PT's are now doing "Functional Dry Needling". This procedure does not have an actual procedure code yet. We are billing with an unlisted procedure code. Even when putting the description on the claim for this unlisted code, the claims are still denying which causes an inquiry and sending the notes requested. If the note was sent in with the claim, the claim would be processed as a clean and payable claim on the first submission.
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We use 97140 - Manual therapy to bill dry needling at our clinics in OH and KY.
Still need to be able to send attachments, but maybe using that code instead will help with your specific issue.