1.

Content Improvement

Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content

Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|.

This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. 

Q1 2026 International Release

2.

Clinical Finding

Inactivation of Complication Disorder Concepts (371 concepts)

The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. 

The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype.

The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. 

Access to briefing note is available on request info@snomed.org

Beginning June 2024 International Release and then subsequent releases until complete

3.

Procedure

Review 1263452006 |Anesthesia and/or sedation procedure (procedure)|

A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:

• Inactivation of Classification derived components.

• Review of the current model and possible addition of 363703001 |Has intent (attribute)| to the model.

• Review of current classification of groupers.

Content review - publication date to be determined

4.

Procedure

Review 48537004 |Bypass graft (procedure)| 

A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:

• Improving consistency of descriptions.

• Improving definitions for different types of concepts in the hierarchy (bypass vs shunt)

• Correct use of the term “graft” within the descriptions.

• Correct modeling of 260686004 |Method (attribute)| in the hierarchy.

• Review of the need for 360021005 |Bypass - action (qualifier value)| and 424208002 |Shunt - action (qualifier value)|in the model and testing of 245854003 |Proximal anastomosis (qualifier value)| and 245855002 |Distal anastomosis (qualifier value)| as new 260686004 |Method (attribute)| values in the hierarchy.

• Review for a consistent and appropriate usage of 425362007 |Surgical insertion - action (qualifier value)|and 129407005 |Grafting - action (qualifier value) in the model.

• Review for re-classification of 129376004 |Construction - action (qualifier value)| as a direct subtype of 129284003 |Surgical action (qualifier value)|.

• Given the complexity of some concepts in the hierarchy, potential duplicate, erroneous, or outdated concepts will be identified.

Q2 2026 International Release

5.

MRCM Change

Update to Procedure Content

MRCM change to Surgical approach (attribute) - PLEASE SEE UPDATED TIMESCALES BELOW

This change will be implemented in 4 phases:

• Phase 1: Move 116688005 |Procedure approach (attribute)| from the 408739003 |Unapproved attribute (attribute)| hierarchy to the 762705008 |Concept model object attribute (attribute)|. Add and test new MRCM rules for procedure approach. Make 424876005 |Surgical approach (attribute)| a subtype of 116688005 |Procedure approach (attribute)|. Published February 2025 release.

• Phase 2: Identify and address Surgical procedures currently modeled with 424876005 |Surgical approach (attribute)| and batch change to model using 116688005 |Procedure approach (attribute)|. Planned release time: April 2025. Published April 2025 release.

• Phase 3: Inactivation of surgical approach attribute and changes to MRCM rules. Planned release time: Q2 2025. Published June 2025 release.

• Phase 4: Identify and address procedures that could be modeled by 116688005 |Procedure approach (attribute)|

Phase 1 - February 2025 International Release - COMPLETE

Phase 2 - April 2025 International Release - COMPLETE

Phase 3 - Q2 2025 International Release - COMPLETE

Phase 4 - Q1 2026 International Release

6.

Descriptions Update

Forward slash in FSN

A review has commenced of those concepts with a forward slash in their FSN.  Editorial guidance exists disallowing the use of forward slashes in FSNs, and we have commenced a systematic review of those existing terms containing them.

Many areas are excluded for example, medicinal products where strength /1 is the denominator, assessment scales, explicit "and/or", gene names, enzyme and other substance naming, organisms, ratios, per in units (or future consideration), intervertebral structures, content added with an Orphanet map and others. The review is ongoing.

If the meaning is clear i.e. single meaning there is no change but groupers, disjoint ('or)' terming and ambiguous terms will be reviewed and possibly inactivated or have a new replacement FSN without a forward slash. Subject matter experts are being consulted as part of this work.

2025 International Release

7.

Procedure

Review of 129376004 |Construction - action (qualifier value)|

129376004 |Construction - action (qualifier value)| is a subtype of 257903006 |Repair - action (qualifier value) and sibling of 129377008 |Reconstruction - action (qualifier value)|.

