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.