Frustrated by the Coding Practicum?

Coding and Billing40 Comments

You just got through the coding modules. E/M coding almost killed you, but you survived. Now you’re looking back and wondering if you remember anything from the last four modules. At the same time, you are looking ahead at the giant pile of reports to code in the practicum; you may have even coded a few of them. You may feel frustrated, overwhelmed, and possibly astonished at the work it takes to learn medical coding. From someone who has been where you are now, allow me to offer a few words of advice…

Learning to use your books and apply guidelines has been the focus of the course thus far. Now you get to work on developing a new skill—abstraction. The practicum is composed of authentic medical charts, dictated by actual physicians in patient care situations. This means you will be reading physician-level writing and abstracting the pertinent info for code assignment. Abstraction is definitely a skill unto itself. A huge part of going through each of these charts is learning to identify key words and phrases and turn them into the right codes—this takes A LOT of practice. Don’t expect to be able to get all the codes right immediately!

Your scores on the practicum reports are not considered when we determine your eligibility to take the final exam. You need to attempt every report, but you do not need to get an 85% on them like you do on the Unit Tests and Module Exams. This gives you the opportunity to learn from each report by going through the documentation and coding what you can, submitting your codes, and working backward from the codes you missed. This is a valuable way to learn abstraction while simultaneously gaining indexing skills and learning which codes are appropriate for disparate report types.

The practicum component of online medical coding training takes a lot of discipline, but hopefully with these ideas in mind you can move through the reports with a little less stress and, instead, focus on learning from each report.

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  1. fabiola September 06, 2014

    I don’t understand a bit :(
    I am new to this.  I am frustrated and I just started

  2. Sue Roberts September 09, 2014

    Thank you so much for the random words of encouragement. They fit my own experiences thus far exactly. Gives me the incentive to keep pushing forward.

  3. Gretchen September 10, 2014

    I’m so glad I just read this blog! I have been frustrated by abstracting all the right info from the scenarios within the E/M Coding part. I was worried I wouldn’t ever get it right… This gives me hope! Thanks for sharing!

  4. Career Step September 15, 2014

    Hi Fabiola,

    We’re sorry to hear you’re still confused and frustrated. Contact your coding instructors! You can reach them directly at 1-888-657-5752 or .(JavaScript must be enabled to view this email address). They can help you figure out what you’re missing and give you the encouragement to keep moving forward.

    Chin up!

  5. Becky September 16, 2014

    Thank you for this post. I go back to it when I want to throw my computer down and stomp on it. I have noticed I’m learning as I’m going. Thanks for the words of encouragement.

  6. Jeannette September 16, 2014

    I am not at the practicum portion yet.  Just into module 3, the medical records stuff.
    It is so great to hear what the rest of you are asking and replying to where you are. 
    Thanks so much for your input!  There seems to be a lot of support.  I look forward to using it more.

  7. Mary Cook September 22, 2014

    Actually, I am pretty good at E/M coding although I do remember my initial frustration.  I am sure it will take much more practice for it to become second nature.  I can see the progress I have made, however.


  8. Patricia September 26, 2014

    Thank you!  I am glad I read it too.. still not that confident but understand that my scores are not important in this module… yeah! Keep going it will end

  9. Career Step September 29, 2014

    Keep up the good work everyone! If you run into problems, don’t hesitate to contact your coding instructors at 1-888-657-5752 or .(JavaScript must be enabled to view this email address).

  10. Amy September 30, 2014

    I just started the Practicum portion a week ago. Im soo frustrated that Im ready to quit!!! I can’t seem to get any problems correct on the first try & the E/M coding drives me crazy!! When will it ever get easier?? Also in a time crunch since my time is running out in 2 months. Not sure if I should extend or if I have enough time to figure this out. Any suggestions would be really appreciated.

  11. Instructor Craig Laursen September 30, 2014


    Very few students get all the codes correct the first time through. As an instructor, I have seen students make great progress going through the report and assigning what they find and then going back through a second time after they know the correct codes from the answer page.
    You already know how to code (the process) now its a different skill of learning how to apply the process. This takes time and practice.
    We are here to answer your questions! Please email .(JavaScript must be enabled to view this email address) with your questions!

  12. Tricia October 13, 2014

    I have been working on the Practicum and I am failing terribly. The code I choose makes sense to me but then it is incorrect. I just don’t understand what I’m missing. During the modules, I could pick the E/M codes almost every time. Now with the Practicum, I can’t get one right. UGH

  13. Amy October 16, 2014

    I am sooo done with this!!! I can’t seem to do anything right! Im on the Practicum problem #102 and its still not sinking in. I just want to quit!! This makes me feel really dumb. What am I missing?? Are there key words I should be looking for that Im not getting??? When is it going to come together?? Feeling very frustrated:(

  14. Instructor Craig Laursen October 21, 2014

    Tricia and Amy,

    You are not alone! The frustration you are feeling is the reason I wrote this blog post.

