CPTCoder: A Reliable LLM System for Medical Procedure Code Prediction

AbstractWe present **CPTCoder**, a human-in-the-loop system that predicts standardized medical procedure codes from clinical text. Clinical procedure coding is an extreme multi-label classification problem over a long-tailed space of short numeric identifiers, where a single-digit difference denotes an entirely different procedure. CPTCoder adapts an instruction-tuned LLM with a code-aware vocabulary and constrained decoding that guarantees all outputs are valid codes. To support human review, we derive per-code posterior inclusion probabilities from n-best reweighting, producing interpretable confidence scores that rank predictions and flag uncertain cases. A post-decoding constraint repair step enforces mutual-exclusion rules between conflicting codes. To enable reproducible research in this underexplored setting, we release **MIMIC-CPT**, a PhysioNet-accessible benchmark of 37,885 expert-cleaned report–code pairs with a deliberately hardened test split: 88% of test examples contain label combinations unseen during training, and over a third include codes with five or fewer training occurrences. We additionally provide 413,085 weakly aligned pairs and evaluate on a separate live dataset from a hospital, which includes out-of-domain radiology reports with billing-expert-verified labels. CPTCoder achieves 0.61 and 0.51 micro-F1 on the hardened MIMIC split and Hospital-298 respectively, outperforming the strongest baseline by 12 and 5 absolute points while reducing digit-level near-miss errors.