It's connotation is: A replacement for the phrase "That's F@#$ed Up"
i.e.. "Hey dude my mom says I gotta stay in this weekend and clean my room" "Ah man, That's Hacked up!"
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To be sick, especially with a cold or other illness that induces coughing.
Dude, my brother came home with a cold last night and now I'm all hacked up!
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" Hey dude, wanna go hack it up later?"
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"Yea, man, I was hacking it up with Joe earlier"
When ur so stoned you can't even swallow
Aiden: I was so hacked up last night i couldn't even talk