1) My idea is to use ICD9Proc as they have billable/nonbillable indication and mapped to SNOMED in OHDSI. So we take SNOMED concepts ICD9Proc are mapped to:
--a.concept_code as source_code, a.concept_id, a.concept_name, a.vocabulary_id, a.concept_class_id, -- uncomment if you want to see how the source looks
b.concept_id, b.concept_name, b.vocabulary_id, b.concept_class_id
from concept a
join concept_relationship r on a.concept_id = r.concept_id_1 and r.invalid_reason is null and r.relationship_id ='Maps to'
join concept b on b.concept_id = r.concept_id_2
and a.vocabulary_id='ICD9Proc' and relationship_id = 'Maps to'
and a.concept_class_id not like '%nonbill%'
--checking your case
and lower( a.concept_name) like '%vasect%'
As we can see ICD9Proc "63.73" Vasectomy is a billable concept, So excluding concepts with the descendants you'll lose this one.
2) let's just look on Wikepedia:
Intra-vas device: The vasa deferentia can also be occluded by an intra-vas device (IVD). A small cut is made in the lower abdomen after which a soft silicone or urethane plug is inserted into each vas tube thereby blocking (occluding) sperm
Injected plugs: There are two types of injected plugs which can be used to block the vasa deferentia. Medical-grade polyurethane (M.P.U.) or medical-grade silicone rubber (MSR).
Vasectomy using silicon plug (4150395) might describe intra-vas-device case (not only the injection).
Injected plugs made from medical-grade silicone rubber maps to SNOMED "Vasectomy using silicon plug (4150395)"
Medical-grade polyurethane injection maps to "Injection vasectomy (4172860)", because it has parent concept 4107447 "Cyanoacrylic injection", and the child concept must include the meaning of the parent concept.
It looks messy in SNOMED, actually. Seems, it should be this way: "Injectiovasectomyn vasectomy" should have child concepts
"Cyanoacrylic injection vasectomy", "silicon injection";
"Intra-vas device vasectomy" concept should be added with children:
"silicone plug vacesctomy insertion" and "urethane plug vacesctomy insertion".
You can report the issue to the SNOMED https://www.snomed.org/
I can't find the proper link at a glance but you can try.