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This page provides information on planned changes to upcoming SNOMED International Release packages in three sections:

  1. EARLY VISIBILITY OF PROPOSED CONTENT CHANGES (with provisional release date)
  2. EARLY VISIBILITY OF PUBLISHED CHANGES (with confirmed release date)

Please submit any feedback relating to the items below to

1. Proposed Content Changes


Planned Release timing

(*this is provisional only and is subject to change)

1.Body Structure

Inactivation of 6920004|Defect (morphologic abnormality)|

6920004|Defect (morphologic abnormality)|is planned for inactivation. 286 concepts currently modelled with 6920004|Defect (morphologic abnormality)| will be reviewed and remodelled; this may include inactivation and replacement.

Please see the briefing note for further details.

Q1 and Q2 2023 International Release
2.Clinical Finding

Update Hierarchy 90708001 |Kidney disease (disorder)|

As part of the Quality Initiative Project, work has commenced on 90708001 |Kidney disease (disorder)|. Work is being undertaken in stages and upcoming sub-hierarchies will be posted here as the work progresses:

  • 236423003 |Renal impairment (disorder)| -  In progress
2023 International Release and future releases
3.Clinical Finding

Primary and Metastatic Project - New Metastatic Morphologic Abnormality Concepts

Metastatic disorders will be defined by their specific metastatic neoplastic morphologic abnormality concepts, and new metastatic morphologies are being added to the international edition of SNOMED CT as needed. In cooperation with the Netherlands extension of SNOMED CT, SNOMED International will be promoting certain of their existing metastatic morphology concepts to the International release to be used to model new metastatic disorder concepts. 

Ongoing monthly commencing January 2023 International Release

Change for Clinical Drug Concepts Containing Pancreatic Enzymes

Clinical drug concepts in the International Release containing pancreatic enzymes will be modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release.

The editorial guide and existing content will be reviewed and updated accordingly in a future release.

2023 International Release and future releases

Drug Content Analysis Project (DCAP) - Addition of Anti-Infective Clinical Drug Concepts 

DCAP was launched in September 2022 to identify clinical drug concepts that are published in participating National Release Center extensions and that are eligible for promotion to the international release (supported by appropriate references to authoritative source material).

Concepts that are already published in the Norwegian drug extension have been reviewed by multiple countries participating in the group and content eligible for promotion to the international release of SNOMED CT has been identified.

Approximately 100 concepts will be promoted to the international release and corresponding concepts for Medicinal Product (MP) 'containing only', and Medicinal Product Form (MPF) 'containing only' (MP 'containing', and MPF 'containing') will be created in the international release as required.

Q2 2023 International Release
6.Qualifier Value

Planned Inactivation of Subtypes of 129284003 |Surgical action (qualifier value)|

As part of the Quality Initiative, a review has been undertaken of the 129284003 |Surgical action (qualifier value)| hierarchy which has identified:

  • 36 concepts with no usage or descendants.
  • 4 concepts with 3 or less descendants and no usage.
  • 5 concepts with low usage and less than 2 descendants with no usage.

As a result of this review, 45 concepts in the qualifier value hierarchy that are descendants of 129284003|Surgical action (qualifier value)| will be inactivated. The complete list of concepts can be accessed here.

April 2023 International Release
7.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. 

Q2 2023 International Release

Update to MRCM

Extend the domain of 246454002 |Occurrence (attribute)| by including << 71388002 |Procedure (procedure)|.

The following is the expected MRCM range after the change.

246454002 |Occurrence (attribute)| << 272379006 |Event (event)| OR << 404684003 |Clinical finding (finding)| OR << 71388002 |Procedure (procedure)|

Q2 2023 International Release

2. Published Content Changes

1.Clinical Finding

Inactivation of Concepts that state Delivered/Not delivered

Obstetric content that conflates the delivery status with the disorder of the mother that prompted the admission to hospital will be inactivated.

There are 250 concepts that state the delivery status of the mother within the FSN:

  • 198905007 |Placenta previa with hemorrhage - delivered (disorder)|
  • 198906008 |Placenta previa with hemorrhage - not delivered (disorder)| 

These concepts are classification derived and are used to record whether the baby was, or was not delivered during that inpatient stay for the care of the mother who has placenta previa with a hemorrhage.

