CoLa-ICD: A Knowledge-Enhanced Framework for Long-Tail Automated Medical Coding
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CoLa-ICD is a knowledge‑enhanced framework designed to improve automatic medical coding of ICD codes in long, imbalanced clinical documents. It enriches ICD labels with external terms, models dependencies among related codes, and strengthens the alignment between label semantics and clinical evidence, particularly for rare codes. Experiments demonstrate that CoLa-ICD achieves state‑of‑the‑art performance in AUC, F1, and P@k, with larger gains in larger and sparser label spaces.
The paper introduces Span-Centric Learning (SCL), a method that decouples coding knowledge acquisition from its application in full clinical documents. SCL first trains on short text spans to learn coding knowledge, then fine‑tunes on a small set of annotated documents, enabling an 8B LLM to outperform state‑of‑the‑art methods with only 248 full documents. The approach also yields explicit, human‑aligned supporting evidence for each predicted ICD code and can learn code knowledge from spans even when the codes are absent from the full documents.
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EHRAdapt is an adapter that maps electronic health record tuples directly into a frozen language model’s embedding space, using learned embeddings for modality, time gaps, and dedicated vectors for event codes. It represents each event vector as a sum of a frozen, ontology‑trained semantic prior and a low‑rank evidence residual, enabling robust learning even for rare clinical events. Experiments on four million patient records with three large language model backbones show that the full adapter outperforms all ablations in next‑event prediction and improves rare‑disease discrimination in classification tasks.
Generative approaches to automatic International Classification of Diseases (ICD) coding use large language models (LLMs) to predict ICD codes from clinical documents. However, original ICD code strin...