Because some concepts modeled with 129376004 |Construction - action (qualifier value)| as target value concept for 260686004 |Method (attribute)| may not be considered a reparative procedure, a review of the 129376004 |Construction - action (qualifier value) and 410614008 |Construction (procedure)| hierarchies is being undertaken.

Expected outcomes may be the classification of 129376004 |Construction - action (qualifier value)| directly under 129284003 |Surgical action (qualifier value)| and the creation of new actions that better define the differences between reparative and construction procedures.

Q2 2026 International Release

8.

Association Relationships File

Additional Relationships

The new "additional relationships" take the same form as the inferred relationships and can be stored in the same format in the RF2 package. Modeling Advisory Group (MAG) recommends that extensions can use the existing relationship files or create new relationship files for them. By default, there is a single file for each component (1 concept file, 1 relationships file, 1 simple refset file, etc.). Edition and extension publishers can decide to split the content of any of those files for business reasons while following the naming convention. The new attributes should be placed under 1295449009 |Additional relationship attribute (attribute)|. The concept 900000000000227009 |Additional relationship (core metadata concept)| should be assigned to characteristicTypeId in the relationship files.

To be determined - 2026 International Release

9.

Description Update

Inactivation and Replacement of Concepts Using "Arm" and "Leg" in the FSN 

Concepts that use "arm" or "leg" without qualification are ambiguous, as the anatomical site may be misinterpreted. 

Work has commenced on updating Disorder content. Following this, Finding and Procedure content will be managed as resourcing permits. 

2025 International Releases

10.

Deprecation

Notice of Deprecation - Concept Non Current Indicators

Concept Non Current (CNC) indicators will be deprecated in the January 2026 International Edition of SNOMED CT. The plan is to stop adding these indicators to active descriptions when the concept they are attached to is made inactive. Additionally, all currently active CNC indicators will be made inactive. They will be left in place as inactive components. This deprecation is not expected to have any impact on existing SNOMED CT implementations but will instead simplify the product and reduce associated maintenance costs.

For further information please see here.

January 2026 International Release

11.

Clinical Finding

Morphologic Abnormality

Procedure

Situation with Explicit Context

Remodel 128928004 |Neuroendocrine neoplasm (morphologic abnormality)| and Subtypes

128928004 |Neuroendocrine neoplasm (morphologic abnormality)| its subtypes and related concepts in other hierarchies will be revised to align with the 5th edition of the WHO Blue Book chapter on Endocrine and Neuroendocrine Tumours as well as to SNOMED CT editorial guidance as part of the Histology Content Quality Group  Please see “Neuroendocrine neoplasms (NEN) - PART 2” here for more information about these changes.

Please see the Histology Content Quality Group site here for more information about the groups’ mission.

Q1 2026 International Release

12.

ICD-O

Planned Deprecation of the SNOMED CT - ICD-O version 3.1 Morphological and Topography Maps

Please see briefing note here.

2026 International Release

13.

Description Length

Proposal to Increase the Character Limit for Descriptions

Please refer here for full summary of consultation.

Please see here for conclusion on increasing description type length limits.

July 2026 International Release

14.

Clinical Finding

Changes to Hierarchy 198609003|Complication of pregnancy, childbirth and/or puerperium (disorder)|

A briefing note documenting the proposed changes for the hierarchy 198609003|Complication of pregnancy, childbirth and/or puerperium (disorder)| and descendants was shared with key stakeholders in May 2025. Feedback was received from a wide range of stakeholders.

The model for 198609003|Complication of pregnancy, childbirth and/or puerperium (disorder)| and subtypes will be updated in the international edition of SNOMED CT. The model will employ the attribute 246454002 |Occurrence (attribute)| with a value of 307159006|Pregnancy time period (qualifier value)| or a subtype. This work will aim to clarify the meaning of existing content by modeling concepts with either a maternal or fetal temporal period (and rarely both maternal and fetal).

The work will also inactivate a small number of supertype concepts such as 198609003|Complication of pregnancy, childbirth and/or puerperium (disorder)| and 362972006 |Disorder of labor / delivery (disorder)|) and utilize semantically clearer alternatives for example 1269083008 |Fetal intrapartum disorder and/or maternal disorder during intrapartum period| and 1269075002 |Maternal disorder during intrapartum period|.