January 2023 International Release



Update for 399248000 |Procedure related to anesthesia and sedation (procedure)|

745638006 |Injection of anesthetic agent (procedure)| and its 283 subtypes will gain a supertype of 399097000 |Administration of anesthesia (procedure)|. 

January 2023 International Release

Inactivation of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|

To resolve ambiguity for 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, this concept will be inactivated as ambiguous. New concepts will be created to represent the associated strain and species.

840533007 |Severe acute respiratory syndrome coronavirus 2 (organism)| will be a sibling of the “Severe acute respiratory syndrome (SARS) coronavirus” strain and a subtype of the “Severe acute respiratory syndrome-related coronavirus” species.

Current children of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, which represent Severe acute respiratory syndrome (SARS) coronavirus strain subtypes will be inactivated using "Outdated component" as the inactivation reason with a "Replaced by" association to the concept representing “Severe acute respiratory syndrome (SARS) coronavirus."

Details of the change can be found in this Briefing Note.

January 2023 International Release
4.Qualifier Value

Planned Inactivation of Concepts in the 260299005 |Number (qualifier value)| Hierarchy

Following the deployment of the concrete domain functionality in SNOMED CT, concepts in the 260299005 |Number (qualifier value)| hierarchy are no longer necessary and plans have been made for their inactivation.

To provide adequate time for any national extension or implementation affected by this change, concepts in the 260299005 |Number (qualifier value)| hierarchy will be inactivated in the January 2023 International Release.

Concepts will be inactivated with reason “Non-conformance to editorial policy” and no historical relationship or replacement concept will be provided.


118586006 |Ratio (property) (qualifier value)| and descendants have been relocated to 118598001 |Property (qualifier value)| hierarchy.

272070003 |Ordinal number (qualifier value)| and descendants have been relocated to 362981000 |Qualifier value (qualifier value)| hierarchy.

A briefing note will also be distributed to selected Advisory and Project Groups.

Please contact with any inquiries.

January 2023 International Release
5.Body Structure

Remodeling of 771527003|Structure of synovial sac (body structure)| and Subtypes

The content in this area is being updated to align with this model.

February 2023 International Release
6.Clinical Finding

Inactivation of 118222006 |General finding of observation of patient (finding)|

118222006 |General finding of observation of patient (finding)| is a high level finding with little clinical value.  The concept will be inactivated with an inactivation target of Clinical finding.  Descendants count is 4237 concepts. 

February 2023 International Release
7.Qualifier Value

Update to 307159006|Pregnancy time period (qualifier value)| and Subtypes

Concepts referring to temporal periods for pregnancy and birth (307159006 Pregnancy time period (qualifier value) and subtypes) will be updated with the addition of a small number of concepts to make this area of content more comprehensive.

A new concept which explicitly covers 'maternal antenatal and/or intrapartum and/or postpartum period’ will be added.

Definitions will be added to aid modeling and interpretation.

February 2023 International Release

Update to MRCM

Extend the range of 719722006 |Has realization (attribute)| by including 71388002 << |Procedure (procedure)|, << 272379006 |Event (event)|, << 404684003 |Clinical finding (finding)|.

Please see here

February 2023 International Release
9.Content Improvement

Inactivation of "X by body site" concepts in various hierarchies

Concepts that include "X by body site" in multiple hierarchies are being inactivated, e.g., 371571005 |Imaging by body site (procedure)| and 301810000 |Infection by site (disorder)|, because they are classification groupers with no clinical use.

February 2023 International Release
10.Clinical Finding

Neoplasm of Connective and Soft Tissue Disorders

Around 30 concepts which include “neoplasm of connective and soft tissue" in their FSN will be inactivated as "Classification derived component." 

March 2023 International Release
11.Clinical Finding

Measurement Findings

The next set of changes for measurement findings content will involve the positive and negative results content (~150 concepts). Measurement findings concepts which include 'positive' or 'negative' in the FSN will be updated as follows:

1) The FSN and PT will be updated to include 'detected' or 'not detected.' Existing descriptions with 'positive' or 'negative' will be retained as synonyms.
2) The Has interpretation value of 10828004 |Positive (qualifier value)| or 260385009 |Negative (qualifier value)| will be updated to 260373001 |Detected (qualifier value)| or 260415000 |Not detected (qualifier value)|.

