China

Large language models (LLMs) are increasingly used to support clinical practice. Medical coding is a process where experts map unstructured clinical notes to alphanumeric codes for diagnoses and procedures. We introduce Code Like Humans: a new reasoning-based framework for medical coding with LLMs that implements official coding guidelines for human coders. It is the first solution to support the full US ICD-10 classification space (+70K labels), and it achieves comparable results with fine-tuned classifier models on rare classes. However, the performance on frequent classes is still lacking, and we also find that some medical conditions are systematically undercoded. These limitations suggest that LLM-based medical coding should assist human coders rather than automate the task.

EMNLP 2025

Code Like Humans: A Multi-Agent Solution for Medical Coding

clinical coding

llms

multi-agent

clinical nlp

### Welcome to The 63rd Annual Meeting of the Association for Computational Linguistics (ACL 2025)

Message from the General Chair: 
*It is my great pleasure and honor to welcome you to the 63rd Annual Meeting of the Association for Computational Linguistics (ACL 2025), held in beautiful Vienna, Austria, from July 27 to August 1, 2025. ACL2025continues our field’s tradition of excellence in scholarship, innovation, and inclusivity, and I am deeply grateful to the many volunteers who have worked tirelessly to bring this event to life.* 
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ACL 2025

Welcome to The 63rd Annual Meeting of the Association for Computational Linguistics (ACL 2025)

poster

## Welcome!
"I am excited to welcome you to this year’s edition of the Conference on Empirical Methods in Natural Language Processing! Importantly, it marks the 30th edition of EMNLP. With over 8,000 submissions, more than 3,000 accepted papers, and thousands of attendees, we have come a long way from that first
workshop, which had 14 accepted papers. As the field looks ahead, Suzhou is the fitting location for celebrating this milestone: rooted in a long literary tradition, yet modern and forward-looking, and home to a large share of the NLP community." 

*Message from the General Chair, Dirk Hovy*

Celebrate 30 Years of EMNLP! 
EMNLP 2025 will be held in Suzhou, China from November 5th to November 9th, 2025.

Retrieval augmented generation (RAG) is a popular framework for question answering that is powered by two large language models (LLMs): an embedding model that retrieves context documents from a database that are relevant to a given question, and a generator model that uses the retrieved context to generate an answer to the question. Both the embedding and generator models can be fine-tuned to increase performance of a RAG pipeline on a new task, but multiple fine-tuning strategies exist with different costs and benefits. In this paper, we evaluate and compare several RAG fine-tuning strategies, including independent, joint, and two-phase fine-tuning. In our experiments, we observe that all of these strategies achieve about equal improvement in EM and F1 generation quality metrics, although they have significantly different computational costs. We conclude the optimal fine-tuning strategy to use depends on whether the training dataset includes context labels and whether a grid search over the learning rates for the embedding and generator models is required.

A Comparison of Independent and Joint Fine-tuning Strategies for Retrieval-Augmented Generation

In collaborative creation tasks, people iteratively steer an artifact towards a specific target by refining it over multiple rounds of interaction. In contrast, while generative AI excels at creating artifacts in one turn, it often struggles with making refinements in subsequent exchanges. To close this gap, we present mrCAD, a dataset of humans playing a multi-turn game communicating using natural language and drawing. In each game, a pair of players created and refined computer-aided designs (CADs) over multiple turns to match a target design. Only the Designer could see the target, and they must instruct the Maker using multiple modalities of text and drawing at each turn. mrCAD consists of 6,082 communication games, 15,163 instruction-execution rounds, played between 1,092 pairs of human players. Analysis finds that players relied more on text in refinement than in initial generation instructions, and used different linguistic elements for refinement than for generation. We also find that state-of-the-art VLMs are better at following generation instructions than refinement instructions. These results lay the foundation for modeling multi-turn, multimodal communication not captured in prior datasets.