Q1 2026 International Release

15.

Situation with Explicit Context

Proposed Inactivation of <<443938003|Procedure carried out on subject (situation)|

Please see here

Update 30 October 2025

After consultation and review of the feedback received, these concepts will not be inactivated but instead remodeled to define them with their procedure hierarchy counterparts. 

January 2026 International Releases

16.

Clinical Finding and Procedure

Update for Fetal Model and Inactivation of Non-Unique Fetal Part Structures

The concept model for fetal procedures and findings will be updated in the international edition of SNOMED CT. The model employs the attribute 246454002 |Occurrence (attribute)| with the value 303112003 |Fetal period (qualifier value)| and its subconcepts for modeling purposes. Finding and procedure sites will be revised to utilize canonical or morphological structures (excluding unique fetal structures) such as persistent or malformed structures.

For example, concepts modeled with site 'fetal head structure' will have site replaced by 'head structure' in combination with 'fetal period' occurrence.

Currently, there are 60 concepts within the international edition of SNOMED CT that are modeled using < 367570001|Fetal part (body structure)|. These concepts will be reviewed and revised. Once complete, 118 descendants of 367570001|Fetal part (body structure)| will be reviewed. Non-unique fetal parts, such as ‘fetal head’, will be inactivated from the anatomy hierarchy in a subsequent release.

National extensions should update the model for fetal findings and procedures to ensure consistent classification. If any subconcepts of 367570001|Fetal part (body structure)| are required for other use cases, please submit this information to info@snomed.org 

Remodel of findings and procedures completed for August 2025 release.

Review and inactivation of fetal body structures in progress for 2026 International Releases

17.

Organism

Review of 409793007|Antimicrobial resistant bacteria (organism)| and Descendants

409793007|Antimicrobial resistant bacteria (organism)| and descendants will be reviewed and content corrections made as appropriate.  The review will focus on:

• Aligning taxonomic lineages of resistant bacteria with those of bacterial (only) portions of the organisms hierarchy. Missing ranks including (and limited to) order, family, genus, species will be added as necessary.  Example:

  • The lineage of beta-lactam resistant Escherichia coli, beta-lactam resistant Escherichia (genus), beta-lactam-resistant Enterobacteriaceae (family), beta-lactam-resistant Enterobacterales (order).  

• Aligning organisms that are said to be resistant with corresponding antimicrobial substances hierarchy.  Example: 

  • Ampicillin < penicillin < beta-lactam

• Making the grammar and description style consistent throughout the hierarchy and compliant with the editorial style guide. The pattern “antimicrobial-resistant organism” will be maintained.  The antimicrobials themselves may be hyphenated.  

  • Examples: Ampicillin-resistant Escherichia coli

Q1 2026 International Release

18.

Clinical Finding

Review 408574004|Imaging result abnormal (finding)| and 408573005|Imaging result normal (finding)| and Descendants

These concepts are clinical findings and align with the editorial guide i.e. normal/abnormal observations, judgments, or assessments of patients. A finding site will be added to the concepts where appropriate (and not currently stated) so that the concepts classify as a subtype of the ‘finding of X anatomic structure’ concept where published.

For example

• 441914009 |Imaging of head abnormal (finding)|

• A finding site of 69536005 |Head structure (body structure)| will be added to classify as a subtype of 406122000 |Head finding (finding)|.

This will improve consistency and subsumption of the content as each concept will classify under the appropriate ‘Finding of body structure X’ parent where one is published. This work is being undertaken to complete content tracker IHTSDO-101.

Q1 2026 International Release

19.

Disorder

Review of 43275000 |Otitis (disorder)| and Descendants (298 concepts)

 Work is being undertaken to complete content tracker IHTSDO-773. Planned updates include:

• Modelling changes to ensure consistency, correct classification and to sufficiently define concepts where possible.

• A review of whether inflammation for <<65363002 |Otitis media (disorder)| concepts should be modeled with 14242009 |Tympanic mucosa structure (body structure)| as the finding site.

