Table Of Contents

Introduction

Background

SNOMED CT provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.

SNOMED International maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation.

Purpose

This document provides a summarized description of the content changes included in the June 2026 release of SNOMED Clinical Terms^® (SCT) International Edition.

It also includes notes detailing the known content or technical issues where the root cause is understood, the fix has been discussed and agreed to, but has yet to be implemented.

The SNOMED International release notes are available alongside the June 2026 International Edition.

Scope

This document is written for the purpose described above and is not intended to provide details of the technical specifications for SNOMED CT or encompass every change made.

Audience

The audience includes National Release Centers, WHO-FIC release centers, vendors of electronic health records, terminology developers and managers who wish to have an understanding of changes that have been incorporated into the June 2026 International Edition.

Please note, you may have to register for a user account in order to access the links included in these release notes.

Content Development Activity

Summary

Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The June 2026 International Edition has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. Convergent Medical Terminology (CMT), Global Medical Device Nomenclature Agency (GMDNA), Orphanet and other domain specific collaborations as well as requests received via the Content Request System (CRS). 

Additionally quality improvement activities are advanced via project driven initiatives summarized below.  Additional work items impacting every release are updates to the SNOMED CT derived maps such as ICD-10 and ICD-O; details are included in these release notes.  

Information about editorial decisions may be found in the SNOMED CT Editorial Guide; mapping guidance for ICD-10 can be found here.

Quality Assurance

Inactivation End Stage Renal Disease

46177005 |End-stage renal disease (disorder)| and its subconcepts have been inactivated with reason outdated and replaced by corresponding 433146000 |Chronic kidney disease stage 5 (disorder)|and its subconcepts, for further information please see this briefing note.

The change involves a total of 43 concepts for inactivation, new additions, modeling and description changes.

The update has been undertaken for this content tracker.

Number of concepts edited (approx): 43

Update Hierarchy 75506009 |Construction of stoma (procedure)|

The model for 75506009 |Construction of stoma (procedure)| and descendants has been reviewed. A summary of the changes is below:

• 272727007 |Internal stoma (morphologic abnormality)| has been inactivated with historical association to 41796003 |Anastomosis (morphologic abnormality)|

• 272725004 |External stoma (morphologic abnormality)| has been inactivated with historical association to 245857005 |Stoma (morphologic abnormality)|

Content in this area was previously modeled with two role groups, the new model utilizes a simpler approach using one role group with 260686004 |Method (attribute)| = 129354008|Exteriorization - action (qualifier value)| with Procedure site - Direct of the body structure to be exteriorized. The body wall structure where the stoma is to be located is no longer represented using a procedure site attribute.

For those concepts stating the location of the stoma, the location is now represented using the 116688005|Procedure approach (attribute)|.

The terms "Construction of", "Creation of", "Formation of" X [Stoma] have been eliminated from the fully specified name (FSN) and are now acceptable synonyms.

Sufficiently defined stated parents have been substituted with a proximal primitive parent as needed.

The changes have been implemented for this content tracker.

Review Hierarchy 1805005|Surgical closure of stoma (procedure)|

A review of the model for 1805005 |Surgical closure of stoma (procedure)| and descendants has been undertaken. A model which utilizes 405813007 |Procedure site - Direct (attribute)| has been implemented consistently across the hierarchy. Changes have also been made for the value of 363700003 |Direct morphology (attribute)| to support subsumption.

Description changes have been made for added consistency to naming patterns, the FSN has been standardized to "Closure of X -stoma". Descriptions named "Take-down of X - stoma" are now acceptable synonyms.

These changes have been implemented for this content tracker.

Number of concepts edited (approx): 37

Body Structure 

New Content - Gene and Chromosome Bands

New concepts for gene and chromosome band structures are needed to support the modeling of genomics content. New concepts for the cell structures contained within the top 20,000 LOINC terms have been added. Additional content in this area will be added over subsequent releases.

For further information, please see this briefing note.

SEP and Laterality Anatomy Reference Sets

The release file for the lateralizable body structure reference set has been updated and validated.

The release file for the SEP reference set has been updated and validated.

Clinical Finding

Review of 397578001 |Device in situ (finding)| and Descendants

The value for Has interpretation relationship on the concepts  << 397578001 |Device in situ (finding)| hierarchy has been updated from 52101004 |Present (qualifier value)| to 264031007 |In situ (qualifier value)|. The presence of a device does not mean it is in its natural or original position, which is the meaning of in situ.

The concept 264031007 |In situ (qualifier value)| was made a subtype of 52101004 |Present (qualifier value)|. Concepts where descriptions use both the terms 'present' and 'in situ,' have been reviewed with creation of new concepts to represent both meanings, as required. The concept model for this hierarchy has also been reviewed and updates made as required.

Inactivation of 87991007 |Gender identity disorder (disorder)| and Related Subtypes

This change reflects current clinical consensus that the term gender identity disorder is outdated and no longer appropriate. Contemporary clinical approaches distinguish between gender identity itself (which is not considered pathological) and any associated distress, which may warrant clinical support. This is now represented with alternative terminology, including gender dysphoria and gender incongruence.

