Frustrated by the Coding Practicum?

Coding and Billing70 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.

Leave a comment below »

  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!

  41. Shirl September 21, 2016

    This was me last week! I was so frustrated that I was in tears and just had to walk away for the weekend. Now I’m refreshed, but I’m still not getting all of the answers right on the first try…Many times I have the right codes, just the wrong order and so the portion of that code is still wrong…frustrating!

  42. Alyssa September 22, 2016

    So thankful for this blog! I’m so happy to hear that I am not alone with these fears and frustrations with the practicum.. I was beginning to feel EXTREMELY stupid, because I miss so many questions!  It terrifies me because I’m beginning to think that there’s no way I will be able to pass the final exam with the scores I’m getting on this practicum. It also scares me because I only have 40 days left and I only have 37% done on this module. It feels like I am going so slowly… I know I can purchase an extension but I really want to get done WITHOUT having to buy one. Sometimes I want to cry and give up, but I won’t because I’m almost there! Just have to push through everybody! We can do this!

  43. Career Step September 28, 2016

    Hi Shirl,
    Thanks for your comment and reaching out to us. Please know you are not alone as you are working through the course. We have many resources to help you be successful—please take a look at this link to learn about the support that is available to you.

    Hope this helps and best wishes!

  44. Career Step September 28, 2016

    Hi Alyssa,
    We are so glad the blog has been a help to you. Keep your chin up and continue to work hard—you will be finished before you know it! Please let us know how we can help in anyway at all. Take a look at this link that provides information the student services available to help you be successful in your course.

    Best wishes!

  45. Anneliese September 28, 2016

    Thank you so much for the encouragement!!I was frustrated but plugging along as I felt I was getting all kinds of exposure to codes and ways to observe a case. I can’t wait to be done and working in this career!

    Thank you Career Step and all instructors!!


  46. Kathryn October 02, 2016

    This gave me hope, I feel like it’s all in a different language! And I’m overwhelmed. So, I’m finding myself frustrated and almost dreading each example. Was feeling like an idiot! Thank you for THIS! I needed that encouragement. Took a much needed breath and can get back to it

  47. Vicki Roberts October 03, 2016

    I am not doing well with the Practicum.  It is very discouraging.  I am emailing pages and I wish the answers they gave were a bit more detailed.  Sometimes it seems on one question they want one thing and then on a similar question they don’t want a particular element.  A lot of it seems random.  Hoping to get thru this and be done with the whole thing.

  48. Career Step October 03, 2016

    Hi Anneliese,
    You are doing great! Keep up your dedication and positive attitude and please let us know if we can help you in anyway at all! Take a look at this link that provides information the student services available to help you be successful in your course.

    Best wishes!

  49. Career Step October 03, 2016

    Hi Kathryn,
    Please know you are certainly not alone! Keep pushing through and let us know how we can help! There are resources available and other students you can chat with about the course. Take a look at this link to learn more:

    Hope this helps and best wishes!

  50. Parastou October 05, 2016

    Thank you for giving those hints. It gave me more strength to go forward. And I feel better finding I am not alone in this.

  51. Career Step October 05, 2016

    Hi Parastou,
    You are sure welcome, we are so glad this post help you feel encouraged to keep going strong in the course. You are certainly not alone, take a look at this blog post highlights the wealth of resources available to help you succeed:

    We wish you the very best of luck as you continue on the road to a new career!

  52. Amy October 06, 2016

    Soooo glad to hear I’m not alone!  After relatively doing ok on most of the curriculum so far, this coding practicum makes me feel sooo stupid!  It’s almost like I haven’t learned anything up to this point!  Just when I think I’ve figured out the codes and I check my scores, it’s very frustrating when you get them wrong and you wonder HOW did you use those codes and why not the ones I found?  It is very discouraging to say the least!  I feel a little better now knowing I’m not going to be perfect on all of them but it is still frustrating to think you might have finally figured things out and this coding practicum is like a kick in the gut!!

  53. Sue October 06, 2016

    Wow, so glad you shared this blog. I was getting so frustrated with assigning wrong codes. It’s really really good to hear it’s a normal process. At least I do feel that I am learning from most of my mistakes. Feeling better smile

  54. Kim October 07, 2016

    I see myself as a perfectionists and when I do not get a concept within a few tries, I start questioning my abilities in learning what is needed. I have had many days that I just want to scream, and other days that I find what I am learning “a gift”, no matter how many I get wrong, being able to go back and look at the scenario with the correct answers and navigating through the code books has helped in many ways. I do wish that there was some kind of song or poem to put to the steps of coding, so we do not miss steps, kind of like reading music notes. “EGBEF- Every good boy eats fudge or FACE, which we learn in music classes”. Overall, I think that talking to a coding instructor will be my next step in defining what I am missing and to possibly give me pointers in being successful.