    Please understand that we DO NOT expect you to be getting perfect scores right now! Tricia, you are not failing terribly. Try to look at each report as both a challenge and a lesson. Amy, when you get stuck on a specific report like this I would suggest either working backwards or emailing us with your questions (.(JavaScript must be enabled to view this email address)).

    The reality is that we have taught you the basics. The guidelines and the coding process are foundational to being a coder. The next step is learning to apply the basics to widely varying coding situations. So many factors can come into play with a medical record and how it is coded. We are introducing you to only a few of these variables now, but throughout your career as a coder you will be presented with new ones. This can be a frustrating process at first (which you are experiencing now), but it will become a career that is extremely rewarding because of the challenge.

    That last paragraph is more about perspective, of course, but we want to help you NOW as well. Don’t get so frustrated that you want to quit! This whole process will be worth it in time. Please call us or email before you get to the breaking point. We love to answer questions and help students that are struggling. Some of our most successful students contact us multiple times per week. Please reach out before throwing in the towel.

    .(JavaScript must be enabled to view this email address)


  15. Hemvati Patil October 23, 2014

    hi guys, i am in same boat as u all are, really frustrated. when i can’t find codes for key words, i try finding synonym for keywords online and then look into coding book for code. Hope it helps.

  16. Craig Laursen October 23, 2014

    This is a really good tip, Hemvati, thank you!

    Finding just the right main term and sub-term can be a challenge. Sometimes the physician and the codebooks don’t use the exact same language. I remember having the hardest time with OB/GYN reports until I found “Pregnancy, complicated…” Indexing takes practice and gets easier with experience, which you will get a good chunk of in the practicum.

  17. Linda Marie November 24, 2014

    You guys I am also in the same boat and feel like I’m sinking fast!!!  I did great with the rest of the program but the practicum, is horrible!!  Just when I think I get it - its wrong.  Have a tendency to over think things and thought I had it under control,  but now seem to be under thinking them, and my concentration factor seems to be about the size of a gnat at the moment.  It is very difficult to plug along, when I might get one question right.  And that’s after spending a lot of time on the problem.  I am down to the 2 month finish date and thinking I might need an extension.  This stuff has got to click at some point!

  18. Career Step December 08, 2014

    Hi Linda Marie,

    Keep your chin up! You’re learning more than you realize, and all your hard work will pay off. If you ever need help, or even just a little encouragement, make sure you reach out to your instructors at 1-888-657-5752 or .(JavaScript must be enabled to view this email address).

    Best of luck!

  19. Amber April 22, 2015

    Do most people go through the practicum more than once?

  20. Career Step April 23, 2015

    Hi Amber,

    No, most people do not go through the practicum more than once. You’re welcome to do each report as many times as you’d like, but you’re only required to attempt each one at least once. There is not even a required score or anything, we just encourage you to give each one a good honest try and use it as a learning experience as you move on.

    Hopefully that helps, and don’t forget that you can always contact your coding instructors for individualized help at 1-888-657-5752 or .(JavaScript must be enabled to view this email address).

    Best wishes!

  21. heather September 22, 2015

    I feel exactly the same way.  I have done well up to this point (excluding the E codes)but the practicum is so frustrating!  I believe the answers are right but they are wrong every time.  I have done one page 10 times and still can’t get what they want.  I feel like giving up and I still have ICD-10 to do.

  22. Career Step September 24, 2015

    Hi Heather,

    I’m sorry to hear that you’re having difficulties! If you’re having trouble, feel free to contact your instructors at 1-888-657-5752 or .(JavaScript must be enabled to view this email address), and they may be able to help you see what you’re doing wrong. Don’t get discouraged!

    Best wishes!

  23. Patricia January 15, 2016

    I thought I was the only one having trouble with the Practicum. But I am going to keep going no matter how badly I do, it’s got to get easier along the way I hope. Craig, since you are the man, is there any way us Practicum folks could form a Study Buddy system just for us in the Practicum? Here it is a Friday night and have to wait till Monday to get the instructors. I just have to keep plugging along during the weekend or I will never finish in time.

  24. Christa February 09, 2016

    My teacher told me that you have to pass the practicums with a 85% or higher in order to take the final exam. Does anyone know for the test this year 2016?

  25. Coding Support February 10, 2016

    Career Step students only need to attempt the practicum. If you enrolled through a community college or university, you would need to check for their specific requirements.

  26. Annette April 07, 2016

    I am so appreciative for this blog!!  Especially seeing that others are feeling as I am. I feel as though I am failing miserably…just when I think I have the codes right….NO! I am 100 plus pages into the practicum and have a deadline of June 2 and things are still not clicking.  Again thank you for the blog post.

  27. Craig Laursen April 12, 2016

    Keep moving forward! Try not to worry about your scores. Don’t let things that are marked wrong for sequencing discourage you. If you are finding the codes and learning from each report you are doing exactly what you need to do.
    Keep up the good work!

