract
This study presents a novel two-stage Retrieve-Rank system for automated ICD-10-CM medical coding, comparing its performance against a Vanilla Large Language Model (LLM) approach. Evaluating both systems on a dataset of 100 single-term medical conditions, the Retrieve-Rank system achieved 100% accuracy in predicting correct ICD-10-CM codes, significantly outperforming the Vanilla LLM (GPT-3.5-turbo), which achieved only 6% accuracy. Our analysis demonstrates the Retrieve-Rank system's superior precision in handling various medical terms across different specialties. While these results are promising, we acknowledge the limitations of using simplified inputs and the need for further testing on more complex, realistic medical cases. This research contributes to the ongoing effort to improve the efficiency and accuracy of medical coding, highlighting the importance of retrieval-based approaches.
fields
cs.AI 1years
2025 1verdicts
CONDITIONAL 1representative citing papers
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The NordDRG AI Benchmark for Large Language Models
The paper releases the first public, rule-complete benchmark for LLM reasoning over NordDRG hospital payment logic, with top models scoring 13/13 on logic tasks and 7/13 on full grouper emulation.