Changes implemented:

• Inactivation reason: OUTDATED

• Historical associations: POSSIBLY REPLACED BY → 93461009 |Gender dysphoria (disorder)| or a descendant and 1332230002 |Gender incongruence (finding)| or a descendant

Concepts impacted:

• 67123006 Adult gender identity disorder, sexually attracted to both sexes (disorder)

• 54417002 Adult gender identity disorder, sexually attracted to females (disorder)

• 59216005 Adult gender identity disorder, sexually attracted to males (disorder)

• 61180001Adult gender identity disorder, sexually attracted to neither sex (disorder)

• 87991007 Gender identity disorder (disorder)

• 57715001 Gender identity disorder of adolescence (disorder)

• 68963006 Gender identity disorder of adolescence, previously heterosexual (disorder)

• 30509009 Gender identity disorder of adolescence, previously homosexual (disorder)

• 18003009 Gender identity disorder of adulthood (disorder)

• 13670005 Gender identity disorder of adulthood, previously heterosexual (disorder)

• 77815007 Gender identity disorder of adulthood, previously homosexual (disorder)

• 5095008 Gender identity disorder of childhood (disorder)

• 191787001 Psychosexual identity disorder (disorder)

Procedure

Update Hierarchy 62141006|Radical excision (procedure)

A review of the 62141006 |Radical excision (procedure)| hierarchy has been undertaken. New qualifier values have been added

• 1388945007 |Radical excision - action (qualifier value)|

• 1389005005 |Radical amputation - action (qualifier value)|

1389005005 |Radical amputation - action (qualifier value)| is a subtype of Radical excision - action (qualifier value) and 129309007 |Amputation - action (qualifier value)

129311003 |Evisceration - action (qualifier value)| has been moved to become a descendant of 1388945007 |Radical excision - action (qualifier value)|

Remodeling of concepts in the hierarchy has been undertaken using the new qualifier values for sufficient definition.

Number of concepts edited (approx): 169

Situation with Explicit Context

Inactivation - Awaiting <x> (situation)

The patterns "Awaiting <procedure> (situation)" and "<procedure> awaited (situation)" are administrative therefore out of scope for the international edition. A pre-coordination pattern (PCP) ticket has been created here to record that the pattern is not permitted in international content.

The twelve concepts using the pattern Awaiting <x> (situation) have been inactivated with the reason: 723277005 |Nonconformance to editorial policy component (foundation metadata concept)|. There is no historical association value. The awaiting <procedure> (finding) concepts will follow the same logic and be inactivated for the July 2026 release.

Organism

Update Case Significance

In response to a member request, a review has been undertaken of case significance indicator assignments for >150 concepts within the Organism hierarchy. The case sensitivity assignments were updated according to the editorial guidelines for these concepts. Based on consultation of authoritative primary references, secondary editorial actions were applied as required, including inactivation of concepts and descriptions, addition of synonyms, and revision of FSN and preferred terms, to ensure conformance with established editorial guidelines.

Substance

Promotion from LOINC Extension

73 new substance concepts developed by the LOINC Ontology project team have been promoted to the International Release from the LOINC Extension. These mostly consist of "Immunoglobulin G antibody to X substance (substance)" type concepts, e.g., 700651010000101|Immunoglobulin G antibody to Solidago virgaurea (substance).

Collaboration/Harmonization Agreements

Convergent Medical Terminology (CMT)

52 new CMT disorder concepts have been added for the June 2026 release with a key focus on ophthalmology and gastrointestinal disorders together with a small number of other disorder concepts.

Orphanet

Working in collaboration with Orphanet efforts are ongoing to update rare disease concepts in SNOMED CT to maintain alignment with Orphanet for the annual update of the SNOMED CT to Orphanet Maps. This map is at disorder level. In scope content has been annotated with attribution to Inserm Orphanet.

All of the concepts added for the Orphanet project have been mapped to ICD-10.

Gravity

Eight new concepts have been added to support the Gravity Project work with a focus health, behavior and health care findings.

International League Against Epilepsy (ILAE)

In line with approved harmonized terminology, this project is working on alignment including restructuring to update the hierarchy  << 313307000 |Epileptic seizure (finding)|.

Further information about this collaboration is available here.

Internal Quality Improvement

Machine Readable Concept Model (MRCM) Changes

There have been no changes for the MRCM in the June 2026 International Edition.

Future changes that are currently in progress can be viewed via the MRCM Daily Build Browser

Please see Early Visibility Release Notifications for future planned changes to MRCM.

Annotation Reference Set

The addition of content for the Annotations refset was commenced in the July 2024 International Edition release and is ongoing for attribution of in scope content that is part of a collaboration agreement. Where content with attribution no longer falls into scope for a collaboration agreement, the attribution has been inactivated.

SNOMED CT derived products

SNOMED CT - ICD-10 map

The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health Organization 1994) 2016 Version map (SNOMED CT to ICD-10 Map) is included in the SNOMED CT International Edition as a Baseline. The SNOMED CT to ICD-10 Map was created to support the epidemiological, statistical and administrative reporting needs of SNOMED International member countries and WHO Collaborating Centers.

