title: A method for modeling co-occurrence propensity of clinical codes with application to ICD-10-PCS auto-coding.
abstract: Natural language processing methods for medical auto-coding, or automatic generation of medical billing codes from electronic health records, generally assign each code independently of the others. They may thus assign codes for closely related procedures or diagnoses to the same document, even when they do not tend to occur together in practice, simply because the right choice can be difficult to infer from the clinical narrative.
  
  
  
  We propose a method that injects awareness of the propensities for code co-occurrence into this process. First, a model is trained to estimate the conditional probability that one code is assigned by a human coder, given than another code is known to have been assigned to the same document. Then, at runtime, an iterative algorithm is used to apply this model to the output of an existing statistical auto-coder to modify the confidence scores of the codes.
  
  
  
  We tested this method in combination with a primary auto-coder for International Statistical Classification of Diseases-10 procedure codes, achieving a 12% relative improvement in F-score over the primary auto-coder baseline. The proposed method can be used, with appropriate features, in combination with any auto-coder that generates codes with different levels of confidence.
  
  
  
  The promising results obtained for International Statistical Classification of Diseases-10 procedure codes suggest that the proposed method may have wider applications in auto-coding.
authors.affiliation: 3M Health Information Systems, 12215 Plum Orchard Drive, Silver Spring, Maryland 20904, USA msubotin@mmm.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Subotin
authors.affiliation: 3M Health Information Systems, 12215 Plum Orchard Drive, Silver Spring, Maryland 20904, USA.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Davis
mesh_terms: D000465:Algorithms; D059019:Clinical Coding / Q000379:methods*; D057286:Electronic Health Records; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D000069550:Machine Learning; D009323:Natural Language Processing; D011336:Probability
keywords: Clinical Coding; ICD-10; Logistic Regression; Probability Learning