Deep Label-Wise Attentive Temporal Convolutional Networks Improve Medical Coding
Authors: Muhammed Yavuz Nuzumlalı, Alexander Fabbri, Irene Li, Dragomir Radev
Organizations: Yale University
Abstract
Medical coding is the task of assigning a set of diagnosis and procedure codes for a hospitalization using recorded notes. It requires aggregating information from different parts of the text and focus to different sections for each individual code, making it a very difficult problem even for professional human coders. We model the task as a multi-label text classification problem. To overcome the mentioned difficulties, we propose a deep neural model consisting of a multi-layer temporal convolution network (TCN) followed by label-wise attention. While multi-layer TCN helps extract a global document representation with the ability to learn relations over very long sequences, label-specific attention mechanism allows the model to focus on different aspects of the same document for each individual label. Our method achieves significantly better F-1 scores (9% increase) compared to the previous state-of-the-art model, with a remarkable increase in recall score (28% increase), which we believe is the more important metric for a clinical decision support setting.
Automatic medical coding assigns ICD codes to clinical notes, but it remains challenging due to long documents, imbalanced label distributions, and diverse terms. These challenges are especially severe for rare codes, which have limited training instances and are easily confused with semantically similar labels. We introduce CoLa-ICD, a knowledge-enhanced framework for long-tail prediction. CoLa-ICD enriches ICD labels with external terms, models dependencies among related codes, and learns stronger alignment between label semantics and clinical evidence for long-tail prediction. Experiments show that CoLa-ICD improves long-tail prediction with larger gains in larger and sparser label spaces and achieves state-of-the-art performance in AUC, F1, and P@k. Our code is available at https://github.com/youwillbethebest/Cola-ICD.
ClinicalEncoder26AM is a multilingual Diagnosable ColBERT for clinical and biomedical texts, which aligns at multiple levels its token-level semantic with ClinicalMap25, a clinical latent space inspired by BioLORD-2023 and enriched with synthetic and annotated supervision. The post-training recipe builds upon BGE-M3, and combines synthetic clinical notes, patient--doctor conversations, and annotated resources such as MedMentions, while considering both named-entity-level and sentence-level representations in a multi-adapter distillation, along with a ColBERT-style retrieval objective. In this system demonstration paper, we evaluate the model in the MultiClinNER shared task by finetuning it as a BIO tagger for patient symptoms, disorders, and procedure spans, using a lightweight two-layer CNN head to improve local boundary detection. The resulting system remains simple, processes most documents in a single 8192-token window, and achieves state-of-the-art multilingual entity recall, while achieving Top 5 overall across all entity types and languages in Character-weighted F1 scores. Training curves further show that ClinicalEncoder26AM is markedly more data-efficient than the base M3 model, supporting the usefulness of its clinical post-training for downstream information extraction. The model can be downloaded on https://huggingface.co/Parallia/ClinicalEncoder26AM-Diagnosable-Colbert-L2-for-multilingual-medical-texts
Clinical coding maps clinical documentation to standardized medical codes, an essential yet time-consuming administrative task that could benefit from automation. Current models on ICD coding are typically optimized for codes from a specific ICD version. However, in reality, ICD systems evolve continuously, and different versions are adopted across time periods and regions. Moreover, ICD coding suffers from the long-tail problem, and rare code performance can be a bottleneck for developing implementable models. We examine whether it is viable to train version-independent models by combining data annotated in different ICD versions, which may help address these challenges. We add ICD-9 data to the training of a modified label-wise attention model for ICD-10 prediction, and find that despite the version mismatch, adding ICD-9 yields a 27% increase in micro F1 for 18K rare ICD codes compared to training on ICD-10 alone. On 8K frequent ICD-10 codes, the multi-version training also substantially improves macro metrics, with far fewer model parameters.