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Because this is a primitive hierarchy and subtypes will not auto classify, much work would be required to reorganize hierarchies and maintain the use of navigational concepts.  Inactivating concepts may be met with requests to create intermediate primitives. The Content Managers Advisory Group [CMAG] at 2020 Use of navigational concepts is being consulted regarding current use of navigational concepts. 

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Intermediate primitive groupers add a substantial management burden, thus, are discouraged. They may however be added on a case-by-case basis with approval from the Chief Terminologist or the Principal Terminologist Head of Terminology when, for example:

• • The concept model is not robust enough to support the full definition of a subset of terms, e.g. genomics (i.e. genetic diseases for which we cannot state, the majority of cases of this disease present with X).
  • There are variances in the clinical manifestations.

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