  55. Career Step October 10, 2016

    Hi Amy,
    Thanks for sharing your experience! It is obvious you are working hard—keep going and don’t give up! Please let us know how we can help in anyway! You can reach us at .(JavaScript must be enabled to view this email address) or 1-888-657-5752.

    Best wishes!

  56. Career Step October 10, 2016

    Hi Sue,
    That’s wonderful news—you have a great attitude! That certainly is what the coding practicum is all about, learning from your mistakes and improving.

    Best wishes!

  57. Career Step October 10, 2016

    Hi Kim,
    Thanks for reaching out to us and sharing your experience! We are always available to help you with anything you need to be successful in the course.  Please contact us at .(JavaScript must be enabled to view this email address) or 1-888-657-5752.

    Best wishes!

  58. Jaci October 17, 2016

    Great article. Thank you! There are some great tips in the article and in the comments. One thing that frustrates me, though, is that you say to contact coding support in order to understand, but I feel like I would be emailing and/or calling on almost every scenario. I really wish there were better explanations on the answer pages instead of having to rely on guessing/inferring or bugging the coding instructors several times a day.

  59. Tarra October 22, 2016

    Am I the only one using the 2015 edition books? I started the coding course in the middle of Nov. 2015 but didn’t get to the point of using the coding books until 2016. Because the books have updated I am missing a few codes and getting some questions wrong. Should I buy new books or are there other tools for the updated codes.

  60. Career Step October 25, 2016

    That’s great feedback, Jaci. Thank you! We’ve passed that along to our support team. In the meantime, don’t ever feel bad about contacting your instructors—that’s why they’re there. You should also check out the Student and Graduate Community ( There’s an Ask An Instructor feature that lets you connect with an instructor over chat. This could be a an easier way to get in touch with someone. smile

    Hope this helps!

  61. Randy Johnson October 26, 2016

    Hi Tarra,
    There are other students that are using the 2015 code books. We recommend purchasing the new code books. The 2017 ICD-10-CM and ICD-10-PCS code books are available. The 2017 CPT and HCPCS code books will be available in December.

    Hope this helps,
    Randy Johnson
    Career Step Instructor

  62. Eileen October 26, 2016

    I just received this blog link as I am over 1/3 done with the Practicum and I see my emotional rollercoaster in everyone’s comments.  Glad to see that this appears to be ‘normal’ for this part of the course.  I feel empowered when I get the majority of codes correct though often they are not in the correct order.  I try to keep positive and not get discouraged and this blog sure has helped and will continue to do so.  Thanks again.

  63. Darci November 05, 2016

    I’m not quite at the halfway point in the coding practium and have been experiencing the same frustrations a everyone else.

    I have been going back and re-doing each case until I get 100% But I also write down all the answers so that I can use this a “study tool” for later.

    I wish everyone the best of luck in a successful finish of the coding practicum.

  64. LJ November 05, 2016

    I have 32 days left and I’m determined to finish the practicum and pass the final on time… Thanks for the blog.. Took some pressure off!

  65. Career Step November 08, 2016

    Hi Darci!
    Thanks so much for passing on how you have found success in the coding practicum and we wish you the best of luck as you continue on through the second half of the practicum!

  66. Jackie December 01, 2016

    After getting an extension I now have about 40 days left but promised myself to get it done by Christmas due to wasting far too much time on frivolous distractions. I’ve found the sequencing of the codes to be the most frustrating part of the practicum like many others here. I compromised between my want to be perfect and an imperfect answer system; I give myself three trys to get to 85% or better. After that its on to the the next one. Yes, some of the correct answers baffle me to no end when my pick seemed to make more sense and a more thorough explanation would be much appreciated then (Checking O2 levels via the ear? What kind of crazy is this?! The other code made perfect sense! Ugh!). Knowing now the practicum scores don’t matter is a relief, but in the field every code matters so I’m keeping my system, no matter that it takes so much extra time. I hope others feel free to adopt my method if they feel stuck and overwhelmed. I wish I had from question #1 instead of #90. Best of luck to everyone and Happy Holidays too!

  67. Tanya McIntosh December 03, 2016

    I am almost on Introduction to Coding and cant wait

  68. Ghia December 06, 2016

    I thought I am the only one who is struggling in the practicum part of the course. I got a very few right answers, the easy ones but the long progress notes, it is frustrating. And sometimes the secondary codes, I will get a wrong answer if is submitted in the wrong order. Sometimes I am in the right category but my answer is still wrong because you have to be specific. I do get online help and use resources they offer and it helps me get the answers right (sometimes). So, I guess we just have to keep moving on and learn from our mistakes. Good luck everyone.

  69. Career Step December 08, 2016

    Hi Jackie,
    Thanks for sharing your ideas on studying! We wish the best of luck and a very happy holiday season!

  70. Career Step December 08, 2016

    Hi Ghia,
    Thanks for your comment—you certainly are not alone. You do have a great attitude, keep up the great work and continue to use the available resources.

    Best wishes!



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