mrCAD: Multimodal Communication to Refine Computer-aided Designs

Mainstream large vision-language models (LVLMs) inherently encode cultural biases, highlighting the need for diverse multimodal datasets. To address this gap, we introduce Pearl, a large-scale Arabic multimodal dataset and benchmark explicitly designed for cultural understanding. Constructed through advanced agentic workflows and extensive human-in-the-loop annotations by 45 annotators from across the Arab world, Pearl comprises over 309K multimodal examples spanning ten culturally significant domains covering all Arab countries. We further provide two robust evaluation benchmarks Pearl and Pearl-Lite along with a specialized subset Pearl-X explicitly developed to assess nuanced cultural variations. Comprehensive evaluations on state-of-the-art open and proprietary LVLMs demonstrate that reasoning-centric instruction alignment substantially improves models’ cultural grounding compared to conventional scaling methods. Pearl establishes a foundational resource for advancing culturally-informed multimodal modeling research. All datasets and benchmarks are publicly available.

Pearl: A Multimodal Culturally-Aware Arabic Instruction Dataset

The reliability of large language models (LLMs) is greatly compromised by their tendency to hallucinate, underscoring the need for precise identification of knowledge gaps within LLMs. Various methods for probing such gaps exist, ranging from calibration-based to prompting-based methods. To evaluate these probing methods, in this paper, we propose a new process based on using input variations and quantitative metrics. Through this, we expose two dimensions of inconsistency in knowledge gap probing. (1) **Intra-method inconsistency:** Minimal non-semantic perturbations in prompts lead to considerable variance in detected knowledge gaps within the same probing method; e.g., the simple variation of shuffling answer options can decrease agreement to around 40%. (2) **Cross-method inconsistency:** Probing methods contradict each other on whether a model knows the answer. Methods are highly inconsistent -- with decision consistency across methods being as low as 7% -- even though the model, dataset, and prompt are all the same. These findings challenge existing probing methods and highlight the urgent need for perturbation-robust probing frameworks.

Do We Know What LLMs Don’t Know? A Study of Consistency in Knowledge Probing

Large language models perform surprisingly well on many zero-shot classification tasks, but are difficult to fairly compare to supervised classifiers due to the lack of a modifiable decision boundary. In this work, we propose and evaluate a method that converts binary classification tasks into pairwise comparison tasks, obtaining relative rankings from LLMs. Repeated pairwise comparisons can be used to score instances using the Elo rating system (used in chess and other competitions), inducing a confidence ordering over instances in a dataset. We evaluate scheduling algorithms for their ability to minimize comparisons, and show that our proposed algorithm leads to improved classification performance, while also providing more information than traditional zero-shot classification.

Using tournaments to calculate AUROC for zero-shot classification with LLMs

Evaluating the factuality of long-form generations from Large Language Models (LLMs) remains challenging due to accuracy issues and costly human assessment. Prior evaluation pipelines attempt this by decomposing text into claims, searching for evidence, and verifying claims, but suffer from critical drawbacks: (1) inefficiency due to complex pipeline components unsuitable for long LLM outputs, and (2) ineffectiveness stemming from inaccurate claim sets and insufficient evidence collection of one-line SERP snippets. To address these limitations, we adapt the existing decompose-then-verify evaluation framework and propose **FaStFact**, a fast and strong evaluation pipeline that achieves the highest alignment with human evaluation and efficiency among existing baselines. FaStFact first employs chunk-level claim extraction integrated with confidence-based pre-verification, significantly reducing the cost of web searching and inference calling while ensuring reliability. For searching and verification, it gathers document-level evidence from crawled website pages for retrieval during verification, addressing the evidence insufficiency problem in previous pipelines. Extensive experiments based on an aggregated and manually annotated benchmark demonstrate the reliability of FaStFact in both efficiently and effectively evaluating the factuality of long-form LLM generations. We submit the paper with code and benchmark, and will make them publicly available to facilitate research.