Please see the briefing note (20221116 BN Positive_Negative measurement findings.pdf) for more information.

March 2023 International Release
12.Clinical Finding

Metastatic Content with 'Involving' and 'Metastasis to X of Unknown Y'

Approximately 75 disorder concepts of the type 'Malignant tumor involving [x structure] by [separate] metastasis from [y structure]' and 30 disorder concepts of the type 'Metastasis to [x structure] of unknown primary' will be inactivated.


369554006 Malignant tumor involving right fallopian tube by separate metastasis from left fallopian tube (disorder)
285643007 |Metastasis to adrenal gland of unknown primary (disorder)|

The current Editorial Guidance indicates that the primary malignancy and the metastatic malignant neoplasm should be recorded using two separate SNOMED CT concepts, and these replacements will be provided as inactivation target values, and if not available they will be created.

March 2023 International Release
13.Clinical Finding

Remodel 16356006|Multiple pregnancy (disorder) to Become Subtype of 77386006 |Pregnancy (finding)|

16356006|Multiple pregnancy (disorder) will be updated to a clinical finding with a semantic tag of (finding) and a subtype of 77386006 |Pregnancy (finding)|.

Current subtypes of 16356006|Multiple pregnancy (disorder) will be reviewed as some subtypes should retain the semantic tag ‘disorder’ where the concept meets the criteria of being always and necessarily an abnormal clinical state.

A new parent will be assigned designated by whether the semantic tag has been changed.

March 2023 International Release
14.Clinical Finding

Primary and Metastatic Project - New Primary Malignancy Disorders

Approximately 150 new primary malignancy disorders will be added to SNOMED CT.

Inferred subtypes of 372087000 |Primary malignant neoplasm (disorder)| that were assigned by the classifier based on the morphology hierarchy (now revised), but which did not state primary in the FSN ('agnostic') have been reviewed.  

These previous subtypes of 372087000 |Primary malignant neoplasm (disorder)| will have a new subtype concept added that states 'primary' to provide an option for selection by clinicians.

March 2023 International Release
15.Clinical Finding 

Inactivation of 307844003 |Minor surgery status (finding)| and Subtypes

Concepts that have explicit context should be in the situation hierarchy. Therefore 307844003 |Minor surgery status (finding)| and 5 subtypes with context "done" + a procedure will be inactivated.

One concept 314471005 |Minor surgery done (finding)| will be inactivated and replaced by 1268934004 |Minor surgery done (situation)|.

March 2023 International Release
16.SubstanceReview of Concepts Defined by Stated = 105590001 |Substance (substance)|

Concepts in various hierarchies (including Procedure, Clinical finding, Observable entity, Event and Specimen), which are defined by the stated attribute value of "105590001 |Substance (substance)|" are being reviewed.

Many of these concepts are being remodeled by removing the attribute/value relationship—provided that this change doesn’t result in a change to the meaning of the associated concepts. Some of these concepts may need to be remodeled with a more specific substance.

Some of the grouper concepts will be inactivated—specifically the groupers that are classification derived and/or have only one subtype. This change is part of the Substance-Drug project and will allow for the correct subsumption of the subtypes, if and once the attribute values are changed to subtypes of 373873005 |Pharmaceutical / biologic product (product)|.

March 2023 International Release

3. Project Information and Work in Progress




Planned Release timing

(*this is provisional only and is subject to change)

1.General Information

Browse Content Changes for the International Release

For content changes that are ready for publication in the next release please browse here

Concept Inactivation

For concept inactivations that are for publication in the next release please browse here

MRCM Changes

Forthcoming MRCM changes can be viewed here

Quality Initiative

Information about the project can found here

Content Request Service (CRS)

Please see Guidance for Requesting Changes to SNOMED CT

Further information about CRS is available here.

Content Development

Information can be accessed here.