• A review of groupers e.g. 270490007 |Acute otitis media with effusion (disorder)|

• Inactivation of duplicate or ambiguous concepts.

• Inactivation of non-synonymous or erroneous synonyms.

Q1 2026 International Release

20.

Clinical Finding

Remodeling of Cirrhosis Disorder Concepts (~60 concepts)

The cirrhosis disorder concepts (~60) are currently modeled with two role groups:

1) 363698007 |Finding site (attribute)| with value 10200004 |Liver structure (body structure)| and 116676008 |Associated morphology (attribute)| with value of 64770007 |Nodular regeneration (morphologic abnormality)|;

2) 363698007 |Finding site (attribute)| with value 10200004 |Liver structure (body structure)| and 116676008 |Associated morphology (attribute)| with value of 57977008 |Chronic fibrosis (morphologic abnormality)|.

A new concept "Cirrhosis (morphologic abnormality)" will be created as a subtype of 64770007 |Nodular regeneration (morphologic abnormality) and 57977008 |Chronic fibrosis (morphologic abnormality)|.

This new concept will be used to remodel these disorder concepts, resulting in only one role group:

363698007 |Finding site (attribute)| with value 10200004 |Liver structure (body structure)| and 116676008 |Associated morphology (attribute)| with value new concept|Cirrhosis (morphologic abnormality). 

Q1 2026 International Release

21.

Product

Rationalization of Units of Measure Concepts

A proposal originated from a DEUSG member (UK) and was presented and discussed at DEUSG between July and September 2025. Support was expressed by DEUSG members for rationalization of two overlapping sub-hierarchies:

• 732935002 |Unit of presentation (unit of presentation)|

• 408102007 |Unit dose (qualifier value)|.

The current drug model only uses Unit of presentation to model Clinical Drug concepts.

Please see this informational briefing note.

Q1 2026 International Release

22.

Product

Update of Case Significance of Descriptions for Drug Related Content

Please see this informational briefing note for further details.

April 2026 International Release

23.

Procedure

Change to Angiography Procedure Hierarchy

As part of ongoing quality improvement work within the angiography procedure hierarchy, the concept 446030004 | Angiography using contrast (procedure) |has been reviewed and will be corrected.

The FSN of this concept does not specify arterial or venous angiography. However, the concept includes the synonym “Arteriography”, and procedure site 51114001 | Arterial structure (body structure) which is incorrect.

The modeling of 446030004 | Angiography using contrast (procedure) | will be updated to the more general 59820001 | Blood vessel structure (body structure) | to accurately reflect the FSN. The synonym “Arteriography” will be inactivated from this concept. A new arterial-specific concept will be added - Angiography of artery using contrast (procedure), to provide an explicit parent for arterial angiography procedures.

As a result of these changes, 446030004 | Angiography using contrast (procedure) | will subsumes a broader set of angiography procedures (increase from 599 to 1065 descendants). The new concept - Angiography of artery using contrast (procedure) | will subsume 599 arterial angiography procedures previously inferred under the general concept.

This change clarifies the distinction between angiography and arterial-specific angiography and supports more accurate querying and analytics.

January 2026 International Release

1.

Procedure

Surgical Transplantation Procedures

Procedures in the 77465005 |Transplantation (procedure)| hierarchy remodeled following circulation of the briefing note (available on request info@snomed.org) are still under review following feedback received and discussion at the Editorial Advisory Group. 

Note this project excludes procedures on the eye (for Ophthalmology CRG to revise), and hematopoietic cell transplants including bone marrow and stem cell procedures that are not surgical transplantations.

The majority of tissue transplant procedure concepts (nerves, muscle, tendon, skin etc), will be inactivated as duplicate to the grafting procedure concept where this exists (and the transplant procedure will be added as a synonym to the grafting procedure), or if an existing concept is not available then a new grafting procedure will be created.

Very high level groupers will be inactivated (eg 120158008 |Thorax transplantation (procedure)|). Approximately 100 concepts will be inactivated as part of this update.

January 2025 International Release

2.

