{
  "abstract": "Clinical codes assigned from discharge summaries support clinical research, reimbursement, health resource allocation, and service planning. In Australia, ICD-10-AM and ACHI are used to code diagnoses and interventions for admitted episodes of care, but manual coding is time-consuming, labour-intensive, and subject to variability. This study investigates large language models for automated ICD-10-AM and ACHI code assignment from discharge summaries. We first normalised a public ICD-9-CM coded dataset into the Australian coding system using General Equivalence Mappings and semantic similarity over code descriptions, with validation by a domain expert clinical coder. We then fine-tuned Meta-Llama-3-8B and compared full-parameter fine-tuning with a parameter-efficient QLoRA baseline. Finally, we applied Direct Preference Optimisation (DPO) using gold-standard-guided preference pairs, where the gold-standard ICD-10-AM/ACHI code list was treated as the preferred response and the supervised fine-tuned model output as the non-preferred response. Experiments were conducted on a mapped MIMIC-III subset and a de-identified Australian hospital dataset. Among the evaluated model variants, the DPO-aligned full-parameter model achieved the highest score, with micro-F1 scores of 0.7397 on the mapped dataset and 0.7834 on the Australian hospital dataset. These findings suggest that gold-standard-guided DPO can improve agreement with reference code sets compared with supervised fine-tuning alone. However, the results are limited to high-frequency diagnosis and procedure codes, short-document evaluation settings, and DPO preference pairs reviewed by one annotator.",
  "abstract_shown": true,
  "affiliations": [
    "School of Computer, Data and Mathematical Sciences, Western Sydney University, Parramatta, NSW, 2116, Australia. 18531738@student.westernsydney.edu.au.",
    "School of Computer, Data and Mathematical Sciences, Western Sydney University, Parramatta, NSW, 2116, Australia.",
    "School of Computer Science and Engineering, University of New South Wales, Kensington, NSW, 2052, Australia."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rajvir Kaur"
    },
    {
      "affs": [
        1
      ],
      "name": "Jeewani Anupama Ginige"
    },
    {
      "affs": [
        2
      ],
      "name": "Oliver Obst"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0685gwf99shnt.bib",
  "cited_by": 0,
  "doi": "10.1186/s12911-026-03631-w",
  "fulltext_url": "https://europepmc.org/articles/PMC13685342",
  "id": "0685gwf99shnt",
  "issns": [
    "1472-6947"
  ],
  "landing_url": "https://europepmc.org/article/MED/42902234",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "R858-859.7"
    ],
    [
      "openalex",
      "3605|Medical Coding and Health Information"
    ]
  ],
  "openalex": "W7170350844",
  "pdf_url": "https://europepmc.org/articles/PMC13685342?pdf=render",
  "pmcid": "PMC13685342",
  "pmid": "42902234",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/0685gwf99shnt.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:41Z",
      "native_id": "MED:42902234",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42902234"
    },
    {
      "first_seen": "2026-10-30T13:46:03Z",
      "native_id": "67e66b49dd464372ba324d406676df29",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s12911-026-03631-w"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:R858-859.7",
      "subfield": "general"
    }
  ],
  "title": "Gold-standard-guided direct preference optimisation for ICD-10-AM and ACHI code assignment from discharge summaries.",
  "title_text": "Gold-standard-guided direct preference optimisation for ICD-10-AM and ACHI code assignment from discharge summaries.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:03Z",
  "url": "https://research.draconitic.com/paper/0685gwf99shnt",
  "venue": "BMC medical informatics and decision making",
  "versions": []
}