2.Project Information

Cancer Synoptic Reporting

Concepts representing cancer synoptic reporting content will be added to the International release starting with the July 2021 release. 

Cancer synoptic reports are used by many member countries to record pathology examination of cancer specimens including the College of American Pathologists (US and Canada), Royal College of Pathology (UK), Royal College of Pathology Australasia (Australia, New Zealand), PALGA (The Netherlands), Swedish Society of Pathology, and others.

This content primarily encompasses observable entity concepts and also includes supporting concepts from other hierarchies, e.g. property values.

For more information about this project, please see the Cancer Synoptic Reporting Clinical Project Group here

2023 International Release and future releases
3.Project Information

Epilepsy Content ILAE Collaboration

Review of << 313287004 |Seizure related finding (finding)| and << 84757009 |Epilepsy (disorder)| (excluding Orphanet related content) for currency and clinical correctness with the addition of missing clinically relevant content. 

Please refer to the project status report for further information.

2023 International Release and future releases

Expected completion by mid 2024

4.Project Information

Nutrition Content

Information about the work of the Nutrition Care Process Clinical Project group is available here.

2023 International Release and future releases

Project Information

Content Improvements in the Substance and Product Hierarchies

Please see briefing notes here Drugs Project

2023 International Release and future releases

6.Content Improvement

Implementation of the new anatomy concept model

The completion of the revision of hierarchical relationships provides stable anatomy content and improves the quality of classification results in other hierarchies.

Over forthcoming releases, the plan is to implement the new anatomy concept model. There are almost 35,000 anatomy concepts and they will be modeled by different types of 'part of' relationships. The new model will enable us to automatically generate hierarchies to further improve quality and consistency. 

Information about the work completed in previous release for revision of IS_A relationships can be viewed here

2023 International Release and future releases


Content Improvement

Update for Inactive Concepts Without Semantic Tag

Remaining cases of the legacy issue inactive concepts with active FSN without a semantic tag (Content Tracker IHTSDO-645) will be addressed to assign a semantic tag.  The number of inactive concepts requiring this update is 351.

Q2 2023 International Release
8.Content Improvement

Disorder X without Disorder Y

The vast majority of existing X without Y concepts originated from ICD-9 with the specific meaning of "X disorder without mention of Y disorder".  As the phraseology indicates a lack of data about disorder Y as opposed to a specific exclusion, this type of concept has not been included in ICD-10, nor proposed for ICD-11, except in the case of "Traumatic brain injury without open intracranial wound".  

Addition of new X without Y concepts may only be made under the following conditions:

  1. The request for new content must be accompanied by a rationale as to the difference between "X disorder without Y disorder" and "X disorder."
  2. Approval for addition is given by the Head of Terminology.

For the most part, existing X without Y concepts will be inactivated as AMBIGUOUS with a historical MAY BE relationship to "X disorder".  Exceptions to inactivation will be made on a case-by-case basis.

2023 International Release and future releases
9.Content Improvement

Planned changes to Implantation and Insertion procedures

Work commenced on content tracker IHTSDO-175.  Ongoing structural changes for the Procedure concepts related to the content tracker, more information is available here

2023 International Release and future releases

10.Content Improvement

Planned changes to 'Co-occurrent and due to' pattern

During the implementation of the new Description Logic features a conflict was uncovered between the modeling of 'Co-occurrent and due to' and General Concept Inclusions (GCIs). This has resulted in the need to reconsider the modeling of "Co-occurrent and due' and update the Editorial Guide for this area.

The plan is to update the Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' starting from the July 2019 release.

2023 International Release and future releases

11.Content Improvement


Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter.

At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A relationships when inactivating concepts that have a historical association to an inactive concept. When changes are made to a historical relationship for a concept that was previously inactivated using WAS_A, effort will be made to assign a new historical relationship that facilitates traceability of the concept (e.g. DUPLICATE or AMBIGUOUS) as opposed to NON-CONFORMANCE TO EDITORIAL POLICY.

Existing WAS_A relationships will be inactivated in a future release once a plan for batch reassignment of historical relationships has been developed. Until then, SNOMED International will not continue to use or maintain WAS_A relationships.

2023 International Release and future releases
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