The SNOMED CT to ICD-10 Map is released in Release Format 2 (RF2) only. It is located in the file der2_iisssccRefset_ExtendedMapFull_INT_20200731.txt, which is in the Map folder under Refset, in each of the three RF2 Release Type folders. 

The SNOMED CT to ICD-10 Map is released as Refset 447562003 |SNOMED CT to ICD-10 extended map (foundation metadata concept).

The ICD-10 Mapping Technical Guide (including exemplars) is here.

Content Development Activity Summary

The map is a directed set of relationships from SNOMED CT source concepts to ICD-10 target classification codes.  The SNOMED CT source domains for the map are constrained to subtypes of 404684003 |Clinical finding (finding)|, 272379006 |Event (event)|, and 243796009 |Situation with explicit context (situation)|. The target classification used is the ICD-10 WHO version 2016 (https://icd.who.int/browse10/2016/en#/).

The map provided for this release has been updated and represents a complete map from the June 2026 release of the SNOMED CT International Edition to the ICD-10 WHO version 2016.

This includes:

Mapped content for June 2026 release

• Addition of 181 new mapped concepts (includes 1 reactivation)

• Updates to 77 existing mapped concepts

• Retirement of 175 mapped concepts

The SNOMED CT to ICD-O morphology map has zero content changes for this release.

We welcome feedback on any issues that users may detect when deploying the map. Issues can be reported to mapping@snomed.org.

SNOMED CT to OWL conversion and classification

The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit

Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.

Technical notes

Known Issues

Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented.  This can be due to a number of reasons, from lack of time within the new monthly editing cycles, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.  

For the current SNOMED CT International Edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:

https://snomed.atlassian.net/issues/?jql=project%20%3D%20ISRS%20AND%20%22product%20release%20date%22%20%3D%20%222026-06-01%22%20AND%20status%20%3D%20%22Known%20Issue%22%20AND%20%22snomed%20ct%20product%22%20%3D%20%22SNOMED%20CT%20International%20edition%22%20ORDER%20BY%20priority%20DESC%2C%20updated%20DESC%20%20%20%20%20%20%20%20%20%20%20%20%20%20

Resolved Issues

Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release.  They can also be issues found during testing of the current release, which were resolved before the final deployment of the Production release.  Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.  

The Resolved Issues for the current SNOMED CT International Edition can be found here:

https://snomed.atlassian.net/issues/?jql=project%20%3D%20ISRS%20AND%20%22product%20release%20date%22%20%3D%20%222026-06-01%22%20AND%20status%20%3D%20%22Known%20Issue%22%20AND%20%22snomed%20ct%20product%22%20%3D%20%22SNOMED%20CT%20International%20edition%22%20ORDER%20BY%20priority%20DESC%2C%20updated%20DESC%20%20%20%20%20%20%20%20%20%20%20%20%20%20

Technical updates

RF2 package format

The RF2 package convention dictates that all relevant files are included, regardless of whether or not there is content to be included in each release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and files that (intentionally) include only header records.  The reason that these "empty" files are included in the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in future releases 

2. ...files that happen to contain no data in this particular release (and are therefore included in the package with just a header record), but are still relevant to RF2, and could therefore contain content in future releases.

This allows users to easily distinguish between the two scenarios, as otherwise if files in option 2 were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

ADVANCED NOTICE: Deprecation of the CNC Indicators from the International Edition

Following on from the announcements in late 2024 and early 2025, the plan to deprecate the Concept Non Current Indicators from the International Edition release is as follows, and implementation was started in the January 2026 International Edition release:

ADVANCED NOTICE: Increase to the maximum length of Description Types

These changes will be implemented in the July 2026 International Edition as per the agreed Transition plan:

• As highlighted in earlier communications, with the exception of the Medicinal Product hierarchy, the vast majority of descriptions will remain at their current length, well below 255 characters.

• The original plan was to increase several International Edition descriptions to around 330 characters in length. However, these still require further investigation, and so these updates will be postponed until the analysis is complete. They will then be deployed in a subsequent International release, once they are ready for publication.

• The only change, then, for the July 2026 International release, will be to transition the International Edition to the new Description Length Limit. This simply requires an update to the DescriptionType files (eg. der2_ciRefset_DescriptionTypeSnapshot_INT_20260701.txt), to update the “descriptionLength” fields from 255 to 4096.

A community consultation was completed to solicit feedback on the proposal to increase the size limits of SNOMED CT concept descriptions to 4096 from the current limit of 255 characters. While this change does not represent a modification of the existing specification, there is a potential for it to be disruptive to implementers who have coded fixed length limits into their systems.  

Please read the full proposal, along with the latest Q&A blog post for details of the planned changes, the potential benefits, and the issues that may need to be considered to prepare for the transition in July 2026. Please see here for the original conclusion of the plan to increase the limit of characters allowed in Descriptions.

Early visibility of impending changes in Monthly International Edition releases

Please see the 2026 Early Visibility Notices for details of forthcoming changes.