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Understanding the Limits of Agentic ICD Coding

arXiv · AI, language, vision and robotics · article · Sep 12, 2026 · UTC

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 gu

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First collected: 2026-09-20T16:41:15.630Z. This is not the publication date.