export interface SubsumptionResult {
    /**
     * Relationship outcome. `'unknown'` is returned when the terminology
     * server could not be reached — callers MUST check `checkable` before
     * treating `'not-subsumed'` as authoritative.
     */
    outcome: 'subsumes' | 'subsumed-by' | 'equivalent' | 'not-subsumed' | 'unknown';
    related: boolean;
    /**
     * Whether this result is authoritative. `false` when the terminology
     * server returned an error or was unreachable — `outcome` will be
     * `'unknown'` in that case and `error` will carry the reason.
     */
    checkable: boolean;
    error?: string;
}
export interface HierarchyInfo {
    code: string;
    system: string;
    display?: string;
    parents?: string[];
    children?: string[];
    ancestors?: string[];
    descendants?: string[];
}
export interface HierarchyValidationResult {
    /**
     * True if the code belongs to the required hierarchy.
     *
     * When `checkable === false` this field is meaningless and should be
     * treated as "unverified" rather than "invalid" — the validator could
     * not reach the terminology server to make the determination. Without
     * this distinction the validator produces false negatives during
     * tx.fhir.org outages.
     */
    isValid: boolean;
    /**
     * Whether the underlying subsumption check was authoritative.
     * `false` means the terminology server was unreachable or returned
     * an error; callers should degrade gracefully instead of failing
     * validation.
     */
    checkable: boolean;
    message?: string;
    hierarchyInfo?: HierarchyInfo;
}
export declare class TerminologyHierarchyValidator {
    private serverUrl;
    private timeout;
    private subsumptionCache;
    private hierarchyCache;
    constructor(options?: {
        serverUrl?: string;
        timeout?: number;
    });
    setServerUrl(url: string): void;
    checkSnomedSubsumption(codeA: string, codeB: string): Promise<SubsumptionResult>;
    isSnomedDescendantOf(code: string, ancestorCode: string): Promise<boolean | 'unknown'>;
    validateSnomedHierarchy(code: string, requiredAncestor: string, ancestorName?: string): Promise<HierarchyValidationResult>;
    validateIcd10Hierarchy(code: string, options?: {
        allowBillable?: boolean;
        requiredCategory?: string;
    }): Promise<HierarchyValidationResult>;
    private icd10CategoryMatch;
    getHierarchyInfo(code: string, system: string): Promise<HierarchyInfo | null>;
    getCacheStats(): {
        subsumption: number;
        hierarchy: number;
    };
    clearCaches(): void;
}
export declare function getHierarchyValidator(): TerminologyHierarchyValidator;
export declare function resetHierarchyValidator(): void;
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