  28. Rena Warmath April 19, 2016

    I’m so glad I found this blog…everyone here is voicing how I’m feeling!  I’m about 30% through the practicum and sometimes I’m ready to throw the books away. Thank you all for making me realize that I’m not as stupid as I feel! Now…back to the practicum…

    Hi Rena,
    We are so happy this post was helpful for you and made you feel not alone, and certainly not “stupid” smile

    Keep up the great work!

  29. Barbra Perkins April 25, 2016

    I think the coding practicum is a bit overwhelming.  Consider how we learned to code and how the unit tests were structured.  Multiple choice….T/F…fill in the blank. We still had to know the info but if I made a mistake, I would get the answer so I could see what was wrong.

    Personally, I took this course because after 3 college degrees (I am not dumb)and 20 years in the legal profession, I decided to go into something new.  Mistake. I have until Dec 31st to finish and with my frustration level and the fact that I have other things going on (run my own eBay…contract legal work) I do not have the energy, time or even the motivation to go through the practicum.  I just don’t get all of it and do not want to spend the time to know it.

    Hi Barbra,

    We are sorry to hear you’re having trouble with the practicum! We have resources available to help you with the course such as online forums and chats, and our instructors would be more than happy to help you. Additionally, if you need more time, we have extensions available to give you extra time to finish the course.

    Best wishes!

  30. coding support April 28, 2016

    Hi Barbara-

    Yes! the practicum is challenging.  Please keep in mind this is not a test, only an experience reading and coding real reports before you get into the real world.  We ask for an attempt on each report, but do not look at your specific scores. If you have made it thus far in the program, it is just a matter of pushing through to the end.  Please let student support if you need assistance on any specific report. 

    Best wishes!

  31. Joan Hazel August 18, 2016

    Thanks. I needed this. It helps to take some of the pressure off that I have put on myself.

  32. LG August 18, 2016

    OMG, thank you for writing this blog! It’s obvious you were echoing the feelings of all of us here in this coding practicum. I am having trouble in the practicum like everyone else and it feels like no matter what I do, I always get something wrong in some way. I am utilizing all the tools available to me but it still comes out wrong but I believe I’ll get it.

  33. Career Step August 24, 2016

    Hi LG,
    Thanks for your comment, we are so glad this post was helpful. Keep working hard and using the available resources. You can do this!!!

  34. Stephanie Adcock September 01, 2016

    I am so glad you sent me this blog. I have been working on this practicum and it has made me feel like maybe I made a mistake on choosing this program. Every time I start to do fairly well, the next several problems give me fits-when I think my codes are right, they are not!! I feel a whole lot better seeing that other people are in the same boat and makes me not want to quit!

  35. Sharon Glockzin September 12, 2016

    I also appreciate getting this blog. I thought I might be that one person in the entire course who is feeling totally inadequate! I am a burned out RN looking for something that I enjoy doing and can hopefully do from home. Somedays I wonder…! I will continue to get through this practicum because I’m just too stubborn to give up.

  36. Debbie September 12, 2016

    Thank you so much for the email with this blog. I have been feeling so frustrated and wondering if I had made a mistake choosing to pursue a career in medical coding. It is a relief to know that I am not alone. Does anyone know what format the final exam is in? The way I feel right now, I am worried about passing it. I felt like I was doing great with the program until the practicum part. Thank you again for the encouraging email and blog.

  37. Judy September 15, 2016

    I to appreciate this blog! I have really struggled with the practicum. I have cried, yelled and felt very alone. I have been in nursing for 30 years and wanted to get away from bedside care. I felt like I made a mistake by going into this, then I read this blog and found others that felt the same way. I have 100 pages left before my final exam. I just pray I can get it together enough to pass with a good score and remember guidelines going forward. Gone too far to look back now.

  38. Career Step September 16, 2016

    Hi Judy,
    Thank you for sharing your experience with us, we are so glad this post helped you to feel like you aren’t alone in your frustration. It sounds like you are so close to finishing the course—we know you can do this!

    Best wishes!

  39. Jennifer September 21, 2016

    I am working on the practicum also and it is definitely a relief to hear that I’m not alone in my frustrations or that everyone else is just breezing through this without a care or a question. And being a perfectionist, I want to get everything right every time…but that’s not happening and I had to reevaluate my approach to each practicum question and the medical coding profession, otherwise I’d end my study time in tears and questioning my sobriety. Instead of focusing on the fact that I “missed” the question, coded it in error or just plain didn’t code it at all…I’ve really tried to focus on why I coded something wrong (which I do a LOT) and add it to my monsterous pile of notes so that the next time I’m sitting around scratching my head about a problem, I’ll go, “Now we had this in an earlier question…how was it done before?”  I still feel frustration but I also feel encouraged because every day I’m learning a little more, things are starting to make sense a little more, and I’m getting closer to finishing the coarse.  Keep up the good work everyone and someday, we will all be experienced, professional coders!!!

  40. Career Step September 21, 2016

    Hi Jennifer,
    Thank you for sharing your experience and giving encouragement to other hard working students! We wish you the very best of luck as you continue through your course!



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