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In the ValueSet resource, any number of terms ('designations ') in additional languages and dialects can be specified for a particular concept in a value set definition using the ValueSet.compose.include.concept.designation  element. The language is specified as a BCP-47  language code as required by the 'designation.language ' element, with the value taken from the 'languageCode' field of the RF2 Descriptions file ('languageCode' is ISO-639-1, a subset of BCP-47). BCP-47 private use extensions can be used to specify a SNOMED CT language reference set for a term. The format of these extensions is <lang>-x-sctlang-<language reference set ID>. For example, en-x-sctlang-90000000-00005090-07 corresponds to the US English language reference set. The SNOMED CT Expression Constraint Language specification also lists a number of aliases for language reference sets which may be used: ECL specification, Appendix C, Dialect Aliases. The type  of the term (e.g., the SNOMED CT code for "Fully specified name", "Synonym" or "Definition") can be specified in 'designation.use '. More details on working with languages while using SNOMED CT and FHIR can be found here: 

[Note that ValueSet.compose.include.concept is only used when the value set is defined extensionally (i.e. as an enumerated list of concepts). For intensionally-defined value sets (i.e. using one or more filters) additional terms could be added using CodeSystem.concept.designation, as noted below.]

The CodeSystem resource can also similarly be used to specify additional terms ('designations ') for a concept using the CodeSystem.concept.designation  element (the additional terms may be from a published national or other localized SNOMED CT edition or provided in a code system supplement ). If supported by the terminology server, the additional terms are available to be returned in a value set expansion  (controlled by the $expand  operation 'includeDesignations' input parameter).

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  1. I've created a JIRA ticket for this update: