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This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
An encounter is defined as an in-person meeting between a patient and a healthcare provider for the purpose of the provision of healthcare services to the patient. 308335008 |Patient encounter procedure (procedure)| is a subtype of Procedure (procedure).
For example,
185349003 |Encounter for check up (procedure)|
An indirect encounter occurs without a face-to-face meeting. 185316007 |Indirect encounter (procedure)| is a subtype of 308335008 |Patient encounter procedure (procedure)|.
For example,
386473003 | Telephone follow-up (procedure)|
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
The term Diathermy has been used to refer to a broad array of procedures aimed at performing different types of actions and outcomes. In SNOMED CT, the term diathermy may refer to 3 different kinds of procedures:
1. A treatment that provides deep heat to the tissues without destructive action.
Therapeutic application of conductive heat using heated pads, water, or other materials to promote healing.
Employment of physical agents that convert high-frequency electric current or electromagnetic waves to deep heat to promote healing.
2. The use of energy to destroy tissue for different purposes.
A procedure in which tissue is heated to destroy abnormal cells. The heat may be using different types of energy.
3. The use of heat as a destructive procedure to perform a "secondary" action. e.g. Reattachment, repair.
Careful review of the intention of a procedure stating the term diathermy in the descriptions should be done. The term diathermy may be used to name non-destructive procedures. Before naming and modeling such concepts, be sure to carefully read this guide and the associated templates.
Destructive procedure performed by applying electrical energy to heat biological tissues. The term Surgical Diathermy refers to different types of surgical actions performed using electricity (e.g., electrocauterization, electrocoagulation, electrodesiccation). To consistently name the different types of actions and to accurately differentiate them, the descriptions must be based on the specific action stated in the description and secondarily on the term diathermy.
When a specific destructive action (cauterization, coagulation, desiccation) is stated in descriptions, use that action in the FSN for the concept and avoid the inclusion of the term Diathermy. Additionally, add "using electrical energy" to the FSN. The use of the prefix "electro-" to describe a destructive action using electricity is no longer required in the FSN but will be retained on concepts as Preferred or Acceptable description in concepts where such a description was previously used, for searchability and retrieval.
FSN: [Action] of [morphologic abnormality] of [body structure] using electrical energy (procedure)
For example,
232597008 |Bronchoscopic cauterization of lesion using electrical energy (procedure)|
PT: [Action] of [morphologic abnormality] of [body structure] using electrical energy
For example,
Cauterization of lesion of vagina using electrical energy (procedure)
SYN: Electro-[Action] of [morphologic abnormality] of [body structure]
For example,
Electrocauterisation of urinary bladder
If a specific non-destructive action (e.g., repair, reattachment) is included in the FSN along with the term diathermy, the descriptions should follow the pattern below:
FSN: [Action] of [morphologic abnormality] of [body structure] by diathermy (procedure)
For example,
57103007 |Reattachment of retina by diathermy (procedure)|
PT: [Action] of [morphologic abnormality] of [body structure] by diathermy
For example,
Repair of retinal tear or defect by diathermy
When the FSN states the phrase, “Diathermy of X”, without any other considerations, a destructive action using Electrical energy should be inferred. In these cases, using the term Diathermy is allowed in the FSN and PT given that the specific action (e.g. coagulation, cauterization, etc.) is not stated. The destructive action (named Surgical diathermy) may be applied to a Morphologic abnormality or to a Body structure.
Before modeling this type of concept, make sure that the concept is not referring to Therapeutic diathermy (regime/therapy) (e.g. Microwave therapy), if the concept is not a destructive but therapeutic diathermy procedure, please refer to Therapeutic diathermy below.
FSN: Diathermy of [morphologic abnormality] of [body structure] (procedure)
For example,
301876002 |Diathermy of wart (procedure)|
PT: Diathermy of [morphologic abnormality] of [body structure]
For example,
Diathermy of fallopian tube
Diathermy used for non-surgical/non-destructive procedures, e.g. physical therapy and chiropractics. To avoid confusion between surgical and non-surgical diathermy procedures, Therapeutic diathermy procedures should be described including the energy used in the procedure, and must be stated on the FSN. These procedures are subsumed by 91251008 |Physical therapy procedure (regime/therapy)|.
Use the name of the energy used in the procedure (e.g., microwave, conductive heat, shortwave) followed by the term diathermy, then "to", and finally the "Anatomical or acquired body structure" where the procedure is applied.
FSN: [Physical force] diathermy to [body structure] (regime/therapy)
PT: [Physical force] diathermy to [body structure]
For example,
306876003 |Microwave diathermy to lower limb (regime/therapy)|
304394001 |Short wave diathermy to neck (regime/therapy)|
When the specific surgical action ("by coagulation", "by cauterization") is stated, but there is neither any mention of the type of physical force used nor the term diathermy stated in the descriptions, the concept should not be considered a diathermy procedure. Do not use any prefix or the term diathermy in descriptions.
These types of procedures should be classified in other hierarchies, e.g. Cauterization procedure (procedure), Coagulation procedure (coagulation).
FSN: [Action] of [morphologic abnormality] of [body structure] (procedure)
PT: [Action] of [morphologic abnormality] of [body structure] (procedure)
FSN: [Action] of [morphologic abnormality] of [body structure] by [Action] (procedure)
PT: [Action] of [morphologic abnormality] of [body structure] by [Action] (procedure)
For example,
56121000 |Repair of arteriovenous fistula by coagulation (procedure)|
1287542001 |Coagulation of external ear (procedure)|
15593007 |Cauterization of pharynx (procedure)|
See template:
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Centesis may be defined as the act of puncturing a body cavity or space with a hollow needle and drawing out fluid. Each centesis procedure involves both a puncture action and a needle aspiration action. It is correct to have two relationship groups for centesis procedures.
One group has a Method (attribute) of Puncture - action (qualifier value) and a Procedure site - Direct (attribute) of the structure being punctured.
A second group has a Method (attribute) of Aspiration - action (qualifier value) and a Procedure site - Indirect (attribute) of the space being aspirated.
For example,
91602002 |Thoracentesis (procedure)| has:
Role group 1:
Method = Puncture - action
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Duplex ultrasonography, Doppler ultrasound, and Doppler ultrasonography procedures were previously modeled with the Using device (attribute) with a value of 43770009 |Doppler device (physical object)| and a Method (attribute) of 278292003 |Ultrasound imaging - action (qualifier value)| or 302204005 |Ultrasound - action (qualifier value)|. It was not possible to sufficiently model duplex procedures to make them distinct from Doppler scans, and modeling of Doppler procedures was inconsistent with other imaging procedures where the modality was represented in the Method.
The concept model is now updated to be consistent with other imaging procedures. The Using device (attribute) has been removed, and the respective imaging modality has been added as a value for the Method (attribute), i.e. |Doppler ultrasound imaging - action (qualifier value)| and |Duplex ultrasound (qualifier value)|.
Doppler ultrasonography of x (procedure)
For example,
713683001 |Doppler ultrasonography of subclavian vein (procedure)|
Method (attribute) = |Doppler ultrasound imaging - action (qualifier value)|
Procedure site - Direct (attribute) = |Structure of subclavian vein (body structure)|
Duplex ultrasonography of X (procedure)
For example,
1178980000 |Duplex ultrasonography of carotid artery (procedure)|
Method (attribute) = |Duplex ultrasound (qualifier value)|
Procedure site - Direct (attribute) = |Carotid artery structure (body structure)|
Using device = Needle, device
Role group 2:
Method = Aspiration - action
Procedure site - Indirect (attribute) = Pleural cavity structure (body structure)
Using device = Needle, device
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
<< 1288025000 | Prosthetic arthroplasty of joint (procedure)|
Prosthetic arthroplasties refer to the partial or total replacement of bones of a joint with a prosthetic device. All prosthetic arthroplasty concepts must be modeled with a Repair role group to ensure they classify under 442095009 |Repair of joint (procedure)|, along with an Implantation role group for the prosthetic device.
Total joint procedures are modeled by repair and implantation role groups. The repair group must have the 405813007 | Procedure site - Direct (attribute)| value of the entire joint. In the implantation role group, as the prostheses are applied to all of the bones in a joint, the generic joint prosthesis and joint structure concepts should be used in modeling to subsume hybrid total arthroplasties.
The use of bone cement should only be included in the implantation role group. The entire joint in the repair group represents the totality of arthroplasty, as does the total joint prosthesis in the implantation role group.
Bone cement is only applied to one bone in a joint, leaving the other bone uncemented. Hence, a hybrid total arthroplasty should not be a subconcept of a cemented total arthroplasty.
If the cemented component is unspecified, the single implementation role group follows the model of total joint replacements with an additional substance of bone cement.
If the cemented component is known, multiple implantation role groups should be created to represent the prosthesis component of each bone.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Since the skeletal system includes bones and cartilage, it is possible to have a procedure on the skeletal system, i.e. on cartilage, that is not a procedure on bone.
For example,
77825002 |Division of cartilage of wrist (procedure)| is a procedure on the skeletal system (procedure)
Osteotomy is defined as cutting into or through a bone; there are 3 meanings in SNOMED CT:
Cutting into a bone, regardless of whether the bone is divided (incision, general meaning). Model using Method, Incision - action (qualifier value), and Procedure site - Direct (attribute), bone structure (or subtypes).
For example,
118483001 |Incision of rib (procedure)|
Reduction and fixation has two actions by two different means; open reduction of a fracture and insertion of an orthopedic fixation device. This provides an opportunity for general concept inclusion axioms (GCIs) in order to fully represent the meanings without heavy postcoordination modeling. Open reduction of a fracture necessarily involves open manipulation of the fracture and internal fixation of a fracture necessarily involves the insertion of an orthopedic internal fixation device.
For example,
74011006 |Open reduction of fracture of tibia and fibula with internal fixation (procedure)|
Cutting through a bone and dividing it (division by cutting). Model using Method, Division - action (qualifier value), and Procedure site - Direct (attribute), bone structure (or subtypes).
For example,
447867002 |Division of ulna (procedure)|
Cutting into a bone without cutting through it and therefore without dividing it (incision without division).
This is unnecessary; procedures that do not explicitly involve division are modeled simply as Incision.
Skeletal system subdivision
SNOMED CT considers the skeletal system subdivision part of the entire bone (system). This may change if there are procedures on cartilaginous skeleton that involve skeletal system subdivisions.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Aspiration is extraction using negative pressure. When modeling aspiration concepts, procedure site distinction is made if the removal is either (1) a substance from within a body structure or specific morphology, or (2) removal of any of the body structure itself (including cells).
Removing a substance from within a body structure or specific morphology should be modeled using Procedure site - Indirect (attribute) and/or Indirect morphology (attribute).
For example,
Paracentesis of skin (procedure) is removing a substance from within the body structure and not the body structure itself, it is modeled using Procedure site - Indirect (attribute) of Skin structure.
Removing body structure cells should be modeled with Procedure site - Direct (attribute) and/or Direct morphology (attribute).
For example,
Fine needle aspiration biopsy of skin (procedure) removes part of the body structure itself, and therefore is modeled using Procedure site - Direct (attribute) of Skin structure.
The nature of some aspirations means the procedure site will inherently be modeled as either direct or indirect regardless of whether the FSN states a substance is being removed.
Example procedures using Procedure site - Direct (attribute):
Fine needle aspiration biopsy
Bone marrow aspiration
If the substance being aspirated is not stated in the FSN, do not model it, even if it might be implied.
Exception: Aspiration of abscess can use Direct substance = Pus (substance).
Abscesses can be either septic (due to infection) or sterile (not due to infection). Most abscesses are septic; however, pus is characteristic of an abscess - whether septic or sterile. Model with Indirect morphology (attribute) of Abscess (morphologic abnormality) and the Direct substance (attribute) of Pus (substance). Pus does not have to be stated in the FSN.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
The definition of surgical repair is restoring, to the extent possible, an anatomical structure, using a surgical action. Repair is an objective or intended accomplishment, not a means (e.g., suturing, transplanting, etc.) nor a need (e.g., normal functioning, cosmetic appearance, pain relief, etc.).
Surgery that restores structure is usually intended to restore function and appearance. Restoring function, however, is not necessary for a procedure to be considered a repair. It is also possible for surgery to restore function without restoring structure (e.g., surgery to attach a prosthetic limb after amputation). This type of surgery would not be strictly categorized as a repair.
The Method (attribute) is used to model both the objective of a procedure and the means used to accomplish it. If a procedure requires both a repair action and another type of action, then two relationship groups should be used.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Immunization may be active (introduction of a vaccine) or passive (introduction of immunoglobulin/antibodies). A vaccine is a substance that can induce active immunity. Vaccination, by definition, is the introduction of a vaccine, and is, therefore, synonymous with active immunization. Some descriptions include the word vaccination, where it is clear that vaccination is intended. Other descriptions have preferred terms with the word vaccination, and synonyms with the word immunization, to include both active and passive immunization.
For example,
38598009 |Measles-mumps-rubella vaccination (procedure)| has vaccination in all descriptions
86198006 |Influenza vaccination (procedure)| has the synonym, influenza immunization
Example procedures using Procedure site - Indirect (attribute):
Centesis
Aspiration of [space or cavity]
Suction of [space or cavity]
Barbotage
Aspiration of device
Aspiration of [space or cavity] contents
Tap
If it is unknown whether the aspiration is removing either a substance from within a body structure or the body structure cells themselves, model with the broader Procedure site (attribute) and/or Procedure morphology (attribute).
For example,
79433000 |Closure of colon fistula (procedure)| has Method (attribute), Closure - action (qualifier value) with a parent, Repair of colon (procedure)
Surgery that accomplishes a repair (a structural restoration) often uses the suffix -plasty. The term plastic repair is also used. In order to avoid redundancy, the following terms are used:
Prosthetic repair, using external (non-body) materials
Plastic repair, reshaping the body
-plasty
The suffix -plasty is widely used in concepts that apply to prosthetic repairs (e.g. total hip arthroplasty). So -plasty may refer to any general repair (prosthetic, plastic, or other) and not just plastic repairs.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Imaging guidance can be modeled using the Has intent (attribute). The concept 429892002 |Guidance intent (qualifier value)|, a child of 363675004 |Intents (nature of procedure values) (qualifier value)|, is the value for the Has intent (attribute) for imaging-guided procedures.
For example,
432666003 |Biopsy of brain using computed tomography guidance (procedure)| has two relationship groups:
Group 1:
Method (attribute) of Biopsy - action (qualifier value)
Procedure Site - Direct (attribute) of Brain structure (body structure)
Where the procedure involves a device and/or morphology as the object of the action for which imaging guidance is being performed, that morphology, device, and/or anatomic structure in/on which the procedure is being performed are all the direct object of the imaging action. The direct device or direct morphology is included in the imaging role group.
For example,
In Aspiration of cyst using ultrasonic guidance (procedure), the Ultrasound imaging role group will include a Direct morphology (attribute) of Cyst (morphologic abnormality).
X using fluoroscopic guidance (procedure) is a subtype of Fluoroscopy (procedure).
For example,
710291004 |Endoscopy using fluoroscopic guidance (procedure)| has the following relationship groups
Group 1:
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Where a procedure is undertaken during a specific period of life, such as in the maternal pregnancy period, the descriptions may include the term during. However, the concept is modeled with Occurrence (attribute) with a value of <282032007 |Periods of life (qualifier value)|.
For example,
1287360000 | Injection of epidural anesthesia during maternal intrapartum period (procedure)| has an Occurrence (attribute)| of 1156682000 |Maternal intrapartum period (qualifier value)|.
Obstetric procedure (procedure) is modeled with two GCI axioms using the Occurrence (attribute) with a value of either Maternal perinatal period (qualifier value) or Pregnancy time period (qualifier value).
There are two modeling patterns for procedures containing obstetric in descriptions.
For procedures containing obstetric in descriptions, but a specific maternal period cannot be determined, concepts should be modeled using |Obstetric procedure| as the primitive parent concept and fully defined by a specific method.
For example, Obstetric operation (procedure) is fully defined by the parent |Obstetric procedure| and the Method (attribute) of Surgical action (qualifier value).
For procedures which a specific maternal period can be determined, the primitive parent is |Procedure| with Occurrence of either <<Maternal perinatal period (qualifier value) or <<Pregnancy time period (qualifier value).
For example, Diagnostic ultrasound of gravid uterus (procedure) can be fully defined by |Procedure| and Ultrasound imaging of the Uterus with Occurrence of Maternal antenatal and/or intrapartum time period (qualifier value).
Fetal procedures are fully defined by an Occurrence (attribute) of <<Fetal period (qualifier value). Generic body structures, for example, kidney, head, etc., should be used for procedure sites, unless the structure is unique to a fetus. Structures not unique to a fetus, such as, fetal head, fetal kidney, etc., will be inactivated in future releases, so they should not be used for modeling fetal procedures.
For example, Ultrasonography of fetal head (procedure) can be fully defined by |Procedure| and Ultrasound imaging of the Head with the Occurrence (attribute) of Fetal period (qualifier value).
Procedure Site - Direct (attribute) of Brain structure (body structure)
Method (attribute) of Computed tomography imaging - action (qualifier value)
Has intent (attribute) of Guidance intent (qualifier value)
Using device (attribute) of Endoscopic device (physical object)
Method (attribute) of Inspection - action (qualifier value)
Group 2:
Method (attribute) of Fluoroscopic imaging - action (qualifier value)
Has intent (attribute) of Guidance intent (qualifier value)
Biopsy of brain using CT guidance
432666003 |Biopsy of brain using computed tomography guidance (procedure)| is subsumed by 702707005 |Biopsy of head (procedure)| and by 34227000 |Computerized axial tomography of brain (procedure)|.
The generic 35039007 |Uterine structure (body structure)| should be used, because 9258009 |Gravid uterus structure (body structure)| cannot return the complete substructures of the uterus.
The generic 69536005 |Head structure (body structure)| should be used, because the 54527006 |Fetal head structure (body structure)| cannot return the complete substructures of the head.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
The concept model for flap procedures is based on three attributes in a role group as outlined below:
363701004 |Direct substance (attribute)| must have a value from the 256683004 |Flap (substance)| subhierarchy, and indicate the direct flap substance composition, and its blood supply.
363701004 |Direct substance (attribute)| must be used for flap procedures (and not 424361007 |Using substance (attribute)|).
Flap substances exist for free flaps and pedicle flaps (<<261238005 |Free flap (substance)| and << 261235008 |Pedicle flap (substance)|) and reflect the fact that whether a flap is free or pedicle is also a function of its blood supply (i.e. completely unattached from its original blood supply, or still attached via a vascular pedicle).
Also see .
For flap reconstruction procedure, 260686004 |Method (attribute)| must have a value from the 360032005 |Flap reconstruction - action (qualifier value)| subhierarchy and indicate the flap procedure technique, for example, advancement or rotation of flap.
For free flap procedures, the method is 1193839003 |Distant flap reconstruction - action (qualifier value)|
The proximity of the flap donor site to the flap recipient site (local flap/distant flap) must be modeled as part of the methodology of the procedure (and is no longer a characteristic of the flap substance).
If it is known where on the body the procedure to perform the flap reconstruction, or flap creation, or other flap procedure is performed, then 405813007 |Procedure site - Direct (attribute)| is used (do not use 405814001 |Procedure site - Indirect (attribute)|).
Do not include 405813007 |Procedure site - Direct (attribute)| if no location on the body is specified.
Do not include general value 442083009 |Anatomical or acquired body structure (body structure)| if no body site is stated.
FSN: Reconstruction using flap (procedure)
PT: Reconstruction using flap
SYN: Reconstruction with flap
SYN: Flap reconstruction [optional]
FSN: Reconstruction of x body structure using y flap (procedure)
PT: Reconstruction of x body structure using y flap
SYN: Reconstruction of x body structure with y flap
For example,
1193839003 |Distant flap reconstruction - action (qualifier value)| relates to the remote distance between the donor site and the recipient site.
When the donor site is indicated in the FSN, for a flap reconstruction procedure for example, then an additional role group is added including the 260686004 |Method (attribute)| with a value of 1193917004 |Flap creation - action (qualifier value)|. The donor site may be stated by the use of 'from x body structure' in the FSN, or if the donor site is indicated by the flap substance (See Example 2 below).
For example,
FSN: Reconstruction using free flap (procedure)
PT: Reconstruction using free flap
SYN: Reconstruction with free flap
SYN: Free flap reconstruction [optional]
For example,
FSN: Reconstruction of breast using pedicle transverse rectus abdominis myocutaneous flap (procedure)
PT: Reconstruction of breast using pedicle transverse rectus abdominis myocutaneous flap
SYN: Reconstruction of breast with pedicle transverse rectus abdominis myocutaneous flap
SYN: Breast reconstruction using pedicle transverse rectus abdominis myocutaneous flap [optional]
Existing flap procedure concepts may not align with this new terming. No new ‘flap graft’ procedures should be added going forward.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Excision, incision, and biopsy may be difficult to interpret. They are organized according to the following general structure.
Organ excision. Any excisional act involving the organ; usually (organ)-ectomy, or similar, is a synonym. Organ excision , itself, does not specify whether it is complete or partial, nor does it specify what is excised.
For example,
23968004 |Excision of colon (procedure)| or one of the synonyms, Colectomy
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
A regime/therapy is a set, sequence, or group of procedures. 243120004 |Regimes and therapies (regime/therapy)| is a subtype of Procedure (procedure). As a subtype of procedure, Regimes and therapies have the same attributes and use the same concept model as general procedures.
Regime and therapies are either repeated multiple times or performed over an extended period of time.
For example,
Concepts may include complete or total to indicate complete removal or excision of the organ.
For example,
63016009 |Total resection of urinary bladder (procedure)| with the synonyms Complete cystectomy, Total excision of bladder, and etc
Concepts may include partial to indicate removal or excision of part of the organ. Specifying partial excision does not differentiate between a partial excision of or from the organ.
For example,
708929007 |Laparoscopic partial excision of kidney using robotic assistance (procedure)| or one of the synonyms, Partial nephrectomy, laparoscopic with robot assistance
Concepts may indicate removal of a lesion or tissue; excision of a lesion or tissue from an organ may be complete or partial.
For example,
72106008 |Excision of lesion of liver (procedure)|
69031006 |Excision of breast tissue (procedure)|
Excisional biopsy of organ generally means that tissue or a lesion or suspected lesion is necessarily entirely excised, not the entire organ. It is a partial excision of (from) the organ. This is true even when small polyps are removed.
For example,
116237003 |Excisional biopsy of lesion of rectum by transanal approach (procedure)|
An organ incision is any incisional act involving the organ; usually (organ)-otomy, or similar, is a synonym
For example,
45558009 |Incision of lung (procedure)| or the synonym, pneumonotomy
Incisional biopsy of organ; incisional biopsy of lesion of organ; usually with open approach. Incisional biopsy of [organ] necessarily implies incision and removal of a lesion, and is by definition a partial excision, since the site is the organ, and an excision is done, but the entire lesion is not necessarily removed.
For example,
237378001 |Incisional biopsy of breast (procedure)|
Lesion Modelling
The word lesion can be used to refer to both structural and functional abnormalities. If a procedure refers to a lesion that is a structural abnormality, then model with a 405816004 |Procedure morphology (attribute)| of << 52988006 |Lesion (morphologic abnormality)|.
Any incision procedure that does not necessarily involve division (as opposed to ordinarily does not involve division) remains primitive without an available negation operator
A biopsy may not be an excision.
For example
445713002 |Brush biopsy of endocervix (procedure)|
Modeling Biopsies
Biopsies, like other removal procedures, may have two direct objects, the morphology and the site. It is permissible to use Procedure site - Direct (attribute) for biopsies, even if subtypes might have a direct object that is a morphology.
716872004 |Antineoplastic chemotherapy regimen (regime/therapy)|
This regime/therapy might include individual instances of administration of chemotherapy agents; the instances are at separate, predetermined periods of time.
229586001 |Rest, ice, compression and elevation treatment program (regime/therapy)|
This regime/therapy refers to repeated rest, ice, compression and elevation (RICE) for an indefinite period of time.
Regime and therapies are focused on a single purpose but do not have any single sub-procedure as a necessary part.
For example,
385695003 |Cast care (regime/therapy)|, The sub-procedures are all done for the purpose of properly monitoring and maintaining an orthopedic cast, but the sub-procedures may vary from one cast, patient, or healthcare setting to the next. Sub-procedures may include inspecting the cast, checking the skin, reinforcing padding, etc. There is not a single sub-procedure as a necessary part, although the purpose of the sub-procedures is to take care of a cast.
It is possible to have a regime/therapy as an instance of care. An instance of cast care could be the specific care for Mr. Smith's cast on the morning of April 23rd, consisting of the set of procedures: examining the cast; examining his arm; asking about his symptoms; and cleaning the skin.
Has Focus
Regime/therapy may be the value for the Has focus (attribute).
For example,
385978009 |Cardiac rehabilitation assessment (procedure)| has a Has focus (attribute) of Cardiac rehabilitation (regime/therapy)
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Although the use of terminology may vary across specialties, in general, grafting is where tissue is completely separated from its source of origin or donor, without its own blood supply, then affixed to a recipient site. The recipient site provides the vascularity.
Graft of skin is
A section of skin with variable size, thickness, and origin
Completely detached from its original site and moved to cover the area to be repaired without the benefit of any blood supply
For grafting, the recipient site is represented with the Procedure site - Direct (attribute), and the graft is represented with the Direct substance (attribute).
Fixation or attachment of tissue involves skin, bone, cartilage, or fat, rather than whole organs. The term can also be used for fixation or attachment of synthetic materials (e.g., a bioengineered skin graft is a manufactured skin graft grown in the laboratory from the patient's own cells, other allogeneic or xenogeneic sources, and/or synthetic materials; for example, silicone graft).
For example,
783285007 |Full thickness graft of skin to skin of neck (procedure)|
Proximal primitive Is a (attribute) value is 71388002 Procedure (procedure)
A single relationship group consists of:
405813007 |Procedure site - Direct (attribute)| = 43081002 |Skin structure of neck (body structure)|
363701004 |Direct substance (attribute)| = 782792007 |Full thickness graft of skin (substance)|
Values for direct substance should be from the 420934007 |Graft of skin (substance)| hierarchy that include the origin of the material in the description.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
When an imaging procedure involves visualization of a device and/or a morphologic abnormality in addition to an anatomic site, all of these are direct objects of imaging and therefore are represented using Direct morphology, Direct device, and Procedure site Direct attributes.
For example,
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Monitoring of any type is not a notion to be included in SNOMED CT, as it is not really an orderable, and clearly not a resultable, concept. There are 450 subtypes of 239516002 |Monitoring procedure (regime/therapy)| that will eventually be inactivated; new concepts with this label are not to be added.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
A revision procedure may or may not be a subtype of the original procedure. Revision procedure concepts should be in the 118635009 |Revision (procedure)| subhierarchy.
For example,
171839006 |Re-release of carpal tunnel (procedure)| is modeled as follows:
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
There is no need to distinguish between endoscopy and endoscopic procedure, as the procedure always includes inspection and may require minor incisions to allow the endoscope and other instruments to be inserted, or insertion may be via an existing orifice.
In all endoscopic procedures, a role group with Method of Inspection - action (qualifier value) + Using Device is mandatory. For endoscopies that require an incision, the role group to represent the incision is required. Where an additional action is performed during an endoscopy, a third role group is modeled with the applicable action.
Role group:
Method = Inspection
<<Procedure site = <body structure>
Using device = <physical object>
For example
Role group 1:
Method = Inspection
<<Procedure site = <body structure>
Using device = <physical object>
Role group 2:
Method = <action qualifier value>
<<Procedure site = <body structure>
For example
Role group 1:
Method = Inspection
<<Procedure site = <body structure>
Using device = <physical object>
Role group 2:
Method = Incision
Procedure site - Direct = <body structure>
For example
Role group 1:
Method = Inspection
<<Procedure site = <body structure>
Using device = <physical object>
Role group 2:
Method = Incision
Procedure site - Direct = <body structure>
Role group 3:
Method = <action qualifier value>
<<Procedure site = <body structure>
For example
Endoscopes are complex pieces of equipment that support much more than just the act of visualization. However, one does not usually use the scope to access the site of the intended inspection or therapeutic procedure.
USING DEVICE: When an incision RG is included in the concept model then the correct attribute for the device is USING DEVICE. For example, access to the abdominal cavity, or a joint capsule, is achieved by an ordinary incision using a scalpel blade. The laparoscope or arthroscope is then introduced into the cavity through the incision i.e. the endoscope is not the access device.
USING ACCESS DEVICE: Many procedures can be carried out using tools attached to or operated via channels within the endoscope. In some cases the device IS used for access (such as endoscopy of the GI tract), e.g. ERCP in particular allows you to both visualize and operate upon the sphincter of Oddi/ampulla of Vater using cutting devices (knives or wires etc.) and then passing a basket up into the CBD to remove stones. The correct attribute for the device is USING ACCESS DEVICE.
Laparoscopy and laparoscopic procedure are synonymous. These procedures are modeled with at least two role groups:
Role group:
Method = Incision - action (qualifier value)
Procedure site - Direct = Anterior abdominal wall structure (body structure)
Method = Inspection - action (qualifier value)
<<Procedure site = Structure of abdominopelvic cavity and/or content of abdominopelvic cavity and/or anterior abdominal wall (body structure)
Using device = Laparoscope, device (physical object
There can be more than 1 role group if there is more than one site. So Esophagogastroduodenoscopy (procedure) has 3 inspection role groups; one each for esophagus, stomach, and duodenum.
Endoscope selection
Naming individual scopes for procedures involving multiple body sites leads to inconsistent inferences. For procedures involving multiples sites or where it is known there are a number of appropriate scopes that could be employed, use 37270008 |Endoscope, device (physical object)| e.g. see 76009000 |Esophagogastroduodenoscopy (procedure)|
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
As mentioned in the initial Surgical procedures page, the definition of surgical procedure includes intentional non-transient alteration of structures of the body and/or necessarily involves cutting into the body.
Non-surgical actions do not significantly or non-transiently alter anatomy and do not necessarily involve cutting or incision.
For example,
Fine needle biopsy (procedure) or brush biopsy (procedure)
Phlebotomy, a synonym for venipuncture for blood test (procedure)
Aspiration (procedure)
Closed reduction of dislocation (procedure)
Closed procedure naming
The general pattern <open, closed> is accepted
When a procedure is specified as closed, the closed procedure should be fully described, e.g. fine needle biopsy, endoscopic, etc.
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
SNOMED CT has attribute hierarchies for Procedure Site, Procedure Device, and Procedure Morphology. Each has two sub-attributes to represent the direct and indirect object s. Procedure Device also has more specific attributes, Using Device and Using Access Device.
The potential for an endless number of combined procedures that may be performed in the same encounter requires more stringent criteria for addition. Combined procedures acceptable for precoordination are those that represent multiple individual procedures done in sequence or in combination, related to the same focal condition, and performed within the same encounter. These procedures must be sufficiently defined to be added.
The observable entity and evaluation procedure hierarchies have some of the same attributes. There is not and should not be a one-to-one correspondence between the two hierarchies.
Under Revision
48635004 |Fine needle biopsy (procedure)| could be viewed as a kind of centesis , but the former is non-surgical and the latter is surgical. Sampling - action (qualifier value), in general, is not necessarily a surgical action. If sampling involves the surgical removal of part of something, then Surgical biopsy (procedure) should be the action.
The evaluation procedure hierarchy is currently classified under Procedure by method , with many immediate children as follows:
Procedure by method (procedure)
Evaluation procedure (procedure); some children include:
Imaging (procedure)
Measurement procedure (procedure)
Physical examination assessment (procedure)
Evaluation procedures can be defined by a Method (attribute) of Evaluation - action (qualifier value)
Subtypes of Evaluation-action (qualifier value) include:
Examination - action (qualifier value)
Imaging - action (qualifier value)
Measurement - action (qualifier value)
Monitoring - action (qualifier value)
Spectroscopy - action (qualifier value)
SNOMED International is no longer accepting new concepts to the 122869004 |Measurement procedure (procedure)| hierarchy. New requests for content in this area will be created in the 363787002 |Observable entity (observable entity)| hierarchy. If new content is needed in the 122869004 |Measurement procedure (procedure)| hierarchy to satisfy existing use cases, it can be created in national extensions in the procedure hierarchy. Please see Observable Entity and Observable Entity Naming Conventions pages for more information.
SNOMED International is no longer accepting new concepts in the 127789004 |Laboratory procedure categorized by method (procedure)| hierarchy. New requests for concepts which are solely techniques should be created in the 272394005 | Technique (qualifier value)| subhierarchy. New content that is an observation using a technique belongs in the 363787002 |Observable entity (observable entity)| hierarchy. If new content is needed in the 127789004 |Laboratory procedure categorized by method (procedure)| hierarchy to satisfy existing use cases, it can be created in national extensions in the procedure hierarchy. Please see the Technique and the Observable Entity pages for more information.
Many procedure classifications focus on resources required to complete; this may be for reimbursement or tracking purposes (e.g. placement of one stent versus placement of two stents). This information should be part of patient documentation and is not allowed in the International Release.
The order of procedures, e.g. primary, first, second, etc. should be excluded.
In general, the reason for ordering a procedure should not be precoordinated within the procedure concept, i.e. it should not constrain the reporting of results. The reason that a procedure is ordered may influence the interpretation of the results but usually does not influence the way the procedure is performed.
Unacceptable example,
Computed tomography angiography of chest with contrast for evaluation of pulmonary embolus (procedure)
Acceptable example including reason for procedure,
66596009 | Diagnostic radiography for foreign body detection and localization (procedure)|
The meaning of primary and secondary, when describing a procedure, is open to interpretation. Consequently, the concepts will be inactivated.
The interpretation of primary may be:
Not ever done before at this site
The first of multiple procedures, with two sub-meanings:
The first of planned multiple procedures, whether the plan is carried out or not
The first of multiple procedures that were not planned or foreseen, i.e. it is only the first of multiple procedures in retrospect
Examples of unacceptable descriptions,
Primary anterior decompression of cervical spinal cord (procedure)
Primary anterior excision of cervical intervertebral disc (procedure)
Study
Procedures with the word study are unacceptable. They are ambiguous, as they imply context beyond the execution of the procedure.
"First" and “Subsequent” Procedures
"First" and “subsequent” procedures are not allowed, as they are inherently ambiguous and relative. While administratively relevant, the additional descriptions of the procedure are not clinically relevant.
Unacceptable examples
Primary anterolateral excision of thoracic intervertebral disc (procedure)
Antenatal first blood tests (procedure)
Antenatal subsequent blood tests (procedure)
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
In a transplant procedure, the transplanted organ or tissue may not be in the same place as the original organ/structure, and the original organ/structure may or may not remain in situ.
For example, 70536003 |Transplant of kidney (procedure)|
In most kidney transplants, the recipient’s own kidneys remain in situ, but in some cases the kidney is removed. The new kidney is usually placed in the right iliac fossa, but not always; it can be placed in the left iliac fossa, retroperitoneal area, or sometimes within the abdominal cavity.
Due to these reasons, encompassing a variety of scenarios depending on each particular organ and patient, << 24486003 |Structure of transplant (body structure)| is used for the target for 405813007 |Procedure site - Direct (attribute)| for transplantation procedures.
For example, 32413006 |Transplantation of heart (procedure)|
363701004 |Direct substance (attribute)| relationship is only utilized where it adds additional information (autograft, allograft, etc).
For example, 232973007 |Allotransplant of heart (procedure)|
Consultation established that for tissue transplants, graft and transplant are used interchangeably with the preferred option being grafting procedure, with a transplant description placed as a synonym on the grafting procedure concept.
For example, 27493007 |Peripheral nerve graft (procedure)|
See for grafting procedure guidance.
See transplantation template at .
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
Division - action (qualifier value) is a subtype of Incision - action (qualifier value). This does not mean that all procedures, that include the word division, should necessarily be modeled with Method (attribute) of Division - action (qualifier value), like those where the division is accomplished using blunt dissection, not incision.
For example,
Division of adhesion concepts, like 173269002 |Division of adhesions of lip (procedure)|, should be modeled the same as lysis of adhesion concepts, like 45602008 |Lysis of adhesions of peritoneum (procedure)|
Both use Dissection - action (qualifier value). Adhesions are broken down by blunt dissection, often without incising them. This does not exclude procedures that may also involve division by incision.
The preferred name of division of adhesions concepts can be changed to lysis of adhesions for consistency. The use of lysis of adhesions also helps with correct modeling and avoidance of interpreting divisions as necessarily being kinds of incision.
Transection is defined as a division across the longitudinal axis of a structure by cutting. Bisection is defined as division into two parts by cutting. Transection - action (qualifier value) is a subtype of Bisection - action (qualifier value), which is a subtype of Division - action (qualifier value) and Incision - action (qualifier value).
For example,
53176004 |Transection of muscle of eye (procedure)|
60158005 |Bilateral bisection of ovary (procedure)|
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
A surgical procedure is defined as a procedure that involves intentional non-transient alteration of structures of the body, and/or a procedure that necessarily involves cutting into the body. This definition includes all procedures defined by Method (attribute) with Surgical action (qualifier value).
SNOMED CT classifies concepts as surgical procedures if their methods are surgical actions based on the action hierarchy. The surgical action hierarchy distinguishes surgical from non-surgical actions based on the definition above. Note the Or in the sentence; actions that do not involve cutting or incision, but do involve the intentional non-transient alteration of anatomy, are still surgical.
Operation
In SNOMED CT, operation is synonymous with surgical procedure.
Surgical procedures are not defined simply as procedures done by a surgeon (despite some dictionary definitions). Surgeons can perform many non-surgical actions and surgical procedures need not necessarily be performed by a surgeon, i.e. if a non-surgeon performs a surgical procedure, it is still a surgical procedure.
Medical procedure
The use of the term medical procedure is deprecated, i.e., not recommended, because it lacks reproducible meaning. It might be defined as a procedure done by a physician, but even that is deprecated, because it is provider-specific.