FaStFact: Faster, Stronger Long-Form Factuality Evaluations in LLMs

There has been significant research on propagandistic content detection across different modalities and languages. However, most studies have primarily focused on detection, with little attention given to explanations justifying the predicted label. This is largely due to the lack of resources that provide explanations alongside annotated labels. To address this issue, we propose a multilingual (i.e., Arabic and English) explanation-enhanced dataset, the first of its kind. Additionally, we introduce an explanation-enhanced LLM for both label detection and rationale-based explanation generation. Our findings indicate that the model performs comparably while also generating explanations. We will make the dataset and experimental resources publicly available for the research community (anonymous.com).

PropXplain: Can LLMs Enable Explainable Propaganda Detection?

Knowledge-based complex reasoning remains a significant challenge for large language models (LLMs) with in-context learning. To tackle this issue, previous studies focus on ensuring behavior fidelity, factuality, or reliability in generated reasoning processes that guide LLMs to produce solutions. However, these studies often neglect the simultaneous optimization on all these three aspects for each thought. The main challenges are the lack of comprehensive assessment mechanisms and the difficulty of efficient thought-level optimization. This paper introduces the Evolution of Thoughts (EoT) framework, which enhances the factuality, fidelity, and reliability of each thought in the reasoning process through a few LLM inferences. We propose a thought assessment method that is sensitive to knowledge and LLM behaviors, using three scorers to evaluate each thought by considering domain context, semantic alignment, and behavior impact. Additionally, we establish a self-reflective evolution mechanism to facilitate each reasoning process generation in a single-forward inference. Extensive experiments demonstrate that, for knowledge-based complex tasks, EoT improves the factuality and fidelity of reasoning processes by approximately 16.5% and 48.8%, respectively, while enhancing LLM reasoning capability by about 6.2%, outperforming advanced approaches.

EoT: Evolution of Thoughts for Complex Reasoning Tasks

Large Language Models (LLMs) have revolutionized natural language processing, but their varying capabilities and costs pose challenges in practical applications. LLM routing addresses this by dynamically selecting the most suitable LLM for each query/task. Previous approaches treat this as a supervised learning problem, assuming complete knowledge of optimal query-LLM pairings. However, real-world scenarios lack such comprehensive mappings and face evolving user queries. We thus propose to study LLM routing as a contextual bandit problem, enabling adaptive decision-making using bandit feedback without requiring exhaustive inference across all LLMs for all queries (in contrast to supervised routing). To address this problem, we develop a shared embedding space for queries and LLMs, where query and LLM embeddings are aligned to reflect their affinity. This space is initially learned from offline human preference data and refined through online bandit feedback. We instantiate this idea through Preference-prior Informed Linucb fOr adaptive rouTing (PILOT), a novel extension of LinUCB. To handle diverse user budgets for model routing, we introduce an online cost policy modeled as a multi-choice knapsack problem, ensuring resource-efficient routing.

Adaptive LLM Routing under Budget Constraints

Agents powered by large language models (LLMs) have demonstrated strong planning and decision-making capabilities in complex embodied environments. However, such agents often suffer from inefficiencies in multi-turn interactions, frequently trapped in repetitive loops or issuing ineffective commands, leading to redundant computational overhead. Instead of relying solely on learning from trajectories, we take a first step toward exploring the early-exit behavior for LLM-based agents. We propose two complementary approaches, 1. an **intrinsic** method that injects exit instructions during generation, and 2. an **extrinsic** method that verifies task completion to determine when to halt an agent’s trial. To evaluate early-exit mechanisms, we introduce two metrics: one measures the reduction of **redundant steps** as a positive effect, and the other evaluates **progress degradation** as a negative effect. Experiments with 4 different LLMs across 5 embodied environments show significant efficiency improvements, with only minor drops in agent performance. We also validate a practical strategy where a stronger agent assists after an early-exit agent, achieving better performance with the same total steps. We will release our code to support further research.

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