Qualifier Value

Update for Existing AJCC (American Joint Committee on Cancer) Allowable Values and New UICC (Union for International Cancer Control) Staging System Content

For << 1222584008 |American Joint Committee on Cancer allowable value (qualifier value)| and its 584 subtypes the following changes will be made:

• Preferred Term (PT) will be inactivated and a new PT added that contains the existing AJCC code with a new parenthetical addition of AJCC: (AJCC).

• The existing text definition that contains the attribution to the AJCC Cancer Staging System, American College of Surgeons will be inactivated and re-created as an annotation.

New concepts for the UICC (Union for International Cancer Control) staging system will be added:

• As a separate hierarchy, approximately 580 new concepts for the Union for International Cancer Control (UICC) TNM staging system will be added. This work is being done under a collaboration agreement between SNOMED International and the UICC.

January 2025 International Release

3.

Clinical Finding

Changes to 365921005 | Weight change finding (finding) Hierarchy

Following multiple requests from members regarding overlaps and ambiguities in this hierarchy, the Nutrition and Dietetics Clinical Reference Group (CRG) conducted a systematic review. The requests highlighted confusion over similar and overlapping concepts, such as:

• 89362005 | Weight loss (finding) |

• 262285001 | Weight decreased (finding) |

• 161832001 | Weight decreasing (finding) |

• 426977000 | Recent weight loss (finding) |

The following changes will be implemented:

1. Inactivation of 426977000 | Recent weight loss (finding) | and 427572007 | Recent weight gain (finding)
   These terms are considered ambiguous due to the subjective nature of the word "recent."

2. Inactivation of 161832001 | Weight decreasing (finding) | and 161831008 | Weight increasing (finding)
   These terms will be inactivated because they do not align with editorial policy. They represent patterns or trends better handled by information models or statistical tools for data interpretation and analysis.

3. Inactivation of 89362005 | Weight loss (finding)
   This term is a duplicate of 262285001 | Weight decreased (finding) |. The term "Weight loss" will, however, remain as a synonym for 262285001.

January 2025 International Release

4.

Clinical Finding

Review Model for Descendants of 118240005|Finding by method (finding)|

Descendants of 118240005 |Finding by method (finding)| are currently being reviewed to ensure 418775008 |Finding method (attribute)| is appropriately grouped with other attributes.

January 2025 International Release

5.

Descriptions Update

Update for Description Concept Non-Current Indicators

Concept Non Current (CNC) indicators are a type of inactivation indicator that are applied to active descriptions, when the concept they are attached to is made inactive. They are intended to allow implementers to show some visual cue to alert users that a description they have searched for relates to an inactive concept.

A bulk update will be implemented to inactivate CNC indicators where they are no longer required either because:

• The concept has since been re-activated or,

• The description itself has now been inactivated

This will result in a change to approximately 30,000 descriptions for the international edition release for January 2025.

January 2025 International Release

6.

Regime/therapy

Restructure of 384760004 |Feeding and dietary regime (regime/therapy)| 

Following a review by the Nutrition and Dietetics Clinical Reference Group (CRG), in consultation with the Nursing CRG, a restructuring of this hierarchy is underway. The content will be reorganized more logically, identifying and addressing duplicate concepts (e.g. 414096000 |Enteral hyperalimentation (regime/therapy)| and 229912004 |Enteral feeding (regime/therapy)|) and removing outdated content (e.g. 37041007 |Forced feeding of patient (regime/therapy)|). Where possible, content will be sufficiently defined. 

Additionally, the top-level grouper concept 384760004 |Feeding and dietary regime (regime/therapy)| will be inactivated due to its ambiguity as it is unclear what a combined regime would represent or what the logical subtypes would be.  

Open

January 2025 International Release

7.

Physical Object

Hierarchy Improvement 272185007 |Meters (physical object)| and Descendants

To support the addition of Gravity provision of device finding content, an improvement will be made to << 272185007 |Meters (physical object)|. 

January 2025 International Release

8.

