Medical coding converts free-text clinical notes into standardized diagnostic and procedural codes, which are essential for billing, hospital operations, and medical research. Unlike ordinary text classification, it requires multi-step reasoning: extracting diagnostic concepts, applying guideline constraints, mapping to hierarchical codebooks, and ensuring cross-document consistency. Recent advances leverage agentic LLMs, but most rely on rigid, manually crafted workflows that fail to capture the nuance and variability of real-world documentation, leaving open the question of how to systematically learn effective workflows. We present MedDCR, a closed-loop framework that treats workflow design as a learning problem. A Designer proposes workflows, a Coder executes them, and a Reflector evaluates predictions and provides constructive feedback, while a memory archive preserves prior designs for reuse and iterative refinement. On benchmark datasets, MedDCR outperforms state-of-the-art baselines and produces interpretable, adaptable workflows that better reflect real coding practice, improving both the reliability and trustworthiness of automated systems.

Evaluation and Management (E/M) coding, under the Current Procedural Terminology (CPT) taxonomy, documents medical services provided to patients by physicians. Used primarily for billing purposes, it is in physicians’ best interest to provide accurate CPT E/M codes. Automating this coding task will help alleviate physicians’ documentation burden, improve billing efficiency, and ultimately enable better patient care. However, a number of real-world complexities have made E/M encoding automation a challenging task. In this paper, we elaborate some of the key complexities and present ProFees, our LLM-based framework that tackles them, followed by a systematic evaluation. On an expert-curated real-world dataset, ProFees achieves an increase in coding accuracy of more than 36% over a commercial CPT E/M coding system and almost 5% over our strongest single-prompt baseline, demonstrating its effectiveness in addressing the real-world complexities.

This paper studies the use of language models as a source of synthetic unlabeled text for NLP. We formulate a general framework called “generate, annotate, and learn (GAL)” to take advantage of synthetic text within knowledge distillation, self-training, and few-shot learning applications. To generate high-quality task-specific text, we either fine-tune LMs on inputs from the task of interest, or prompt large LMs with few examples. We use the best available classifier to annotate synthetic text with soft pseudo labels for knowledge distillation and self-training, and use LMs to obtain hard labels for few-shot learning. We train new supervised models on the combination of labeled and pseudo-labeled data, which results in significant gains across several applications. We investigate key components of GAL and present theoretical and empirical arguments against the use of class-conditional LMs to generate synthetic labeled text instead of unlabeled text. GAL achieves new state-of-the-art knowledge distillation results for 6-layer transformers on the GLUE leaderboard.