Designed by Toshiaki Kamiya and headed by Takehiro Moriyama, V-Tetris was developed under supervision of Bullet-Proof Software by staff at Locomotive Corporation who would later work on both Virtual Fishing and SD Gundam Dimension War, with the team wanting the game to feel fresh and new with its additional content while keeping the familiarity of the original Tetris.

[2][3][4] In type-C mode, called "Loop Tetris", the player can scroll the cylindrical-esque playing field left or right by pressing the L and R buttons respectively and clear multiple horizontal lines.

[1][2][3][4] V-Tetris was developed under supervision of Bullet-Proof Software by staff at Locomotive Corporation who would later work on both Virtual Fishing and SD Gundam Dimension War, with Toshiaki Kamiya acting as designer.

[7] Bullet-Proof public relations spokesperson Tanaka Shutsuho recounted the project's development process in a 1995 interview with Japanese magazine 3D Virtual Boy Magazine, stating that BPS felt that making a Tetris title for the Virtual Boy would appeal to a wider audience and wanted to maintain simplicity in order to "respect" the legacy of the original game, while gameplay was altered to make use of the console's 3D hardware capabilities to create a sense of depth.

However, Heckel referred to the latter mode as "mind-bending" due to the ability of rotate between stacks and scoring opportunities but regarded its gameplay to be standard and remarked that the music did not compared to previous Tetris games.