MRCM Change

MRCM change to Surgical approach (attribute)

• Phase 1: Move 116688005 |Procedure approach (attribute)| from the 408739003 |Unapproved attribute (attribute)| hierarchy to the 762705008 |Concept model object attribute (attribute)|. Add and test new MRCM rules for procedure approach. Make 424876005 |Surgical approach (attribute)| a subtype of 116688005 |Procedure approach (attribute)|. 

February 2025 International Release

9.

Disorder

Malignant tumor of X - Update Descriptions

Disorder concepts with a current FSN of the pattern:

• Malignant tumor of <body site>

• Benign tumor of <body site>

Will have the existing FSN inactivated and replaced by:

• Malignant neoplasm of <body site>

• Benign neoplasm of <body site>

A synonym including the word 'tumor' will remain active.  This update will be made to approximately 500 concepts. 

February 2025 International Release

10.

Substance

New Substance Groupers for Anesthetics

Based on feedback from the Anesthesia Clinical Reference Group, the substance hierarchy for anesthetics will be reviewed and the hierarchy revised with additional groupers created and subtypes assigned for inhalation anesthetics (1354647001|Volatile liquid anesthetic (substance)) and local anesthetics (1354706009 |Benzoic acid ester local anesthetic (substance) and 1354705008| Amide local anesthetic (substance)).

February 2025 International Release

11.

Disorder

Taxonomic relationship between 1149322001 |Intoxication (disorder)| and 75478009 |Poisoning (disorder)|

Based a query submitted by the Translation Working Group, the SNOMED CT current taxonomic relationship between 1149322001 |Intoxication (disorder)| and 75478009 |Poisoning (disorder)| (the former being a subtype the latter) requires further review. While they are related, both are defined as interference in normal bodily functions caused by exposure to a substance. Based on the severity of the consequences, the relationship is really the reverse: an intoxication is a milder reaction to a substance, while poisoning is more severe as noted in the definition.

The definition of 1149322001 |Intoxication (disorder)| will be updated to make the distinction between the two concepts more comparable. The current relationship between the two concepts will be reversed.   

February 2025 International Release

12.

MRCM

MRCM Update <<540091010000105 |Calculation (calculation)|

The range for Component Attribute will be extended to Include <<540091010000105 |Calculation (calculation)|

April 2025 International Release

13.

New Semantic Tag

New Semantic Tag - Calculation

A new semantic tag of (calculation) will be added as a descendant of (qualifier value). This will enable representation of concepts that are derived from calculations on other observations (e.g., “Anion gap in blood,”  “Anion gap in urine”) with a relationship of Component (attribute) and value from the (calculation) sub-hierarchy.

April 2025 International Release

14.

Observable Entity

Update for Assessment Scale Score Concepts

Concepts that are subtypes of 363788007 |Clinical history/examination observable (observable entity)| that are assessment scores but are not also subtypes of 782487009 |Assessment score (observable entity)|, will gain a parent of 782487009 |Assessment score (observable entity)|.  Estimated 1300 concepts.  

April 2025 International Release

15.

Disorder

Inactivation of Splinter of <x>, Without Major Open Wound Content

Concepts that represent splinters of <x>, without major open wound and splinters of <x>, without major open wound, infected, are classification constructs. These concepts are being inactivated with historical associations to the base concept e.g. Splinter of toe, without major open wound (disorder) will be inactivated as classification derived component with a historical association to Splinter of toe (disorder). The latter will be a new concept. Where required, new 'base' concepts will be created.  

April 2025 International Release

16.

Observable Entity

Clinical Finding

Inactivation and Replacement of 284937000 |Ability to sit on toilet (observable entity)| and Related Finding Concepts

The concept 284937000 |Ability to sit on toilet (observable entity)| and the related finding concepts e.g. 284938005 |Able to sit on toilet (finding)| could be interpreted as relating to the ability to maintain a sitting position on a toilet seat or the ability to sit down on a toilet seat.

These concepts will be inactivated and replaced with new concepts

Ability to maintain sitting position on toilet seat (observable entity)

Ability to sit down on toilet seat (observable entity)

together with relevant finding concepts e.g. Able to maintain sitting position on toilet seat (finding).