Q*bert's cube pyramid gameplay came from an "Escher Pattern", which looked like a screen full of cubes. Warren Davis saw it as a pyramid of cubes and as a programing exercise. Once Davis had a game design in mind, he asked Jeff Lee if he could use a few characters, which Lee was planning to use for another, unrelated game. According to Davis, Lee's idea for Q*bert's design was for him to shoot things out of his nose, which is why he has a long nose.

Q*Bert was originally able to shoot projectiles out of his nose, but this was scrapped in the final game. Co-creator Jeff Lee has said that, while he's unsure if this change enhanced the gameplay or not, he likes how the lack of offensive capabilities gives the character the personality of a "sympathetic plucky noser" who survives "by his wits and dexterity", particularly with the hindsight of how violent video games would become in the decades since.

Q*Bert co-creator Warren Davis, although highly grateful for the character's continued longevity, dislikes that modern portrayals of the character, such as those in Disney's Wreck-It Ralph, Adam Sandler's Pixels, and the Q*Bert: Rebooted game make his nose "flaccid".

Some rejected titles for Q*Bert included Arney Aardvark, Snots & Boogers, @!#?@!, Hubert, and Cubert.